Minister for Health highlights better access, quality, and safety of diabetes care
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From: Department of Health
- Published on: 10 May 2024
- Last updated on: 13 May 2024
The Minister for Health Stephen Donnelly is highlighting an updated guideline for adults with Type 1 Diabetes from the National Clinical Effectiveness Committee (NCEC), aimed at improving the access, quality, and safety of care for adults with the condition.
The Health Service Executive (HSE) is also launching an updated Integrated Model of Care today for people with Type 2 Diabetes Mellitus.
The updated NCEC guideline will see recommendations around making continuous glucose monitoring (CGM) available for all adults with Type 1 Diabetes. CGM enables people with diabetes to monitor their blood glucose levels without the need for finger pricking.
The HSE has implemented a reimbursement application system for CGM sensors, since December 2023.
Type 1 diabetes is an autoimmune condition that causes destruction of the insulin producing cells in the pancreas. This means that people with type 1 diabetes must self-inject insulin or administer via a pump to manage their blood glucose and avoid a range of serious short and long-term complications.
Minister Donnelly said:
"I welcome the publication of this updated NCEC National Clinical Guideline for Type 1 Diabetes in Adults. We have seen great advances in technology in recent years for the management of diabetes. More than 20,000 adults in Ireland live with type 1 diabetes, and it is heartening to see our national clinical guidelines reflect the best available evidence in relation to monitoring blood glucose for these patients.
"I would like to acknowledge the great work of the National Clinical Effectiveness Committee in advancing patient safety and quality, and the Irish clinical effectiveness agenda, under the chairmanship of Professor Gerry Fitzpatrick. I would also like to congratulate Dr Kevin Moore, Professor Derek O’Keeffe, Ms Dervla Kennedy, the members of the Guideline Development Group, and all who worked to bring this updated guideline to its launch today."
Dr Kevin Moore, Chair of the Type 1 DM update Guideline Development Group, said:
"The updated national guideline for adults with type 1 diabetes provides a clear plan to ensure that everyone in Ireland has access to high quality care."
In 2018, the NCEC Type 1 Diabetes Guideline was the first NCEC guideline to be developed in Ireland in 2018 using the England’s National Institute for Health and Care Excellence (NICE) contextualisation process; whereby a recent NICE guideline is adapted for use in another country.
The recommendations are based on the best research evidence and on national and international clinical expertise. This newly updated Type 1 diabetes guideline is based on 2022 updates by NICE.
This initiative was led by a guideline development group from the HSE National Clinical Programme for Diabetes, supported by the Clinical Effectiveness Unit in the Department of Health, and a team from NICE. The guideline was quality assured by NICE and approved by the NCEC.
Professor Jonathan Benger, NICE chief medical officer, said:
"As a trusted organisation that has built an international reputation for developing evidence-based recommendations over the last 25 years, we are delighted our useful and usable guidelines on Type 1 Diabetes have been successfully adapted to play an important role in helping people in Ireland with this condition.
"It is important for us to work collaboratively with partner organisations, for the benefit of patients, to improve efficiency and reduce duplication in guideline development.
"The increasing number of people with diabetes is a significant concern for both our countries and this new guideline, based on our own, brings together recommendations that will help improve the treatment and management of the condition."
The newly updated Integrated Model of Care for people with Type 2 Diabetes Mellitus was led by chair Dr Eoin Noctor in collaboration with the National Clinical Programme for Diabetes and a large multi-stakeholder working group consisting of people with diabetes, healthcare professionals, academics, and patient advocacy group Diabetes Ireland.
Dr Eoin Noctor, Chair of the working group for the Integrated Model of Care for people with Type 2 DM, said:
"It is an exciting time for type 2 diabetes care in Ireland, with major developments over recent years – there has been significant funding allocated for posts to develop integrated care and modernised care pathways, a widespread focus on treatments to prevent and delay Type 2 Diabetes, and the establishment of the hub model to enhance care of people with type 2 diabetes in the community.
"This latest Model of Care for people with type 2 diabetes was a fantastic opportunity to lay out these changes in a single structured format, and to build on these developments to clearly set out a road to achieving the highest standards of care for individuals diagnosed with type 2 diabetes. After an extensive discussion writing process, the consultation group are delighted to see the Model of Care reach this point and look forward to seeing it implemented with the support of all partners."
Professor Derek O’Keeffe, National Clinical Lead for Diabetes, said:
"This evidence based collaborative documents will improve diabetes care in Ireland. I would like to acknowledge the tireless efforts of the entire multidisciplinary working group who contributed to them, including People living with Diabetes, advocates, academics, and clinicians, led by our excellent chairs.
