Joan McDowell

Rural Vincentians’ (Caribbean) beliefs about the usage of non-prescribable medicines for treating Type 2 diabetes

Aims  To explore beliefs among persons in St. Vincent, a rural Caribbean Community, regarding the usage of non‐prescribable medicines for treating Type 2 diabetes.

Challenges of optimizing glycaemic control in children with Type 1 diabetes: a qualitative study of parents' experiences and views

To explore the difficulties parents encounter in trying to achieve clinically recommended blood glucose levels and how they could be better supported to optimize their childs glycaemic control.

Quality of life in people with type 2 diabetes in relation to deprivation, gender, and age in a new community-based model of care.

Objectives. To evaluate changes in health related quality of life (HRQL) for individuals with Type 2 diabetes following the introduction of a new community-based model of care. Methods. A survey method was used in which HRQL, Problems Areas In Diabetes (PAID) and demographics were assessed before and 18 months after introducing the new service. Results. Overall HRQL and PAID scores were lower than published levels in individuals with diabetes but remained stable during the transition to the new model of care except for the bodily pain domain and deteriorating PAID scores for older patients. Four domains of SF36 health showed deterioration in the highest socio-economic groups. Deterioration was also observed in males, most notably mental health, in patients aged 54 years or less, 75 years or more and patients from socio-economic groups 1 and 2. HRQL was lowest at baseline and follow-up in socio-economic groups 6 & 7. Low levels of distress in patients across all deprivation categories was observed but remained stable over the transition. Conclusions. HRQL and distress associated with diabetes remained stable following the introduction of the new community-based model of care except for deterioration in the bodily pain domain and deteriorating PAID scores for older patients. Relevance for Practice. (i) Health related quality of life assessment is practical and acceptable to patients. (ii) In clinical governance terms it is good practice to monitor the impact of change in service delivery on the health of the patients in your care. (iii) Screening with health related quality of life tools such as generic and disease specific tools could help identify health problems otherwise undetected within current clinical care. Systematic identification of the most vulnerable groups with Type 2 diabetes should allow care to be better targeted.

Insulin initiation among adults and children with diabetes in the United Kingdom

There is no doubt that insulin therapy is effective in the management of people with diabetes. Indications for the use of insulin are agreed, but wide variations exist in the practice of starting people with diabetes on insulin. Current health care practices in the United Kingdom are increasingly being based on scientific evidence. This literature review concentrates on current insulin initiation practice, examining the evidence base for the insulin regimens used, the process for determining starting doses and the decision making process involved. It concludes that there are wide variations in practice among the multidisciplinary team and that there is little published regarding the commencement of people with type 2 diabetes on insulin. It is likely that custom and habit still play a large role in current practice. Copyright

Structured diabetes patient education in Scotland

This article describes how Scotland is addressing the need to review structured diabetes education to support self‐management and record this on the national database.

Community diabetes nurse specialists: service evaluation to describe their professional role

This paper presents a service evaluation on the role of Community Diabetes Nurse Specialists (CDNS), which was undertaken as a response to various changes. Quantitative and qualitative data were captured over 6 months. It was found that GPs refer patients to CDNSs four times more frequently than other health professionals. The clinical care of CDNSs mainly relates to diabetes education, insulin, assessment and self-management. Telehealth is used twice as frequently as face-to-face communications. The CDNSs do not refer patients onto other health professionals, but have multiple communications with other health professionals and agencies. They manage very complex clinical and social situations, using high-level clinical decision making and balancing person-centred care and patient safety. Structured patient education is being delivered. CDNSs mentor other staff and students, although their own formal professional development is very limited. To conclude, CDNSs are the end point for patient care in the community, managing complex patient situations, while adopting a person-centred approach.