Outpatient clinic
There is a weekly consultant-led multidisciplinary diabetes clinic every Wednesday morning in the outpatient department. Patients are seen for review of diabetes management including assessment of complications and review of medication.
All patients are assessed for hypertension, hyperlipidaemia and other metabolic risk factors. Annual review is undertaken for a few patients whose GP has referred them for full diabetes management, because the GP does not offer structured diabetes care.
A diabetes specialist nurse (DSN) is available to see those patients in clinic who need educational input. In particular the DSN can support problem solving with those patients who have poor diabetes control, seeing patients requiring insulin, follow up for inpatients and follow up for women postnatally.
The diabetes specialist dietitians (DSD) are also available in clinic to give advice on lifestyle changes and dietary management of blood glucose, lipids, blood pressure and weight.
There is a multidisciplinary diabetes foot health clinic every Wednesday morning at the same time as the diabetes outpatient clinic. Here patients with diabetes foot problems are assessed by specialist podiatrists whislt receiving other treatment.
Drop-in, Problem and GP based clinics
We aim to provide non-urgent assessment, advice, education and support to people with diabetes.
Examples of reasons why people attend the drop-in service include:
- difficulties with home blood glucose monitoring
- broken/lost equipment (eg pen devices, blood glucose meters)
- sickness/travel advice
- changing insulin delivery devices.
The diabetes drop-in clinic operates every Monday, 1.30pm-2.30pm and Friday 9am - 9.30am, in the Hackney Diabetes Centre and is staffed by the Ddabetes specialist nurses.
Patients requiring an individual nurse consultation to start insulin, or needing to see a doctor cannot be dealt with in the drop-in clinic and should be referred directly by letter to the Hackney Diabetes Centre or diabetes outpatient clinic.
The drop-in clinic is not an emergency service
The problem clinic
This is held on Thursday afternoons in in the outpatient department of Homerton Hospital. The problem clinic is for patients with specific diabetes-related problems, which are proving difficult to manage. For example, assessment of poor glycaemic control, nephropathy, erectile dysfunction, neuropathy, refractory recurrent hypoglycaemia and refractory hypertension.
The problem clinic is not a replacement for the diabetes review clinic in hospital on Wednesday mornings (see Outpatient clinic) or in general practice. The consultant physician requests blood tests and investigations when necessary.
For each patient seen in the problem clinic, a treatment plan is constructed in a letter to the GP, with recommendations for future management.
GP based clinics
The diabetes specialist nurses and diabetes specialist dietitians from the Hackney Diabetes Team visit 45 of the 46 GP surgeries in City and Hackney to conduct diabetes clinics.
Frequency of clinics
Clinic frequency is based on the number of patients with diabetes registered at each surgery. The diabetes specialist nurse clinic and dietitian clinics are held as often as the GP list size requires.
Appointments
Most appointments are 30 minutes long and the appointment diary is kept by the GP surgery in each case.
Patients are invited to see the diabetes specialist nurse to discuss management of their diabetes, as well as hyperlipidaemia (blood cholesterol) and hypertension (high blood pressure); for assessment of blood glucose control; review of medication; problem-solving; and other education regarding diabetes.
Patients are invited to see the diabetes specialist dietitian to discuss dietary aspects of diabetes management, as well as hyperlipidaemia (blood cholesterol) and hypertension (high blood pressure); for dietary review when diabetes medication is changed, for example initiation of insulin therapy; and for weight management; or to discuss other aspects of diet and diabetes.
Feedback
At the end of each clinic, the diabetes specialist nurse or diabetes specialist dietitian gives feedback to the GP or practice nurse regarding management changes for the diabetes patient seen.
New patient clinic
For all newly diagnosed patients with type 2 diabetes.
We offer package of care for those people recently diagnosed with type 2 diabetes. Referrals to this service are mainly from GPs and practice nurses.
There are three steps in the new patient pathway clinic. All patients are automatically offered appointments for step 1, 2 and 3.
Step 1: Individual consultation - Friday morning
Patients are seen in Hackney Diabetes Centre for an initial individual consultation with the a diabetes specialist nurse and diabetes specialist dietitian.
