Diabetes: It Takes a Village 

Siobhan Harris

Disclosures

July 24, 2019

"You can just walk in as if you are going to a supermarket and pick whatever services are available to make sure you stay well," says Rashmi Joshi who's been making use of the new diabetes village which has just opened in Leicester.

The village is a pilot project developed by Leicester City Clinical Commissioning Group (CCG) in partnership with Silver Star Diabetes, a local health charity.

It offers a range of services that are important for effective diabetes management, including blood sugar checks, lifestyle coaching advice, foot care, eye screening, and diabetes education classes.

It's not only available to anyone living with type 2 diabetes but also open to those at risk of developing diabetes, who haven't got a diabetes diagnosis.

A One-stop Shop 

Up until now patients would have had to make multiple visits to their GP practice for regular checks on blood sugar and insulin. Then they would have to have made separate visits to other places for a wider range of care.

Professor Azhar Farooqi is chair of Leicester City CCG and lead on diabetes.

"What we aim to do is provide an increasing range of services including prevention and early diagnosis screening for diabetes," he told Medscape UK.

"We'll offer lifestyle advice both in terms of preventing and managing diabetes including information on better diet and exercise. We're also planning to provide help for other aspects of diabetes. So, if people are worried about their feet or feel they'd like their eyes, blood pressure or blood sugar checked all those things can be done in the village as well."

Access to Information and Services

Rashmi Joshi has had diabetes for almost 10 years. He is a big fan of the new facility. "It's a wonderful initiative as it gives people who are diabetic or who could be diabetic and do not know, a place where they can go and get themselves tested. Then they can learn more about how to look after themselves," he says.

"This is a one-stop shop where many services will be provided and to have everything under one roof makes huge sense. It'll help people who really don't understand what diabetes is all about how to look after themselves.

"You can have your blood tested for sugar levels, your cholesterol and weight checked and advice on healthy diet and exercise. What I also found good was the podiatrist services were there as well. People don’t understand how important it is to look after your feet if you are diabetic. Your sensations might be reduced tremendously so make sure feet are checked," adds Rashmi Joshi.

Specialist podiatrist Dhruv Jogia provides services at the village. He agrees about the lack of knowledge: "Whilst delivering my talk on the diabetic foot at the Diabetes Village event, I was surprised to find that only 25% of diabetics in the room had ever had a Diabetic Foot Assessment. I will be doing regular Diabetic Foot Assessments to grade risk levels, those patients will then be redirected to the important support, treatment and advice required to prevent complications like ulcers, infection, gangrene, and ultimately preventing amputation."

No Appointment Necessary

The new village concept means that local patients can drop in on a Thursday between 10am and 6pm and pick and choose the services they require all in one location.

Rather than making an appointment at their GP practice and potentially being referred to a specialist clinic based at one of the city hospitals, for the next 6 months patients can drop in at the village on a Thursday and get a diabetes check in just a few minutes.

The local charity Silver Star Diabetes says the idea was born out of the needs of people with diabetes and others having to make up to eight visits to different professionals on different days at different times and at different venues.

Nikki Joule, policy manager at Diabetes UK, said: "If you’re living with diabetes, attending all of your appointments can be exhausting, and the practical difficulties of attending each of them can mean that many people with diabetes end up missing some. We look forward to seeing how effective this ‘diabetes village’ will be in helping people with diabetes attend all of their medical appointments, which are vital to keeping them healthy."

Current Structure Under Pressure 

"We've got about 5 million people with diabetes in the country and another 10 million people who are at high risk of developing diabetes in the future so we're talking about a large percentage of the population," says Prof Farooqi.

"The current health services and structure, including making appointments with your GP, just aren't able to cope with the number of patients that we need to get to. This idea offers a much more flexible facility for people if they work or can't get an appointment with their GP. We are not saying that this centre will replace standard NHS care, far from it, but it'll help people become more aware of issues. Eventually, we aim to be on the NHS computer system, so we can send messages to people's GPs electronically," he explains.

Is It Cost-effective? 

The NHS spends 10% of its budget for England and Wales on diabetes care. That’s more than £25,000 being spent on diabetes every minute. The vast majority on type 2 diabetes.

This is the first diabetes village in the UK but can the NHS afford to roll them out nationwide? Do these types of facility represent value for money for the NHS? Prof Farooqi thinks so.

"These centres can be relatively cost effective as they have a much looser structure than traditional NHS clinics. Quite often people want someone to signpost information to them. Obviously, there is a cost to set up these types of services but it isn’t as high as setting up traditional NHS services."

It also has the potential to save the NHS money further down the line.

"Earlier diagnosis of diabetes prevents complications, and it’s the complications that are costly to the NHS. It's not so much the condition itself but the effects of uncontrolled diabetes. For example, if someone requires an amputation, loses their vision, or develops kidney disease, that's very expensive for the NHS. So picking up things earlier makes it most cost effective for the NHS," adds Prof Farooqi.

Patient Self-care

The emphasis for diabetic health care going forward is to give people more responsibility for their own health.

Prof Farooqi agrees. "We need to put more of the care into the hands of the patients. Part of what this village is going to be doing is giving patients the knowledge and the skills to manage their own condition and health issues much better. It's not about relying on the healthcare professionals. The only way we are going to manage the increasing health costs is to make the public more health aware and able to change their own lifestyles."

Rashmi Joshi is testament to that. He was initially on insulin injections after diagnosis just under a decade ago. He took up cycling and reduced his carbohydrate intake. This lowered his weight, blood glucose level and cholesterol to such an extent that within a year he no longer needed insulin injections.

"The whole essence of a place like this is getting information on how to look after yourself if you have diabetes or preventing it if you don't. It's up to people to take control of their own health, to do exercise, to take care of their diet, and to keep themselves regularly tested so they know where they are at," advises Rashmi Joshi.

Language No Barrier

In Leicester City there is a higher than average number of people with diabetes (8.9% compared to 6.4% nationally) and this is expected to rise further to 12% by 2025. Leicester also has a higher proportion of BAME (Black Asian Minority Ethnic) residents compared to the UK national average with a genetically higher risk of diabetes.

The new centre has made provision for this and has information material in different languages.

"The excellent side of it is you just drop in; you don’t need to pre-book. Sometimes people don’t understand how to pre-book due to various issues including language barriers and so on. There are people who can speak several different languages at the centre too so that's not going to be a barrier," explains Rashmi Joshi.

Patient Feedback 

The 6 month pilot is to help fashion how the village will develop. People who use it will be asked for their feed-back.

"We want people to use the village and come to us and tell us whether the diabetes village is a service they want to keep and whether it’s a service they will use. This is a first for the UK and we want to make sure we get it right for patients. It's a concept that will be expanding in the future rather than being dismantled. If it works the plan is to set up other local diabetes villages in other parts of Leicester," explains Prof Farooqi.

Diabetes UK is watching with interest.

Nikki Joule says: "In our Future of Diabetes survey, one third of respondents told us that having a ‘one-stop shop’ for their diabetes appointments was the main thing they’d change about their healthcare. This pilot 'diabetes village' in Leicester is giving people living with diabetes the opportunity to try this out."

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