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News ArticleThe Medicines and Healthcare products Regulatory Agency (MHRA) has issued a national patient safety alert for the NovoRapid PumpCart prefilled insulin cartridge and the Roche Accu-Chek Insight Insulin pump system following concerns raised about cracked cartridges and insulin leaks. Patients are being asked to check the pre-filled glass insulin cartridge for cracks prior to use. The cartridge should not be used if it has been dropped even if no cracks are visible. Closely follow the updated handling instructions in the pump user manual when changing pre-filled glass insulin cartridges. The device, which releases the insulin your body needs through the day and night, comprises a pump, tube, battery and a pre-filled glass insulin cartridge. In some of the reported leakage incidents, the cartridges were found to be cracked and provided an inadequate supply of insulin to patients. However, leakages also occurred in cases where no cracks in the cartridge were visible. In some patients there were consequences of not receiving enough insulin from their pump system, including reports of severely high blood sugar and diabetic ketoacidosis (a serious complication of diabetes when the body produces high levels of blood acids called ketones). Health care professionals are being advised to contact patients over the next six months using said device to discuss their individual needs and source an alternative pump where appropriate. Key patient recommendations are: Check the pump and cartridge regularly for damages, for example cracks or leakage. If you smell insulin (a strong antiseptic chemical smell) this could also indicate a leakage. Do not use the cartridge if cracks or leakage are seen or if the cartridge was dropped. Follow the instructions of your Accu-Chek Insight user manual for replacing a cartridge and for cleaning the cartridge compartment in the insulin pump. During the day and before going to sleep please carefully check that your insulin pump is delivering insulin and there are no leakages. Never change treatment delivery methods without first consulting a relevant healthcare professional. Failure of insulin delivery due to leakage may not result in an alert notification from the insulin pump and cracks and leakages may not always be visible. You should check blood glucose levels multiple times throughout your day whilst using pumps. Tell your healthcare professional immediately if you suspect a problem with your insulin delivery. Read full story Source: Gov.UK, 26 May 2022
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Content ArticleThe MHRA continues to receive serious reports of harm associated with insulin leakage for the NovoRapid PumpCart prefilled insulin cartridge in the Accu-Chek Insight Insulin pump. In some patients, there were serious consequences arising from inadequate supply of insulin, including diabetic ketoacidosis (DKA). Although the manufacturer Roche Diabetes Care (RDC) has implemented a number of risk minimisation strategies to reduce the incidence of these events, the impact of these is inconclusive and we are taking further action to protect patients. To protect patient safety, diabetes healthcare professionals should inform patients who use the Accu-Chek Insight of the risk of leakage. Clinical care decisions should be made to ensure patients are moved onto alternative pumps where possible.
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Content Article
Safe care for people with diabetes in hospital (January 2020)
Patient-Safety-Learning posted an article in Diabetes
This article in the journal Clinical Medicine looks at the safety of people with diabetes when they are admitted to hospital as an inpatient. Having diabetes in hospital is associated with increased harm. Although the National Diabetes Inpatient Audit has shown that inpatient care for people with diabetes has slowly improved over the last few years, there are still challenges in terms of providing appropriate staffing and education. Progress is still needed to ensure the safety of people with diabetes in hospital. The authors look at some of the key areas of concern for people with diabetes in hospital, including increased risk of hypoglycaemia, hyperglycaemia (including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemia state), medication errors, hospital acquired foot ulcers, increased length of stay and overall increase in death. -
Content ArticleEffective Diabetes Education Now (EDEN) has created some resources for healthcare professionals to ensure vital information about insulin safety is communicated in way that supports the reduction of insulin errors. This webpage features infographic posters and a video about insulin safety.
