Integrated

Diabetes Service

The Integrated Diabetes Service aims to reduce the number of diabetic patients needing secondary care.

Upskilling staff in our member practices with specialist training means diabetic patients in Durham Dales benefit from improved care and personalised treatment plans leading to better outcomes.

what it means

The number of people in the UK with diabetes has more than doubled in the last 20 years, and is expected to reach 5 million by 2025.

This new model for treating and preventing diabetes was designed to both benefit patients and reduce the impact on the NHS.

The Integrated Diabetes Service provides better and more effective care for diabetic patients in primary care – mainly from their GP practice – and to reduce prescribing costs.

How it works

Central to the integrated service is the role of the Diabetic Specialist Nurse, or DSN.

DSNs work purely in diabetes and put their expertise to use in two ways.

Firstly, through clinics with patients, and providing them with the information and motivation to better manage their own diabetes through personalised plans. 

Secondly, by working directly with practice clinicians to increase their skills and knowledge, which are then used to benefit more and more patients.

In addition to nursing clinics, the DSN is joined by a specialist diabetes consultant holding quarterly visits to practices to monitor and review the more complex cases. 

How it helps

Complications associated with diabetes can be controlled and even prevented by making informed lifestyle changes. 

DSNs work with patients to educate them about the best changes to make in their diet or exercise, and implement those changes through personalised plans they set together and regularly review.

This sharing of information helps people make the right choices, and the proactive approach empowers them to take control of their own health. 

Regular reviews can also help control patients’ blood sugar levels by monitoring and potentially making medication changes to optimise the effectiveness of the treatment.

Evidence shows this approach is cost-effective, reduces hospital admissions and leads to better outcomes for patients.

Outcomes:

40%
Lower Admissions*
63%
Patients' Conditions Well Controlled
100%
Of Practices Have Upskilled Staff

* Urgent hospital admissions rates 36% lower for hypoglycemia, and 40% lower for hyperglycemia compared to CCG Average, as of December ‘19