Quality statement 7: Inpatient care for adults with type 1 diabetes

Quality statement

Adults with type 1 diabetes in hospital receive advice from a multidisciplinary team with expertise in diabetes. [2011, updated 2016]

Rationale

Adults with type 1 diabetes may be admitted to hospital for diabetes-related or unrelated conditions. This can disturb normal routines, affecting carbohydrate intake and insulin therapy, and special regimens may be needed in response to procedures that affect the usual management of diabetes. The person's expertise in managing their own diabetes should be respected, and the specialist multidisciplinary team has the knowledge to help the person understand how to best to adapt management when in hospital. The person should be supported to continue to self-manage their diabetes and administer their own insulin if they are willing and able and it is safe for them to do so. Input from a multidisciplinary specialist team can reduce the length of hospital stay for adults with type 1 diabetes and improve their experience of hospital.

Quality measures

Structure

Evidence of local arrangements to ensure that adults with type 1 diabetes in hospital receive advice from a multidisciplinary team with expertise in diabetes.

Data source: Local data collection.

Process

Proportion of hospital admissions for adults with type 1 diabetes in which they receive advice from a multidisciplinary team with expertise in diabetes.

Numerator – the number in the denominator in which the person receives advice from a multidisciplinary team with expertise in diabetes.

Denominator – the number of hospital admissions for adults with type 1 diabetes.

Data source: Local data collection. Contained in the National Diabetes Inpatient Audit.

Outcome

a) Length of hospital stay.

Data source: Local data collection.

b) Patient satisfaction that staff met their diabetes needs while in hospital.

Data source: Local data collection. Contained in the National Diabetes Inpatient Audit.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (hospitals) ensure that adults with type 1 diabetes in hospital receive advice from a multidisciplinary team with expertise in diabetes.

Healthcare professionals (members of the multidisciplinary team) ensure that they provide advice to adults with type 1 diabetes who are in hospital, and enable them to continue to administer their own insulin if they are willing and able and it is safe for them to do so.

Commissioners (clinical commissioning groups) ensure that they commission services in which adults with type 1 diabetes in hospital receive advice from a multidisciplinary team with expertise in diabetes.

What the quality statement means for patients, service users and carers

Adults with type 1 diabetes who go into hospital if they are ill or need an operation get advice from a team of specialists in diabetes, who will respect their expertise in managing their own diabetes. They are supported to carry on injecting their own insulin if they want to and can do so safely, although sometimes intravenous insulin will be needed instead (for example, if they can't eat or are having an operation that affects blood glucose levels).

Source guidance

Definitions of terms used in this quality statement

Multidisciplinary team with expertise in diabetes

The basic structure of a specialist inpatient diabetes team should comprise:

  • for every 300 beds, at least 1 diabetes inpatient specialist nurse whose focus is predominantly on inpatient care

  • a consultant specialist in diabetes management.

There should also be access to a diabetes specialist:

  • podiatrist

  • dietitian.

[Adapted from Commissioning specialist diabetes services for adults with diabetes: a Diabetes UK task and finish group report (2010)]