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News Article
Fear over high rates of diabetes foot amputations
Patient Safety Learning posted a news article in News
Major differences in the rate of foot amputations for people with diabetes in England are incredibly concerning, patient groups say. Such amputations are a sign patients have not received adequate care, as poorly controlled diabetes increases the risk of foot ulcers and infections. One in 10 areas had "significantly higher rates", government data shows. There was nearly a five-fold difference between the best and worst when taking into account risk factors such as age. The government data - published by the Office for Health Improvement and Disparities - looked at the three years leading up to the pandemic. It is believed up to 80% of foot amputations could be avoided with better care. Diabetes UK said the figures "shined a light on the scale of the crisis facing diabetes care" and it warned access to support was likely to have become worse during the pandemic. A report produced by the charity earlier this month said lives would be needlessly lost because of disruption to services over the past two years. Diabetes UK chief executive Chris Askew said the latest figures were "incredibly concerning". "The majority of these major amputations are preventable, but many people living with diabetes are struggling to access the care they need - and in areas of higher deprivation, people are experiencing worse outcomes. These inequalities must be addressed." Read full story Source: BBC News, 27 April 2022 -
Content ArticleYoung people with type 1 diabetes experience higher rates of psychological distress, periods of burnout and feelings of being unable to cope with the daily burden of living with diabetes, than those who are diagnosed as adults. This article in The BMJ considers approaches to reduce anxiety and stress in young people with diabetes including: family, peer, and psychological support and education on living with diabetes. psychological screening assessment tools at diagnosis and annually. ensuring there are adequate local mental health support pathways. psychological and behavioural interventions, such as solution focused therapy, coping skills training, motivational interviewing and cognitive behavioural therapy.
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Content ArticleThe National Paediatric Diabetes Audit (NPDA) is performed annually in England and Wales and aims to provide information that leads to improved quality care for children and young people affected by diabetes. The audit is funded by the Department of Health through the Healthcare Quality Improvement Partnership (HQIP). Key messages in this 2020-21 annual report on care processes and outcomes include: There was an increase of an increase of 20.7% in the number of children aged 0-15 diagnosed with type 1 diabetes compared with 2019-20. Completion rates on recommended health checks were lower than in previous years due to the impact of the Covid-19 pandemic. There was wide variation between paediatric diabetes units in the completion rates of all key annual health checks. A smaller percentage of newly-diagnosed children and young people started insulin pump therapy compared to previous years. The national median HbA1c (a measure of blood glucose control) reduced from 61.5 mmol/mol to 61.0mmol/mol between 2019/20 and 2020/21, following several years of year on year decreases (improvement) in the national median. Children from ethnic minorities were less likely to be using insulin pumps and continuous glucose monitors (CGMs) than white children. However, the highest percentage increase between audit years in the use of CGMs was seen in black children and young people with type 1 diabetes.
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Content ArticleDiabetes UK are calling on government for a recovery plan to tackle 'devastating’ diabetes care delays – before it’s too late Diabetes is serious and people living with diabetes have been ‘pushed to the back of the queue’ during the coronavirus pandemic and a national recovery plan is needed to support front-line healthcare teams in getting vital services back on track. Diabetes UK warn that despite the tireless efforts of the NHS through the pandemic, many people living with the condition are still struggling to access the care they need, putting them at risk of serious complications, which can lead to premature death. This new report published by Diabetes UK as part of our Diabetes Is Serious campaign, shows the scale of the problem and sets out a series of calls to UK Government to tackle it.
