Addressing the landscape of diabetes care within community nursing: Learning from a Sussex-based service evaluation.

Abstract

Aims: Well-established provision in the United Kingdom offers insulin administration for those who are unable to self-manage. An ageing population is increasing pressure on community nursing teams, with many reporting unsustainable workloads. This service evaluation sought to review the community nursing workload of one community trust.

Methods: The electronic records of all those receiving community nursing care for insulin administration were reviewed. Data extracted included age, ethnicity, frailty score (Clinical Frailty Scale), presence of dementia, whether the person is a care home resident, insulin regimen, number of daily nurse visits, HbA1c, and where available, continuous glucose monitoring (CGM) data. CGM data were compared by insulin regimen and diabetes type.

Results: Searches identified 499 cases; 410 were eligible for analysis. Participants with type 1 diabetes were younger and less frail than those with type 2 diabetes, with more nursing visits per day. Median hypoglycaemia was low (0.0 in both groups), but median time-above-range was high regardless of diabetes type (60 in type 1 diabetes, 62 in type 2 diabetes) and insulin regimen.

Conclusion: This service evaluation uncovered evidence of high workload for community nursing teams. Commissioners should recognise this and the potential for future increases in workload with an ageing population. Glucose control was sub-optimal but hypoglycaemia rates were low. Consideration should be given to ways to improve care. Options include involving carers in insulin administration, using longer acting insulins, and greater use of diabetes technology. Research into these strategies will help future proof this service and prevent widening of health inequalities.