The diabetes specialist nurse consultation
The assessment will:
- establish medical history
- establish family history
- discuss history of symptoms
- address pre-conceived ideas and anxieties
- establish existing knowledge of diabetes
- discuss general aspects of diabetes including a simple explanation of diabetes
- discuss general health
- measure blood pressure, random blood glucose, test urine for glucose, ketones and protein
- request blood tests for renal, thyroid and liver function, random lipids, full blood count, calcium, glycated haemoglobin (HbA1c) and fructosamine
- discuss lifestyle including alcohol intake and smoking cessation
- ensure referral for Retinal Screening has been made
- explain structure of patient's future diabetes care
- provde written information about diabetes.
The diabetes specialist dietitian consultation
The assessment will include:
- weight, height and body mass index calculation
- recent change in weight
- past weight history
- assessment of current dietary intake / pattern
- discussion of principles of healthy diet and lifestyle (healthy eating, alcohol and exercise)
- assessment of patient's readiness to make changes in diet and lifestyle
- agreed goals for dietary change and specific advice regarding meal planning
- agreed goals for other lifestyle changes including exercise
- review of progress, often at the final appointment.
Step 2: New patient education for Type 2 diabetes (EDDI)
Patients are invited to attend these group education sessions; two sessions, one week apart. Group education allows the patient to learn more about diabetes in an interactive environment. It is important that patients attend both sessions. Various topics are discussed by the diabetes specialist nurse, diabetes specialist dietitian or diabetes educators, including:
- what is diabetes
- signs and sympotms
- prevalance of diabetes
- principles of healthy eating for diabetes
- benefits of exercise
- tablets for diabetes
- benefits of monitoring blood glucose
- advice during acute illness
- foot care
- importance of annual review, including eye (retinal) screening
- driving/insurance
- alcohol
- smoking cessation
- sexual health
- Diabetes UK.
Step 3: Individual consultation - Wednesday afternoon
Six weeks after the Step 1 consultation, patients are invited to an individual review consultation in Hackney Diabetes Centre.
The diabetes specialist nurse and diabetes specialist dietitian review the patient's progress to date. Finally, the patient has an individual consulation with the diabetes consultant who undertakes a full medical assessment for diabetic complications, cardiovascular risk, foot assesssement, as well as a review of educational issues. The consultant summarises in a letter to the patient's GP the history, physical and laboratory analysis and treatment plan including any recommended changes.
Follow-up
Almost all patients are discharged back to their GP and practice nurse for ongoing care of their diabetes, including annual review, after the three steps of this clinic are completed.
Problem clinic
Patients are seen initially by the diabetes specialist nurse to have their blood pressure, urine, weight and a random blood glucose checked. Home blood glucose monitoring is taught when necessary and education provided.
The problem clinic is held on Thursday afternoons in in the outpatient department of Homerton Hospital. The problem clinic is for patients with specific diabetes-related problems, which are proving difficult to manage. For example, assessment of poor glycaemic control, nephropathy, erectile dysfunction, neuropathy, refractory recurrent hypoglycaemia and refractory hypertension.
The problem clinic is not a replacement for the diabetes review clinic in hospital on Wednesday mornings (see Outpatient clinic) or in general practice. The consultant physician requests blood tests and investigations when necessary.
For each patient seen in the problem clinic, a treatment plan is constructed in a letter to the GP, with recommendations for future management.
Multi-disciplinary diabetes foot clinic
A diabetes foot clinic with input from a multidisciplinary team is run every Wednesday morning.
The clinic is led by Dr Francesco Medici, consultant diabetologist, and it is supported by the foot health team, the diabetes specialist nurse team, footwear specialists and the plaster room technicians. There is also rapid access to radiological imaging including MRI and foot surgery.
The clinic caters for patients with diabetes-related foot problems including ulcers, infections, osteomyelitis and ischaemia.
Key staff
- Dr Francesco Medici DM FRCP
- Foot health team
- Diabetes specialist nurse team
Preconception clinic for diabetic women
Are you diabetic? Might you get pregnant in the future?
