Diabetes across the UK now affects over 5 million people; this is pivotal in galvanising a focused and purposeful approach to tackling the health challenges and embracing the opportunities in diabetes care (Diabetes UK, 2023). We are in the midst of a global pandemic of diabetes, with predicted increases in prevalence occurring across every continent (International Diabetes Federation, 2022).
iDEAL Diabetes
Insights for Diabetes Excellence, Access and Learning (iDEAL) is a community interest company that is not for profit, and designed to work with local communities to share and promote best practice. Our multi-disciplinary team approach, which includes people with diabetes, provides tools and resources that are tailored to local circumstances to reduce variation in diabetes care delivery and outcomes. Our values are to improve and increase access to individualised, supported self-management. This is how the NOW series has evolved.
We bring together all relevant key stakeholders to remove barriers between elements of diabetes care. We involve and incorporate expert opinion in solutions. We also ensure all our publications can be adopted to fit local circumstances.
The NOW Series
This is a series of themed webpages with downloadable resources for both healthcare practitioners and people with diabetes to learn more about aspects of diabetes care delivery and approaches to specific situations.
Act Now
This is a series of recommendations to improve foot care and education, and to reduce the number of major amputations in people with diabetes. The acronym ACT NOW has been devised to help recognise the warning signs that might lead to amputation which, if identified, should activate urgent referral to specialist care from multidisciplinary diabetic foot teams (MDFTs). There should be clarity of referral pathways in primary care to promote rapid access to MDFTs and to facilitate referral of feet at high risk of ulceration to foot protection teams (Edmonds et al, 2020). If its recommendations are followed, the iDEAL group believes that a 50% reduction in major amputations among people with diabetes can be achieved within 5 years.
ACT NOW (https://idealdiabetes.com/act-now-education-resources) has been hugely successful, and a national roll-out of the ACT NOW cards is taking place to assess the difference that they make. Edmonds et al (2020) previously reported that ‘Time is Tissue’ and amputation can occur within 5 days from an initial skin break in a foot with someone with diabetes. Hence the urgent need to ACT NOW if any signs or symptoms of a skin break or infection are detected (Edmonds et al, 2020). In 2022, ACT NOW won the Diabetes UK Research and Innovation Award by Health Professionals, and has also received endorsements from the International Diabetes Federation, which has adopted the use of ACT NOW internationally (International Diabetes Federation, 2022), the Diabetes Research and Wellness Foundation and the Royal College of Podiatry, among others.
Protect Now
PROTECT NOW focuses on diabetes and kidney health. National Institute for Health and Care Excellence (NICE) guidance recognises that one in three adults with diabetes experience either declining renal function or chronic kidney disease (NICE, 2021). Prevention of this, and sharing knowledge about kidney health with diabetes, is vital for both people with diabetes but also health professionals working alongside them (Phillips, 2021a). Prescribing is still not uniform across the UK; as such, guidance about safe prescribing choices and declining renal function with diabetes are all clearly documented in our PROTECT NOW webpage and resources (https://idealdiabetes.com/protect-now).
Screen now
Eye health is an important consideration for care for everyone with diabetes. Retinopathy and potential blindness is still one of the most feared complications of the condition (Rafferty et al, 2021). Practice nurses are particularly pivotal in ensuring people attending their diabetes reviews have access and can attend the annual diabetic retinal screening appointment (Phillips, 2021b).
SCREEN NOW (https://idealdiabetes.com/screen-now-main-page) has been developed to include information about diabetic retinopathy, and macular degeneration. Diabetes and glaucoma is currently under development in a new NOW entitled LET'S SAVE NOW (https://idealdiabetes.com/lets-save-now). Glaucoma is a group of conditions caused by fluid in the eye not draining properly. This leads to pressure that damages the optic nerve, resulting in sight loss. Factors influencing glaucoma are age, family history, ethnicity, diabetes and short-sightedness. Glaucoma undiagnosed or diagnosed too late can cause irreversible blindness (Li et al, 2021).
Let's Talk Now
These are resources about effective consultation conversations in the spirit of Language Matters, and the best approaches to take in conversations with people with diabetes to give them a voice that can be heard (Dickinson, 2017; NHS England, 2018). LET'S TALK NOW (https://idealdiabetes.com/lets-talk-now-health-care-professionals) recognises that consultations occur in a variety of settings and contexts across the journey with diabetes for each individual, and to engender a trusting and supportive environment for that conversation to be heard is vitally important (Phillips et al, 2020).
People with diabetes require health professionals to support, listen and enable solution-focused approaches that are person-centred and individualised (Diabetes UK, 2014).
Let's Treat Now
These resources are focused on recognition, assessment and treatment of hypoglycaemia and hypoglycaemic unawareness. For this NOW we undertook a survey with people with type 1 diabetes about their feelings when talking about hypoglycaemia and discussing hypos in their diabetes reviews. The results indicated people feel uncomfortable discussing any hypos they have experienced and also sometimes felt judged by the health professional. People expressed feeling fear and distress about hypoglycaemia (Przezak et al, 2022).
LET'S TREAT NOW (https://idealdiabetes.com/lets-treat-now) provides a variety of resources and guides about assessment of and treatment for hypoglycaemia for both health professionals and people at risk of hypoglycaemia.
iDEAL Diabetes worked with the 2022 Commonwealth Games in Birmingham after recognising there was no health and safety training about recognising or treating hypoglycaemia for employees or volunteers at the games. We recorded a 10-minute training video and this was translated by volunteers into 28 different languages (https://idealdiabetes.com/hypobox-videos). We were able to provide hypo boxes containing fast-acting glucose treatments at every sporting site. This endeavour was recognised at the Midlands Community Innovation Award and is going forwards to be shared and used at the 2024 Olympic Games in Paris.
Let's Check Now
These are resources to promote the importance of good oral and dental health, and to check for bleeding gums in everyone with diabetes as this indicates a risk of periodontitis and gingivitis. Both conditions alongside diabetes are complex chronic conditions (Preshaw and Bissett, 2019). Access to an NHS dentist can be difficult so promoting 6-monthly dental checks should take place in every diabetes review. Periodontitis untreated can lead to infection developing and also is linked to the development of cardiovascular disease linked to type 2 diabetes (Herrera et al, 2023). Thus, good oral health needs to be promoted to both health professionals and people with diabetes (https://idealdiabetes.com/lets-check-now).
Let's Care Now
These resources are designed to demystify sexual dysfunction for people with diabetes, and for all genders to be able to recognise and seek help as required. Diabetes and the menopause are being added to this NOW to inform health professionals and people affected about how this can affect individuals.
Female sexual dysfunction is often overlooked during consultation conversations and erectile dysfunction can also be missed if the practitioner is unaware or isn't comfortable asking the patient (Sansone et al, 2022). This NOW seeks to offer easy to use assessment approaches and information given in an accessible form for both people with diabetes and also health professionals to try to enable and promote these conversations occurring so help in a timely manner can be provided accordingly. View at: https://idealdiabetes.com/lets-care-now.
New NOWs coming
A series of new NOWs are in production which focus on various aspects of care. This will include one on leadership and leadership approaches, both for health professionals and also people with diabetes. This NOW recognises the role and need for leadership approaches in situations in diabetes care and aims to enable confidence building and a voice for everyone previously struggling to be heard – watch this space!