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News Article
Disruption to diabetes care during Covid threatens thousands, charity warns
Patient Safety Learning posted a news article in News
Thousands of lives are being put at risk due to delays and disruption in diabetes care, according to a damning report that warns patients have been “pushed to the back of the queue” during the Covid-19 pandemic. There are 4.9 million people living with diabetes in the UK, and almost half had difficulties managing their condition last year, according to a survey of 10,000 patients by the charity Diabetes UK. More than 60% of them attributed this partly to a lack of access to healthcare, which can prevent serious illness and early mortality from the cardiovascular complications of diabetes, rising to 71% in the most deprived areas of the country. One in three had no contact with healthcare professionals about their diabetes in 2021, while one in six have still not had contact since before the pandemic, the report by the charity said. Diabetes UK said that while ministers have focused on tackling the elective surgery backlog, diabetes patients have lost out as a result, and there is now an urgent need to get services back on track before lives are “needlessly lost”. Chris Askew, the chief executive of Diabetes UK, called for a national diabetes recovery plan. “Diabetes is serious and living with it can be relentless,” he said. “If people with diabetes cannot receive the care they need, they can risk devastating, life-altering complications and, sadly, early death. “We know the NHS has worked tirelessly to keep us safe throughout the pandemic, but the impacts on care for people living with diabetes have been vast. While the UK government has been focused on cutting waiting lists for operations and other planned care, people with diabetes have been pushed to the back of the queue.” Read full story Source: The Guardian, 20 April 2022 -
News Article
Artificial pancreas to revolutionise diabetes care in England
Patient Safety Learning posted a news article in News
Nearly 900 patients with type 1 diabetes in England are testing a potentially life-changing artificial pancreas. It can eliminate the need for finger prick tests and prevent life-threatening hypoglycaemic attacks, where blood sugar levels fall too low. The technology uses a sensor under the skin. It continually monitors the levels, and a pump automatically adjusts the amount of insulin required. Six-year-old Charlotte, from Lancashire, is one of more than 200 children using the hybrid closed loop system. Her mother, Ange Abbott, told us it has made a massive impact on the whole family. "Prior to having the loop, everything was manual," she said. "At night we'd have to set the alarm every two hours to do finger pricks and corrections of insulin in order to deal with the ups and downs of Charlotte's blood sugars." Prof Partha Kar, NHS national speciality adviser for diabetes, said: "Having machines monitor and deliver medication for diabetes patients sounds quite sci-fi like, but technology and machines are part and parcel of how we live our lives every day. "It is not very far away from the holy grail of a fully automated system, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication." Read full story Source: BBC News, 1 April 2022 Further reading on the hub How safe are closed loop artificial pancreas systems? -
News ArticleEveryone with type 1 diabetes in England should be offered some form of continuous glucose monitoring (CGM) technology to support their care, the National Institute for Health and Care Excellence (NICE) has recommended. Updated draft guidelines published on 31 March recommend that all adults with type 1 diabetes should be offered a choice of either real time or intermittent (flash) CGM through a sensor attached to the skin as part of their ongoing NHS care. NICE also recommends that all young people aged 4 years and over with type 1 diabetes should be offered real time CGM and that some people with type 2 diabetes who use insulin intensive therapy (4 or more injections a day) should have access to Flash. Read full story (paywalled) Source: BMJ, 31 March 2022 Read NICE guidelines here.
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News Article
Lifestyle changes saving thousands from diabetes
Patient Safety Learning posted a news article in News
Thousands of Britons have avoided being diagnosed with type 2 diabetes thanks to an NHS programme aimed at early intervention. The Diabetes Prevention Programme identifies people at risk of developing the condition and gives them a nine-month plan to change their lifestyles. Researchers at the University of Manchester found that the programme resulted in 18,000 fewer people in England being diagnosed with type 2 diabetes between 2018 and 2019 — a 7% reduction. It focuses on eating and exercise habits and enables participants to join peer support groups and receive instruction from health coaches. The programme also offers a digital service that helps participants monitor their progress using wearable technology and mobile phone apps. Emma McManus, a research fellow at the university, said that diabetes was a “growing problem” for the country. The NHS spends about 10 per cent of its annual budget on treating it. “However, if you change your lifestyle, the risk of developing type 2 diabetes reduces,” she said. “Our research has shown that the programme has been successful in reducing the number of new cases of diabetes.” Emma Elvin, a senior clinical adviser at Diabetes UK, said: “This research adds to the evidence that many type 2 diabetes cases can be delayed or prevented with the right support and further highlights how the NHS diabetes prevention programme can be a real turning point for people at risk of type 2 diabetes.” Read full story (paywalled) Source: The Times, 28 March 2022 -
Content Article
In this blog, Lotty Tizzard, Patient Safety Learning’s Content and Engagement Manager, looks at the difficulties people experience in disposing of needles and injection devices safely at home. Variation in services across the UK can lead individuals to dispose of sharps incorrectly, posing a risk to refuse workers and the wider public. -
Content ArticleIn this article for The BMJ, Partha Kar, consultant in diabetes and endocrinology, looks at the importance of education and peer support in self-management for people with long-term conditions. He looks at how diabetes peer support and education programmes have adapted to the need for remote access during the pandemic, and suggests that increased access to these elements of diabetes care may have helped reduce diabetic ketoacidosis hospital admissions during the first wave of Covid-19.
