Establishing a pathway for remote glucose data upload for virtual diabetes consultations

Background: Historically, patients attend diabetes clinics with their glucose meters or glucose diaries. With the move to virtual consultations during Covid-9 pandemic, there is a need to enable timely transfer of glucose data from patients to clinicians. Aims: To identify barriers to glucose data upload, to establish a pathway for remote glucose data transfer from home to clinic, and ultimately to improve the quality of diabetes virtual consultations. Methods: We initially conducted a baseline patient survey to identify barriers to glucose data upload. Then we asked the administrative team to inform patients (via telephone calls or emails) that they will receive Diasend invites to upload their glucose data before the appointment. We sent out Diasend invites and following consultation we collected data of the number of patients who did/did not upload their glucose data and explored with individual patients the reasons for not uploading data. A total of 99 patients were included over four cycles. Results: The first baseline survey showed that 43.5% of patients were not educated on how to upload data. The sum of four cycles of data showed that 7 . 7% of patients did not upload their data because they were not familiar with the process, technical issues, short notice or for unknown reason. The majority of patients who uploaded their data are using FreeStyle Libre. Conclusion: Further Diasend familiarisation is required to achieve better engagement of patients with glucose data upload. This can be included in appointment letters and clinicians need to encourage patients during consultations.

Delivering evidence-based interventions for type 1 diabetes in the virtual world - A review of UK practice during the SARS-CoV-2 pandemic.

AIMS: This review considers the impact of the SARS-CoV-2 pandemic on access to interventions for those living with type 1 diabetes and discusses the solutions which have been considered and actioned to ensure ongoing access care. METHODS: We performed a focussed review of the published literature, and the guidelines for changes that have been effected during the pandemic. We also drew from expert recommendations and information about local practice changes for areas where formal data have not been published. RESULTS: Evidence based interventions which support the achievement of improved glucose levels and/or reduction in hypoglycaemia include group structured education to support self-management, insulin pump therapy and continuous glucose monitoring. The SARS-CoV-2 pandemic had impacted the ability of diabetes services to deliver these intervention. Multiple adaptations have been put in place - transition to online delivery of education and care, and usage of diabetes technology. CONCLUSIONS: Although various adaptations have been made during the pandemic that have positively influenced uptake of services, there are many areas of delivery that need immediate improvement in the UK. We recommend a proactive approach in recognising the digital divide and inequity in distribution of these changes and we recommend introducing measures to reduce them.

Quality improvement project: Increasing glucose data uploads in a specialist diabetes clinic

Aims: The aim of this quality improvement (QI) project was to improve the quality of diabetes telemedicine consultations by improving joint access for healthcare professionals and people with diabetes (PWD) to self-monitored glucose data from PWD. This joint access is especially relevant during the covid-19 pandemic. Methods: The Plan-Do- Study- Act (PDSA) methodology was utilised. Prior to appointments, PWD were contacted via phone and emailed Diasend (Glooko) invitations with registration instructions (first PDSA Cycle). Alternatively, PWD could email electronic documents with glucose data (second PDSA Cycle). Statistical analysis was performed using the chi-squared test. Results: Prior to the first PDSA cycle, 85% (11/13) of PWD surveyed reported that transfer of glucose data to clinicians could lead to at least 'significant' improvements in the quality of diabetes consultations. In a separate baseline survey of 23 PWD, 48% reported being 'unaware' of the option to transfer glucose data and 'unfamiliar with the process';22% of PWD reported 'issues with meter connectivity, equipment'. There was an initial trend for improvement of glucose data transfer rates from 13% at baseline to 29.4% (p = 0.2) after the first PDSA cycle. The impact of the covid-19 pandemic on staff made it difficult to maintain the intervention, meaning that results of the second PDSA cycle were identical to baseline (12.5%). Conclusions: Using QI methodology, we systematically identified barriers to uploading glucose data and trialled targeted solutions. Staff were unable to maintain the intensity of the initial intervention due to the covid-19 pandemic, demonstrating the need for ongoing intervention to maintain improvement.

Time in range: A best practice guide for UK diabetes healthcare professionals in the context of the COVID-19 global pandemic.

The emergence of continuous glucose monitoring has driven improvements in glycaemic control and quality of life for people with diabetes. Recent changes in access to continuous glucose monitoring systems within UK health services have increased the number of people able to benefit from these technologies. The COVID-19 pandemic has created an opportunity for diabetes healthcare professionals to use continuous glucose monitoring technology to remotely deliver diabetes services to support people with diabetes. This opportunity can be maximized with improved application and interpretation of continuous glucose monitoring-generated data. Amongst the diverse measures of glycaemic control, time in range is considered to be of high value in routine clinical care because it is actionable and is visibly responsive to changes in diabetes management. Importantly, it is also been linked to the risk of developing complications associated with diabetes and can be understood by people with diabetes and healthcare professionals alike. The 2019 International Consensus on Time in Range has established a series of target glucose ranges and recommendations for time spent within these ranges that is consistent with optimal glycaemic control. The recommendations cover people with type 1 or type 2 diabetes, with separate targets indicated for elderly people or those at higher risk from hypoglycaemia, as well as for women with type 1 diabetes during pregnancy. The aim of this best practice guide was to clarify the intent and purpose of these international consensus recommendations and to provide practical insights into their implementation in UK diabetes care.

Guidelines for the management of diabetes services and patients during the COVID-19 pandemic.

The UK National Diabetes Inpatient COVID Response Group was formed at the end of March 2020 to support the provision of diabetes inpatient care during the COVID pandemic. It was formed in response to two emerging needs. First to ensure that basic diabetes services are secured and maintained at a time when there was a call for re-deployment to support the need for general medical expertise across secondary care services. The second was to provide simple safe diabetes guidelines for use by specialists and non-specialists treating inpatients with or suspected of COVID-19 infection. To date the group, comprising UK-based specialists in diabetes, pharmacy and psychology, have produced two sets of guidelines which will be continually revised as new evidence emerges. It is supported by Diabetes UK, the Association of British Clinical Diabetologists and NHS England.