The London Diabetes Strategic Clinical Network recommends the adoption of HbA1c for the diagnosis of type 2 diabetes across London. See the London Consensus Statement in Downloads.
NCL Diabetes Treatment Guidelines
The current NCL diabetes treatment guidance was published in August 2021 following a joint review of the evidence for patients across primary and secondary care. The document includes guidance on setting HbA1C targets for individual patients.
The guidance can be downloaded with ‘Pathways’ and is entitled ‘Diabetes (type 2) Treatment Guidelines: Antihyperglycaemic agents for Type 2 diabetes’ and is intended to be a guide for all clinicians working for patients with type 2 diabetes.
Diabetes Structured Education
To find local structured education services, type 'education' into the search bar below.
NCL services:
Camden:
Islington & Haringey:
Coding Attendance at Structured Education
The National Diabetes Audit measures patient attendance for structured education. Despite the offer for type 1 and type 2 diabetes patients in NCL, the percentage of patients recorded as having attended structured education is very low. This is likely due to variability of coding and recording this information within patient's EMIS records. It is, therefore, important GP practices have processes in place to ensure coding of patient structured education attendance. The correct codes are listed within each service page.
Ambulatory Acute Foot Service (AAFS): Royal Free Hospital
Health care professionals can refer directly to the acute foot service for any acute diabetic foot condition. The service includes clinical guidance via the service hotline open seven days per week. The team are able to offer urgent face-to-face, telephone or video reviews for patients following their referral. See the service page for further details.
NCL Low-Calorie Diet Programme for Type 2 Diabetes
The low calorie diet programme is being run as a two year pilot programme across NCL, with 500 places for individual patients to take part in a yearlong programme which includes an evidence based intervention of 12 week total diet replacement. The weight loss achieved has enabled better control and even remission of Type 2 Diabetes. See the service page for further details including the referral criteria.
HbA1c conversion (IFCC/ DCCT)
Area specific guidance for Camden
The Camden Diabetes Integrated Practice Unit (IPU) is a multi-trust partnership set up to meet the needs of people with diabetes in Camden. The Royal Free London NHS Foundation Trust is the lead provider, working in partnership with CNWL, UCLH and Haverstock Healthcare.
Patients with newly diagnosed type 1 diabetes can be reviewed in the Emergency Assessment Unit at UCLH if required.
See Downloads for information on My Type 1 Diabetes, a digital resource to help adults with T1 diabetes to gain more understanding of their condition.
Area specific guidance for Islington
Islington has a number of specific services for patients with diabetes. This includes the structured education resources: the Diabetes self-management programme (DSMP), the expert patient programme and the Windfall programme for Type 1 Diabetes.
Practices are encouraged to consider the use of the Ardens suite of EMIS resources for case-finding and increasing the prevalence of diabetes within their population. The tools also include templates to enable a thorough and efficient annual review, such as the ‘Diabetes (Ardens)’ template or the ‘Multi-Morbidity Annual Review (Ardens)’ template.
Following the national guidance, long-term condition reviews and management should be prioritised for the most vulnerable. The UCLP risk stratification tools within EMIS should enable practices to identify those patients.
The practice of care-planning following the year-of-care approach to long-term condition management is encouraged and incentivised within the borough. Practices are encouraged to consider the use of care-planning, where appropriate, to address a patient’s wider health needs.
