New guideline launched to improve the quality and safety of treating Type 1 Diabetes

The first ever National Clinical Guideline for Adults living with Type 1 Diabetes has been launched in Ireland.

The publication of the guideline will see an agreed framework that will ensure all adults with type 1 diabetes regardless of where they live in Ireland, have equitable access to high quality care. The guideline will also act as a driver to standardise type 1 diabetes care nationally.

There are approximately 20,000 adults living with type 1 diabetes in Ireland. Long term good health depends, perhaps more than with any other long-term condition, on full engagement of the person with type 1 diabetes in life-long day-to-day self-management.

The National Clinical Effectiveness Committee Guideline is the first to be developed in Ireland using the UK’s National Institute for Health and Care Excellence (NICE) contextualisation process; whereby a recent NICE guideline is adapted for use in another country. The recommendations are based on the best research evidence and on national and international clinical expertise.

This initiative was led by a group from the Health Service Executive’s (HSE) National Clinical Programme on Diabetes, supported by the Department’s Clinical Effectiveness Unit and a team from NICE. The guideline was quality assured by the National Clinical Effectiveness Committee (NCEC).

Type 1 diabetes is an autoimmune condition that causes destruction of the insulin producing cells in the pancreas. This means that people with type 1 diabetes must self-inject insulin in order to manage their blood glucose and avoid a range of serious short and long-term complications.

Dr Kevin Moore, Chair of the Guideline Development Group said “Type 1 diabetes care requires a multidisciplinary approach to care that empowers patients to successfully manage this life-long condition. Current evidence shows variation in how care is delivered across Ireland and so this NCEC National Clinical Guideline will standardise the approach with a special focus on patient education and clinical review. Overtime, this will mean better outcomes for patients with type 1 diabetes.”

Current evidence shows the care of people with diabetes varies across Ireland. Care may be limited, unstructured and ad-hoc in some locations with limited access to specialist expert diabetes opinion.

Current services are not supportive of the person with Type 1 diabetes. In order to support the Type 1 diabetes community, the health service needs to provide informed, expert support, education and training as well as a range of other services and interventions for the prevention and management of long term health problems.

Dr Anna Clarke, Health Promotion and  Research Manager, Diabetes Ireland, said: “There is an immediate need for additional Advanced Nurse Practitioner’s in Type 1 diabetes who could avert hospital admissions and distress for people with diabetes by being available to resolve simple queries such as:

• Determining a plan of action for having taken too much or too little insulin,
• Dealing with too high or too low glucose levels
• How to cope with common ever day illness that affects diabetes
• Helping the individual to determine what is an emergency.

“This is not an expensive option but a simple cost effective support mechanism that would bring cost savings almost immediately for the HSE through reduced hospital admissions”

It is accepted that group education for individuals living with type 1 diabetes results in improvement in quality of life, diabetes knowledge and diabetes control and as a result less diabetes complications. Despite an awareness of the importance of group education, only 409 adults with type 1 were recorded as having attended such programmes in Ireland in 2016, with only 159 having attended a programme which meets international standards.

Ms Niamh Downes, a person living with type 1 diabetes said – Given how important Education is to support self management,  I think it should be “prescribed” rather than “offered”. And that every effort be made to make it accessible for the adult with type 1 diabetes, such as providing a medical certificate for workplaces. People with diabetes are experts in living with Diabetes but need education/support. This should be immediately available as a motivated educated patient will have much better outcomes.

“If implemented nationally, this framework would see improved patient outcomes and the incidence of diabetes related complications decreasing thus enhancing quality of life for people with type 1 diabetes.  Diabetes Ireland wants to see immediate implementation of the guideline nationally with the required resources being made available” concluded Dr Clarke.