Charlotte Gosden

The fifth UK paediatric diabetes services survey: meeting guidelines and recommendations?

Aim To assess the provision of UK paediatric and adolescent diabetes services and examine changes in service delivery since 2002. Method Questionnaires were sent to the lead paediatric consultant from all paediatric and adolescent diabetes services (n=205). Questions were based on National Institute for Health and Clinical Excellence and Scottish Intercollegiate Guidelines recommendations for diabetes care in childhood. Results were analysed using parametric and non-parametric tests. Results 129 Services (63%) returned questionnaires involving 220 clinics. Staffing has improved and 98% of consultants have a special interest in diabetes (89%, 2002). In 88% of services, the diabetes specialist nurse worked solely in paediatric diabetes (53%, 2002). Only 21% of clinics have a psychological professional integrated within the diabetes team (20%, 2002). Over 94% of services offered support with intensive insulin regimens causing problems at school for 36% of services. Almost all services offer annual microvascular screening (98–100%) but transitional care was variable; only 76% of services have specific local protocols for transition and 21% organise transfer by letter only. Conclusion Paediatric and adolescent diabetes services are rising to the challenge of providing high-quality care despite rising prevalence and increasingly complex insulin regimes. Services have improved in a number of key areas but serious deficiencies remain.

Diabetes specialist nurses and role evolvement: a survey by Diabetes UK and ABCD of specialist diabetes services 2007

Aims  To review the working practices of UK diabetes specialist nurses (DSNs), specific clinical roles, and to examine changes since 2000.

National guidelines for psychological care in diabetes: how mindful have we been?

Aims  To assess the availability and types of psychological services for people with diabetes in the UK, compliance with national guidelines and skills of the diabetes team in, and attitudes towards, psychological aspects of diabetes management.

The concerns of school staff in caring for children with diabetes in primary school

Boden S, Lloyd CE, Gosden C, Macdougall C, Brown N, Matyka K. The concerns of school staff in caring for children with diabetes in primary school.

A national survey of the current state of screening services for diabetic retinopathy: ABCD-diabetes UK survey of specialist diabetes services 2006.

The main aims were to ascertain the progress made in the implementation of retinal screening services and to explore any barriers or difficulties faced by the programmes. The survey focused on all the essential elements for retinal screening, including assessment and treatment of screen‐positive cases. Eighty‐five per cent of screening programmes have a coordinated screening service and 73% of these felt that they have made significant progress. Eighty‐five per cent of screening units use ‘call and recall’ for appointments and 73.5% of programmes follow the National Screening Committee (NSC) guidance. Although many units worked closely with ophthalmology, further assessment and management of screen‐positive patients was a cause for concern. The fast‐track referral system, to ensure timely and appropriate care, has been difficult to engineer by several programmes. This is demonstrated by 48% of programmes having waiting lists for patients identified as needing further assessment and treatment for retinopathy. Ophthalmology service for people with diabetic retinopathy was provided by a dedicated ophthalmologist in 89.4% of the programmes. Sixty‐six per cent of the programmes reported inadequate resources to sustain a high‐quality service, while 26% highlighted the lack of infrastructure and 49% lacked information technology (IT) support. In conclusion, progress has been made towards establishing a national screening programme for diabetic retinopathy by individual screening units, with a number of programmes providing a structured retinal screening service. However, programmes face difficulties with resource allocation and compliance with Quality Assurance (QA) standards, especially those which apply to ophthalmology and IT support. Screening programmes need to be resourced adequately to ensure comprehensive coverage and compliance with QA.

Association of British Clinical Diabetologists (ABCD) and Diabetes-UK survey of specialist diabetes services in the UK, 2006. 1. The consultant physician perspective

Aims  To identify the views and working practices of consultant diabetologists in the UK in 2006–2007, the current provision of specialist services, and to examine changes since 2000.

The risk management of childhood diabetes by primary school teachers

This article explores the attitudes of primary school staff in relation to managing children with diabetes. It reports the findings of a qualitatively orientated study in which we conducted in-depth, semi-structured face-to-face interviews with 22 staff that held a variety of positions in primary schools and had a range of experience of caring for children with diabetes. We consider the anxieties and apprehensions expressed to us by our interviewees (covering topics such as injecting/blood testing, and the reactions of parents to school decisions), in both their capacities as educators and, increasingly, frontline care-givers to other peoples children. The expansion and formalisation of healthcare responsibilities within the primary school is shown to have impacted upon the risk assessments made of children with diabetes. Analysis of the data therefore focuses on health related risk anxieties as they are played out in adult/child relations and in the specific context of the primary school.