WARNING
This guidance is under active development by NHS England and content may be added or updated on a regular basis.Diabetes Referral and Complications
Many other stories like Williams available on Diabetes UK
- Diagnosed with Type 1 Diabetes when she was 12 years old.
- Developed an unhealthy relationship with food and became extremely conscious of her weight.
- Diagnosed with diabulimia when she was 19.
- Struggled with alcohol consumption.
- Experienced several dangerous diabetic complications:
- Developed retinopathy problems (microaneurysms in her eyes) *
- Damaged blood vessels in her feet
- Impacted her mental health*
Received therapy she needed to accept and understand her diabetes and with the support of dieticians she now has a healthy relationship with food.
- Diagnosed with Type 2 Diabetes when he was 24 years old.
- Developed an unhealthy relationship with food, he was obese – around 120kg.
- In 2016 he suffered his third bout of Bell's Palsy.
- Had some blood tests:
- Kidneys were shutting down- referred to the Cronic Kidney Disease team
- Started taking medicine and changed to living an active healthy lifestyle:
- Aims at least 10,000 steps in daily.
- Kidneys are no longer at a threat level.
- Most recent weight at 41 was recorded as 79kg.
The process definitions and guidance at this stage become more complex and descriptions can be found in National Institute for Health and Care Excellence (NICE) Guidance:
An overview diagram of NICE Guidance: Type 2 diabetes in adults: management is shown below:
The process and workflow around diabetes management has become significantly more complicated. We do however start to see processes starting to repeat:
- Self-monitoring is similar to the self monitoring in the Wellness section.
- Processes to arrangement treatment for the complication is likely to be similar to Diabetes Prevention Programme Referral section.
- Processes to arrange diagnostic tests can be a variation of the treatment processes.
Similar patterns can be seen in NHS England - Transformation Directorate: Digital playbooks
- Scenarios around self-monitoring, virtual treatment, remote monitoring, etc, have similarities to the self-monitoring introduced in the Wellness section.
- Communication and Care Coordination are common themes which overlaps with the communication (and workflow) focus we discussed in the previous sections.
Diabetes Secondary Care Pathways
These patterns continue in Get It Right First Time - Diabetes Workstream
E.g.
Initial management of hyperglycaemia in adults in the emergency department
Management of patients presenting to ED with a foot problem
Community Wound Care Management
IT IS POSSIBLE THESE TWO PATHWAYS FIT TOGETHER. It is not clear but MDFT (multi-disciplinary footcare teams (MDFTs)?) may imply the same multi-disciplinary care shown below. (Diagram below is a gist of an NWR form NHS England South-East (IoW and Hamps.))