BJD

I write to you during these most difficult times for all of us, for our country and the international society, as we are amidst the grip of coronavirus. The current situation and ever increasing COVID-19 case load has created an enormous uncertainty about many things in our personal and professional lives, but it is our duty to support our patients and colleagues during this time.

It is only through mutual collaboration and support that we will defeat this sinister enemy. National and local planning has resulted in diabetologists being called to help at the front line. Many of us are getting to grips with new and challenging ways of working and we are seeing real innovation and great speed of change during this challenge. It will be our duty to ensure that the learning from this experience is not lost, and we will work to ensure that new and exciting innovation is shared across our membership. If your teams are working on new innovations, please do let us know at ABCD so that we can share this (info@abcd.care). In the meantime, please visit our COVID-19 web pages to learn the latest in managing diabetes during the pandemic and learning more about the management of COVID-19 (https://abcd.care/coronavirus).

Colleagues will be concerned about how we will achieve the CPD for this year. The RCP has issued guidance which is available on the RCP and ABCD websites. The GMC has also decided to postpone revalidation temporarily for the coming months and will contact individuals with new dates for their revalidation.

The directors of the ABCD have been closely monitoring developments and we will continue to communicate with you about this on a regular basis. The directors of the ABCD have decided to postpone the Spring ABCD and DTN meetings in Liverpool to 15/16 December 2020, depending on how the situation further develops. The planned programme for the postponed ABCD meeting includes parallel sessions for trainees in ST3 and ST4 grades on the foundation aspects of training to provide a solid foundation in basic aspects of Diabetes and Endocrinology. Associate Professor Jonathan Bodansky has kindly agreed to deliver the 3rd John Wales Memorial Lecture. Professor Bodansky worked with the late John Wales at Leeds General Infirmary and has been a consultant there since 1989. Further details on the conference programme are available at https://abcd.care/events/abcd-conference-2020.

The two planned Regional Meetings have been rescheduled to take place on 20 October and 26 November – see the website for more details (https://abcd.care/events/abcd). Further meetings are planned in the South West in 2020 and in Anglia in 2021. We plan to rename these as ABCD-BJD regional meetings to raise the profile of the ABCD journal. I feel very committed and passionate to ensure that these meetings should become a regular feature of our annual educational offering. There is huge advantage in having multidisciplinary attendance and shared local learning to facilitate collaboration and shared best practice. For these meetings to be successful, we have sought support from DUK, PCDS and TREND for ensuring their members are aware of these opportunities. The trainees in D&E will be contacted through local TPDs to ensure that our trainees take advantage of these meetings. Please spread the word.

It is likely that the Annual General Meeting will be held virtually later in the summer and we will provide full details and information on how you can participate and vote.

I am pleased to announce that Dr Dipesh Patel has been elected as the next Chair of ABCD. He will take over following a period of handover from myself during May and June 2020. We also have a new Meeting Secretary to take over from Dipesh in Dr Umesh Dashora who has served with distinction as BJD News Editor. We are currently recruiting for a new BJD News Editor – if you are interested please contact info@abcd.care. We are also seeking two further candidates for the ABCD committee. A strong and vibrant committee is crucial to the decision making and delivery of ABCD objectives. Please do advise us if you are interested in applying – contact info@abcd.care for more information.

The ABCD committee has backed the Executive recommendation that ABCD should focus on a single national conference every year in the Spring preceded by the annual DTN meeting. From 2021 we are moving the meetings to mid-week (Tuesday/Wednesday) which, I believe, will facilitate better attendance. We hope to continue and build on our collaboration with DPC (Diabetes Professional Care), giving our delegates another platform for CME and networking with other disciplines and colleagues.

ABCD recognises that an adequately trained workforce is the key to the delivery of quality diabetes care, promoting and supporting the leadership within our speciality and more widely in the NHS. ABCD is planning to seek intermediate to long term funding for the National ABCD NCDMP programme, which has run for the last five years. I believe that the time is right to ensure that we secure the long-term future of this unique programme, which has benefited many aspiring young diabetologists. The Association is grateful to NAPP Pharmaceuticals for their commitment and support over the last 2 years to provide an educational grant for the Consultant Development Programme (CDP) component.

BJD continues to be published twice a year at present and we are focusing on our strategic approach to get the journal listed on PubMed. That submission is clearly dependent upon a number of critical factors including the submission of articles to BJD. On behalf of the directors of BJD and the editorial team, I would like to urge ABCD members to consider submission to BJD in the form of interesting case reports, topical review articles of interest and, of course, manuscripts based on original research. See https://bjd-abcd.com/index.php/bjd/pages/view/manuscripts-considered for details of the types of articles considered.

Watch out for the next ABCD-RA meeting in February 2021, which has in the past provided excellent programme content for consultants and trainees alike.

