What is the positive change that has emerged through new collaborations or partnerships during Covid-19 that your project is going to embed?

Enabled by the current close working relationships across clinical and social care networks, bringing together GPs, care home providers and specialist community-based clinical services has generated renewed interest in identifying simple, time-saving interventions that promote quality-of-life without overwhelming frail and vulnerable patient living with Type 1 Diabetes (T1D) and their carers. Engaging with service providers, device manufacturers and clinical scientists, we have mapped out a future where vulnerable patients have diabetes management devices remotely connected to the community diabetes team, with their data driving proactive intervention to reduce patient risk.

Providing diabetes management data, such as insulin delivery, carbohydrates consumed and glucose measurements are available, T1D patient-specific advice remains feasible despite the limitations of virtual clinics. However, for patients identified as frail or vulnerable, including those living with T1D in a care home setting, the loss of face-to-face contact is often combined with the loss of this valuable data stream.

What does your project aim to achieve?

Although virtual clinics and remote data collection have been embraced by someT1D patients, frail and vulnerable patients, including those with cognitive decline, are in danger of being left behind during this transition and yet are likely to be in some of the greatest need of specialist clinical assistance. To redress this, commissioners, General Practice and care providers have indicated their enthusiasm to facilitate further development of diabetes data management and analysis to allow for timely, remote specialist clinical intervention. Local CCGs already fund the core continuous glucose measuring (CGM) technology and all parties now wish to see use of this technology embedded with those T1D patients categorised as frail. We aim to establish the framework of safely achieving that roll-out, including provision of carer – and, where appropriate, patient – training and ensuring the clinical data generating by these devices remains accessible and visible, even if direct face-to-face contact is not feasible.

How will the project be delivered?

We will leverage existing good system-wide support and communication, including local commissioners and care homes. The community diabetes consultant and nursing team’s existing engagement and experience with this population will be supplemented with specialist expertise from regional dementia and frailty care teams and knowledge from local GP partners.

Having established a baseline of glucose management metrics (including time-in-range, frequency of hypo- and hyperglycaemic events) for this population, planned PDSA cycles include evaluating the impact of local availability of CGM and the addition of a clinic prioritisation dashboard. Clinical scientist expertise will be used to consolidate tens-of-thousands of patient-specific data-points into simple, accessible metrics, generating a dashboard of priority patients and enabling pre-emptive action (e.g. reducing basal insulin).

Cycles will include representatives from patient and carer groups to ensure that apparent improvements in glucose management are not generated at the expense of patient quality-of-life or excessive carer / clinician workload.

How is your project going to share learning?

This project offers potential insight into the use of QI in tackling and assessing changes in the care of other long-term conditions in frail and vulnerable patients, including those in residential care. With a community-based specialist care team already in place and connected to the local strategic clinical and research networks, paths of dissemination across the immediate region already exist. Existing connections to the Association of British Clinical Diabetologists (ABCD) and ongoing dialogue with Diabetes UK give natural avenues to disseminate learning opportunities and to receive valuable feedback from clinician, patient and commercial diabetes technology manufacturers.

Progress through the PDSA cycles explored, including anonymised patient and clinician journey mapping, will be made available via the Documents section on the Q website and offered to the Wessex AHSN, ABCD and Diabetes UK for sharing via their online resources.