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Content ArticleThis article in the Journal of Diabetes Science and Technology reviews the literature from various geopolitical regions and describes how a substantial number of patients with diabetes improperly discard their sharps. Data support the need to develop multifaceted and innovative approaches to reduce the risks associated with improper disposal of medical sharps into local communities.
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News ArticleA diabetic pensioner died on the roof of a hospital after staff physically ejected him despite being in a “confused” state. Stephen McManus, a long-term Type 1 diabetes patient, had earlier been rushed to Charing Cross Hospital in west London while suffering a hypoglycaemic episode. Despite colleagues having expressed concerns about his slurred speech and erratic behaviour, a junior doctor decided the 60-year-old had the mental capacity to go home. He was wheeled out of the building by security guards, despite having no phone, money and being in his slippers. His family had not been contacted to inform them he was being discharged. Some time later Mr McManus re-entered the building and managed to gain access to a construction area, somehow finding his way onto the roof. He was found dead the next morning following a police search after his family reported him missing. An inquest has begun trying to establish why Stephen was allowed to leave the hospital in the first place and how he was able to access a potentially dangerous zone. Mr McManus’s family say the case raises profound questions about the treatment of diabetic patients in the NHS. “My father was an extremely vulnerable patient and the nature of his removal from the hospital is inexplicable, Jonathan McManus, his son, told The Telegraph. “Had he been kept in hospital he would no doubt be alive today.” Read full story Source: Yahoo News, 19 February 2022
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News ArticleDiabetes is killing an increasing number of Americans and has accounted for more than 100 000 US deaths in each of the past two years. A national commission has called on the federal government to take a broad approach to the problem, similar to the fight against AIDS. Lisa Murdock of the American Diabetes Association told The BMJ that diabetes was the most common underlying condition in the US and that Covid-19 was an exacerbating factor. Some 40% of Americans who died from Covid-19 had diabetes, she said. The Centers for Disease Control and Prevention has reported that 37.3 million Americans—11.3% of the US population—have diabetes, including 8.3 million who have not had it diagnosed. Read full story (paywalled) Source: BMJ, 3 February 2022
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News Article
Substantial fall in diabetic health checks as GPs reprioritised during pandemic
Patient Safety Learning posted a news article in News
The proportion of patients with type 2 diabetes who have had recommended health checks has fallen substantially, provisional data from 2021 suggests, as have the numbers hitting key disease control targets. In response, primary care experts have called for GP practices to receive targeted investment to focus on the checks, which they had to deprioritise as the vaccination programme was introduced. There are now 3.24 million people with a diagnosis of type 2 diabetes in England, the data across all GP practices shows. National Diabetes Audit figures for England from January to September 2021 showed that: 74% of patients had received a HbA1c check and 70% a blood pressure check compared with 93% and 95% respectively in 2019/20. In the first nine months of last year, 61.9% of patients had an HbA1c under 58 mmol/mol, compared with around 66% in previous years. The proportion of patients with blood pressure targets of under 140/80 was 66.5% in the latest figures compared with around 73-74% during 2015 to 2020. Speaking with Pulse, Professor Partha Kar, NHS England national specialty advisor for diabetes said while this was not the final data, a drop off had been expected for a range of reasons outside GPs control. ‘What we have seen is that there was a massive drop off in wave one. Then around the middle of 2020 it started to pick up again but then it’s dropping off again so irrespective of data cleaning, I suspect you will see a massive drop off compared to where things have been over the last four or five years. ‘We need to be very clear its not because anyone was twiddling their thumbs, it’s because primary care was asked to do something else. ‘We can’t go back to primary care again for the vaccines because they are being taken away from the thing that they’re amazing at which is delivering long-term conditions at scale.’ Read full story Source: Pulse, 2 February 2022 -
Content Article
WHO European non-communicable disease dashboard (January 2022)
Patient-Safety-Learning posted an article in WHO
Non-communicable diseases (NCDs) including cardiovascular disease, cancer, chronic respiratory disease and diabetes, are leading causes of morbidity, disability and mortality in the WHO European Region, causing nearly 90% of all deaths and 67% of premature deaths. The World Health Organization (WHO) Regional Office for Europe has released the WHO Europe NCD Dashboard, which provides graphical data on NCDs in the 53 Member States of the Region and makes comparisons between them. The dashboard enables analysis of a country’s health situation and its progress towards meeting NCD health targets. It includes standardised data from national and international registries and surveys collected by countries, WHO and other international organisations -
Content ArticleThis report looks at research commissioned by the Juvenile Diabetes Research Foundation (JDRF) to understand the varying pandemic experiences of different people affected by type 1 diabetes in the UK. It highlights an enormous withdrawal of NHS services during the pandemic, leading to highly unequal access to type 1 diabetes care.