It is important to control your blood sugars well before you get pregnant. We run a weekly clinic for women who might become pregnant.
We can talk to you about:
- controlling your blood sugar levels
- managing diabetes in pregnancy
- diabetic medicines in pregnancy.
You should be taking the vitamin folic acid (5 mg tablet orally) if you have diabetes and might get pregnant in future.
You do not need to be referred to this clinic - you can contact us yourself.
Making an appointment
Call the antenatal clinic on 020 8510 7175 and make an appointment to be seen on a Wednesday afternoon.
Type 1 Diabetes clinic
The diabetes specialist consultant is Dr John Anderson. The type 1 clinic runs at the Hackney Diabetes Centre on Thursday afternoons 3pm - 7pm.
The Young Adult Clinic, appropriate for young adults with type 1 diabetes runs monthly on a Thursday
Specialist reviews and problem reviews are also undertaken. There are about 100 people with type 1 diabetes on insulin pumps who attend the clinic. Our diabetes specialist dietitians and diabetes specialist nurses provide educational input and have a particular interest in insulin pump treatment as well as more conventional type 1 treatment.
Key staff
Physicians
Dr John Anderson
Diabetes Specialist Nurses
Laura Elwood
Ann Chambers
Janet Reid
Diabetes Specialist Dietitians
Vib Mistry
Luke Morris (insulin pump lead dietitian)
Marianne Ouaknin
Antenatal diabetes/endocrinology clinic
This is a joint clinic involving both the ante-natal and diabetes teams.
Women with gestational diabetes or those with established diabetes are montiored and their treatment adjusted to suit each stage of preganacy. The clinic team aims to ensure women have a pregnancy outcome that equates to that of women without diabetes.
Women are seen by a midwife, and/or obstetrician and a diabetes specialist, with detailed imput by the diabetes specialist dietitian. Women are taught home blood glucose monitoring and detailed individualised dietary advice. If diet alone fails to control their diabetes as preganacy progresses they are started on a multiple insulin injection regimen.
Regular review is arranged to ensure the insulin dose is increased to match the increasing inuslin resistance that accompanies a normal developing pregnancy. Patients who had diabetes before becoming pregnant are monitored for specific complications.
This clinic is held in the ante-natal outpatients department on Wednesday afternoons.
Newly pregnant women with diabetes should be referred urgently by their GP by letter to the ante-natal department.
GP surgery-based clinics
The diabetes specialist nurses and diabetes specialist dietitians from the Hackney Diabetes Team visit 45 of the 46 GP surgeries in City and Hackney to conduct diabetes clinics.
Frequency of clinics
Clinic frequency is based on the number of patients with diabetes registered at each surgery. The diabetes specialist nurse clinic and dietitian clinics are held as often as the GP list size requires.
Appointments
Most appointments are 30 minutes long and the appointment diary is kept by the GP surgery in each case.
Patients are invited to see the diabetes specialist nurse to discuss management of their diabetes, as well as hyperlipidaemia (blood cholesterol) and hypertension (high blood pressure); for assessment of blood glucose control; review of medication; problem-solving; and other education regarding diabetes.
Patients are invited to see the diabetes specialist dietitian to discuss dietary aspects of diabetes management, as well as hyperlipidaemia (blood cholesterol) and hypertension (high blood pressure); for dietary review when diabetes medication is changed, for example initiation of insulin therapy; and for weight management; or to discuss other aspects of diet and diabetes.
Feedback
At the end of each clinic, the diabetes specialist nurse or diabetes specialist dietitian gives feedback to the GP or practice nurse regarding management changes for the diabetes patient seen.
Inpatient services
The diabetes specialist nurses provide constant support and advice for staff and patients on the wards within the hospital.
Work with patients
The diabetes specialist nurses provide education, training, support and follow-up for newly diagnosed people with type 1 and type 2 diabetes. They also deal with acute diabetic admissions.
Work with staff
The diabetes specialist nurse works closely with ward staff to ensure good standards of diabetes care for patients.
They provide education and training for staff on the wards and also arrange link nurse meetings to enhance ongoing staff development.