This document provides guidance for general practices on managing patients with diabetes remotely via either telephone or video consultations.
Following the care processes outlined in the diabetes NSF, guidance has been produced to support the management of patients during the pandemic. Diet and physical activity remain the mainstay for management of diabetes. During this time, when haematological and biochemical monitoring must only be undertaken if the benefit out-weighs the risk of potential coronavirus infection, any new prescribing should only be undertaken following careful risk assessment. HbA1c targets should be a clinical decision, made on an individual case by case basis. Considerations should include:
- Moderate or severe frailty
- Long term benefits from tighter glucose control are unlikely to be achieved due to reduced life expectancy for example patient within the palliative care register
- Whether tight(er) glucose control could trigger hypoglycaemia and as a result, increasing vulnerability such as falls. Other vulnerabilities may include the patient living alone, a reduced hypo awareness, or patients driving or operating machinery.
Within these unprecedented times, the usual call and recall system needs to be replaced with a proactive identification and risk stratification of patients requiring a review. The highest risk patient being those with:
- Last HbA1c over 75mmols
- On insulin or SU
- Over 65 and on triple therapy
- Recent history of DKA or HONK
- Currently pregnant
- Those already identified as fitting national criteria to shield
Review medical records
Assess for physiological signs symptoms of metabolic dysfunction including:
- BMI > 30
- Waist measurement > 32 inches for female and 37 inches for a man
These factors must be considered in the patient’s individual risk as they indicate systemic dyslipidaemia and increased hyperglycaemia.
These patients should be identified and prioritised for remote review, either telephone or video as per patient choice/access.