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Content ArticleThis study in Clinical Child Psychology and Psychiatry assessed feedback from paediatric diabetes patients and their parents or carers regarding virtual consultations, using a solution focused approach, in a hospital setting. Patients completed an electronic survey following their virtual consultation, and of those surveyed, 86% recommended video consultations to be part of their diabetes care. Qualitative data showed reduced travel time, comfort, reduced need for parking and convenience as the major benefits to patients. The results demonstrated that clinical care was shown to be positive and addressed patients concerns, the majority of respondents (84%) reported that the appointment was about what they wanted it to be about. Using the solution focused model helped overcome the challenges faced with virtual consultations particularly with concerns surrounding safeguarding issues, confidentiality, audio/video difficulties and also helped to support the patient journey.
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EventuntilResearch suggests the pandemic has greatly disrupted diabetes care. A study from the University of Manchester suggested that in April 2020 alone there was a 70 per cent drop in recorded diagnoses of type 2 diabetes compared to expected rates based on 10-year trends, with rates of blood tests to monitor diabetes falling by 77 per cent in England. There is now a significant backlog of patients awaiting assessment and review in primary care, increasing the risk of complications – and with them poorer outcomes for patients and greater costs to the service. So what can diabetes teach us about how best to address pandemic-related care backlogs? What actions will need to be taken to most effectively prioritise need? How will primary and secondary care need to work together? How can the workforce be used most effectively, particularly given it has already been under severe strain for almost two years? This HSJ webinar, run in association with Novo Nordisk, will bring together a panel of experts to discuss these questions and possible answers. We would be delighted were you able to join us. The event is entirely non-promotional and will not involve any discussion of medicines. Register
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Content Article
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In this blog, Lotty Tizzard, Patient Safety Learning's Content and Engagement Manager, looks at some of the patient and staff safety issues surrounding insulin delivery. These issues have been identified by a new working group set up by the Safer Healthcare and Biosafety Network (SHBN), and she also highlights potential solutions the group will explore. The SHBN is an independent forum focused on improving healthcare worker and patient safety. It has established a working group on improving injection technique and delivering dual safety in diabetes care. The working group consists of clinicians, policy-makers, charities, manufacturers and patients who are concerned about high numbers of preventable safety incidents related to diabetes treatment. -
Content ArticleAlthough research has focused on safe disposal of sharps in healthcare settings, the issue of disposal by patients in the home setting has not often been addressed. This US study in the journal Diabetes Spectrum aimed to evaluate methods of disposal and patient demographic factors associated with correct disposal of diabetes-related sharps in the community.
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Content ArticleThis guidance document for healthcare professionals highlights language that can discourage a person with type 1 diabetes, and what kind of language can motivate them. The project produced by The Diabesties Foundation and Diabetes India, and was adopted from the Language Matters guidance produced by NHS England. The guidance is available to download in English, Hindi and Tamil.
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