"I would also like to sincerely thank all the members of the Diabetes National Clinical Programme."
Notes
National Clinical Effectiveness Committee (NCEC)
Clinical effectiveness is a key component of patient safety. The integration of best evidence in service provision, through clinical effectiveness processes, promotes healthcare that is up to date, effective and consistent. Clinical effectiveness processes include guidelines, audit and practice guidance.
National Clinical Programme for Diabetes
The National Diabetes Working Group consists of Diabetes representatives comprising of people who are expert by experience (people with Diabetes), Health care professionals (across all levels of service- Health and Wellbeing, Primary Care- ICGP Lead & Practice nurse development co-coordinator, Specialist Ambulatory Care hubs, acute services, medical, nursing & Health and Social Care Professionals), Advocacy group Diabetes Ireland, reps from higher education institutes. The group acts as a sub working committee of the National Programme for Diabetes and provides national advice on diabetes management.
The HSE National Clinical Programme (NCP) for Diabetes was established in 2010 to provide clinical leadership to improve the access to, and quality of, diabetes care nationally, and to improve clinical outcomes for people living with diabetes, while utilising health care resources effectively. Clinical leadership is pivotal to changing our health service where necessary to meet individuals’ clinical needs and expectations. The NCP for Diabetes was established as a partnership between Ireland’s Health Service Executive (HSE) and the medical specialist professional training body, the Royal College of Physicians of Ireland (RCPI). The HSE’s National Clinical Programmes have used Models of Care (MoC) as a framework to co-design, develop and implement changes to improve the quality of services.
The National Clinical Programme has developed a new national model of integrated care to deliver diabetes care now and into the future, so as to enhance the access, continuity and quality of care. This model encompasses disease prevention, management in primary care, specialist support to primary and specialist ambulatory care, self-management support and acute specialist care and therefore addresses care for people with Diabetes across all the healthcare settings. To support its implementation the programme has overseen the recruitment of Specialist Diabetes posts including clinical nurse specialists, dietitians and podiatrists. Structured Patient Education has commenced with the appointment of a national co-ordinator in 2015, national programmes have begun and a national database, enabling centralised access to diabetes structured group education has been established.
Significant resources have been allocated under the Enhanced Community Care Programme and Modernised Care Programme to establish end to end Diabetes integrated care services for people with Type 2 Diabetes Mellitus nationally. Significant resources have been provided to establish 30 Community Specialist Diabetes teams within the community to support General Practice to manage people with Type 2 Diabetes closer to home. The combined approach of a Multidisciplinary integrated team and patient empowerment enables more effective prevention and proactive management of chronic diseases.
Thirty Integrated Care Diabetes community specialist teams have been funded nationally to ensure population coverage. Twenty-five Consultant Endocrinologist for Diabetes Integrated Care have been approved with approx. 21 in post or at recruitment stage. These consultants work 50:50 across the acute service and in the community in Specialist Ambulatory Care hubs.
NICE Contextualisation England’s National Institute for Health and Care Excellence (NICE) provides evidence-based guidance and advice to improve health and social care.
NICE’s Centre for Guidelines develops guidance on the promotion of good health; the prevention of ill health; the appropriate treatment and care for people with specific diseases and conditions; social care and service delivery. The guidelines are evidence-based recommendations for health and care in England on a wide range of topics, from preventing and managing specific conditions to planning broader services and interventions to improve the health of communities; and are used by those working in the UK National Health Service, local government, social care, patients and their families. NICE has published over 300 guidelines since 2002.
Since 2014, NICE has worked with international clients wishing to rapidly contextualise NICE guidelines for their local populations and health care context infrastructure. The process involves a local guideline committee who consider and contextualise NICE’s original recommendations before consultation with relevant stakeholders. NICE quality assures the contextualisation process to ensure the published guidelines meet internationally recognised standards of best practice and are also relevant to local contexts.
In 2017 an agreement was reached between NICE and the National Patient Safety Office’s Clinical Effectiveness Unit, on behalf of the NCEC to work together on the contextualisation of NICE’s clinical guideline, (NG17) Type 1 diabetes in adults: diagnosis and management (2015), resulting in the publication in June 2018 of NCEC NCG 17, Adult Type 1 Diabetes. In 2023, a project to complete a rapid update of the 2018 NCEC guideline in line with corresponding 2021 and 2022 updates to the NICE guideline was initiated. This culminated in the publication of the updated NCEC NCG 17, in May 2024.