Cork doctor outlines new diabetes protocols after Covid disruption

Darragh Bermingham talks to Dr Suzanne Kelly about a new diabetes protocol which will see community care provided in hubs linked to local hospitals
Cork doctor outlines new diabetes protocols after Covid disruption

Dr Suzanne Kelly says “the new integrated care model will place more emphasis on diabetes prevention, self-management and podiatry in the community to prevent ulcers”.

THE Covid-19 pandemic saw services for patients with diabetes disrupted and delayed in some cases.

With routine services resuming again soon and the vaccination programme beginning to take effect, Cork doctor and diabetes lead for the Irish College of General Practitioners (ICGP), Dr Suzanne Kelly, urged diabetic patients to attend appointments when offered.

Speaking to The Echo, Dr Kelly highlighted the importance of the National Clinical Programme for Diabetes in preventing ulcers and amputations as a result of diabetes, and how the programme will provide diabetic hubs in Cork and across Ireland.

“The Covid-19 pandemic disrupted society from March 2020 onwards, and scheduled services for those with chronic disease took a back seat for a while to allow the health services to manage the consequences of the Covid-19 virus that engulfed all our lives,” Dr Kelly explained.

“We are now assessing the impact of the disruption on our diabetes services, and how we can remedy that, with routine services for podiatry resuming in coming weeks in Cork.”

Dr Kelly explained that both patients with type 1 and type 2 diabetes saw first hand the disruption to services last March.

Type 1 diabetes or ‘Diabetes Mellitus’ is mostly diagnosed in patients in the younger age group and is managed by specialist care based in hospitals. Type 2 diabetes, which generally occurs later in life, can be mainly managed by taking medication. The majority of type 2 patients are safely managed by their GP in the community but some with more complicated conditions may need to attend hospitals for additional care.

“Almost all patients with type 1 or type 2 diabetes have experienced changes in how their care is delivered since the pandemic began,” Dr Kelly explained.

“Lots of hospital clinics moved to virtual or phone appointments - this was safer and saved people from long-distance travel for appointments.

“Their local GP was able to manage their blood tests to send to specialists for them but some diabetes patients have particular vulnerability to damage to their eyes, feet and kidneys, and a phone appointment is not suitable,” she added.

“Community podiatry - foot care - services remained open during the pandemic for those needing an urgent review or those who developed complications of their diabetes such as ulcers or infection.”

Dr Suzanne Kelly
Dr Suzanne Kelly

Although podiatry services in Cork have continued through the year to see patients with urgent cases of foot disease in a timely manner, some patients with routine podiatry appointments remain on a waiting list. Almost 200 people have been waiting over a year for podiatry appointments in Cork, according to the latest figures.

HSE data revealed that 515 people are on waiting lists for podiatry appointments in Cork - 188 of these have been waiting more than a year.

“Priority was given to patients who most needed care,” Dr Kelly explained.

“Routine services are resuming in the coming weeks and more patients will be seen.

“Patients with ‘low risk’ disease continue to be advised on foot care by general practice nurses,” she added.

“Everyone involved in the care of diabetes patients knows the importance of foot care with the objective of preventing serious complications such as ulcers or amputations. Limb loss is a devastating complication of diabetes and represents an enormous burden on patients, their families and healthcare team.”

Dr Kelly explained that reducing the number of ulcers and amputations is a major goal of the National Clinical Programme (NCP) for Diabetes.

“The NCP envisioned the podiatrists in the community as the cornerstone in managing the diabetic foot,” she said.

“In the last few years focus was on providing hospitals with podiatrists for patients with active foot disease. The new integrated care model will place more emphasis on diabetes prevention, self-management and podiatry in the community to prevent ulcers,” she added.

Dr Kelly explained the new system will see community care provided in ambulatory hubs linked to local hospitals.

“This means that in Cork we will have a hub offering rapid access to dietitians, podiatrists and clinical nurse specialists. Each hub will have three podiatrists which represents a big increase in provision of foot care. Although Covid-19 has delayed the roll-out, we are all hopeful the hub will be up and running very soon,” she added.

“By investing in diabetes prevention, early good quality podiatry care we will see a year-on-year decrease in complications such as ulcers and amputations.”

With the vaccination programme beginning to take effect, Dr Kelly explained that the risk of Covid-19 is beginning to reduce. She urged any diabetic patient being offered an appointment to attend.

“It is vital that those who are being offered appointments do attend, and not to worry about possible infection risks,” she said.

“Healthcare workers are vaccinated, and clinics are operating with high standards of cleaning and ventilation. Meeting a patient in person at a clinic allows the doctor and nurse to properly assess blood pressure, kidney function and foot health, among other things.

“There are alternatives to attending clinics if people don’t feel comfortable attending appointments,” she added.

“People can manage their diabetes by following a diabetic-friendly diet and continue to be active every day. Patients should take good care of their feet.”

Dr Kelly also signposted helpful booklets available at GP surgeries, diabetic clinics or the HSE website that contain tips on washing feet, keeping the skin in good health, managing toenail care, and wearing correct shoes and socks.

“Most people with diabetes know to contact their GP, practice nurse or podiatrist if they have a foot problem,” she said.

“Patients who check and record their blood sugars should keep it up and this record can be shared with their doctor.

Screening for eye problems has continued through the year so patients should continue to attend their appointments in the opticians,” she added.

“This photograph of the back of the eye is really important to detect early changes in the eye which can ultimately prevent serious sight loss.

“Staying connected with the healthcare providers for your diabetes is essential and staff are adept at filtering patients who can be safely managed in the community with virtual appointments and selecting out those who will benefit most from in person review.”

Dr Kelly added that, if a patient is experiencing symptoms or worrying about their diabetes, they should contact their GP or diabetes team as “early intervention can prevent serious complications”.

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