By the time this news is in paper format, I will have completed 3 years as Chair of ABCD and I will have handed over to Dr Dipesh Patel who will head the ABCD executive team from June 2020. It has been an absolute pleasure and a huge privilege for me to be able to serve the membership of ABCD and I thank you all for your support for the Association and in my role as Chairman of ABCD.

From the desk of the News Editor, Umesh Dashora

JBDS App being developed (Ketan Dhatariya)

JBDS app is being developed in association with the Royal College of Arts. This will hopefully improve the uptake and use of the JBDS guidelines in various areas of diabetes.

New guidelines published

New diabetes guidelines have been published from the Joint British Diabetes Societies for inpatients (JBDS-IP) – Diabetes at the front door and inpatient care of the frail older adults. ABCD and Renal Association guidelines are also worth visiting.

News from the Chair of the Royal College of Physicians, Joint Specialty Committee, Peter Winocour

New online education module produced for the Royal College of Midwives

The diabetes-in-pregnancy work is Diabetes Care Trust (DCT)'s first sponsored project which was conceived by Huw Alban Davies, Chair of the DCT, and developed and completed with a positive result. The work was written with the benefit of a survey of the educational needs of midwives, composed on the basis of results from a freedom of information request received from 110 NHS trusts and replies to a questionnaire received from 698 midwives. The survey was supported by an award of £15,708 from DCT.

ABCD extended this work by helping to produce an online diabetes course for midwives for the Royal College of Midwives as part of their commitment to work with other healthcare professionals to improve care of people with diabetes. Umesh Dashora and Dinesh Nagi from ABCD devoted numerous hours to write the module while Jacquie Simpson and Deborah Burns, Diabetes Midwife Leads and Belfast H&SC Trust reviewed the content. Gail Johnson from RSM facilitated the project. On the last count 320 midwives accessed the course within 4 months of launch with more than 56% having completed the course. Positive comments and suggestions included “Great module, thank you”; “I think it would be helpful to separate gestational diabetes and pre-existing diabetes more as this could make the information clearer. Great module, though, thank you”; “Very informative module and useful for my training and professional development”; “I found this course really beneficial to my learning. However, some of the terminology within the course I found difficult to understand as a first year student midwife”; “I found this module informative and educational. It is also targeted at the right level for midwives”; “I have used this module as a refresher for my learning and as a revision tool”; “I have found it helpful and informative”; “I found this module short but thought provoking and stimulating”; “It updated my knowledge and will improve my clinical care”; “The course was excellent and informative for a new student”; “Very useful, some of the links a little difficult to navigate back from (using Kindle)”. ABCD will work with RCM on the feedback received to produce the second version of this online course. The module is freely available to all RCM members via www.rcm.org.uk.

Diabetes Care Trust supports clinical research and patient care

The Diabetes Care Trust (DCT) is a charity that supports the Association of British Clinical Diabetologists (ABCD). As an important part of its charitable role it provides grants to support projects that are likely to benefit people with diabetes, particularly by improving their understanding of their own condition and by advancing the education of medical and other health professionals involved with the care of those with diabetes. The DCT also supports clinical research aimed at making direct improvements in the care and wellbeing of people with diabetes, as well as the audit and scrutiny of treatments and technology for people with diabetes.

For more information about grants available from the DCT visit www.diabetescaretrust.org. Grants are available for any suitable project, not just to ABCD members.

ABCD collaboration with cardiology and renal societies

ABCD are formally collaborating with UK cardio-renal groups to improve understanding of the disease area and help produce recommendations to improve patient care. This will also create excellent opportunities for education and talks across boundaries for mutual benefit.

More guidance for people on SGLT-2 inhibitors

ABCD has produced more guidance on the use of SGLT-2 inhibitors in people with diabetes.

New book on ‘Life without diabetes’

This new book by Professor Taylor is a ‘must read’ for both health professionals and people with diabetes. It is a definitive guide to understanding and reversing type 2 diabetes and explains the three-step Newcastle weight loss programme in an easy to read fashion. It also contains a great recipe section. Enjoy the read.

Interesting recent research

(Umesh Dashora)

ABCD activities in the era of COVID-19 and beyond

Dinesh Nagi, Umesh Dashora, Susannah Rowles, Dipesh Patel and Andrew Macklin on behalf of the ABCD

The NHS is battling hard to get to grips with the coronavirus pandemic, which has had a sudden effect on the NHS and diabetes services. The unexpected timing of the pandemic and the way the virus has behaved has challenged us in ways we have all found hard to deal with. In times like these, governments, organisations, societies and individuals play a crucial role. ‘Leadership’ – both at an individual and organisational level – plays a crucial role in supporting our response to such a crisis.

Social isolation was the first step to try to counter the spread of the disease and to protect the NHS services from being overwhelmed. ‘Flattening the curve’ has been achieved to a degree. As we reach the beginning of the end of the first phase of this pandemic, which has so far caused more than 32,000 deaths in the UK alone, society and the medical profession have paid a heavy price and the war against the virus has taken its toll on individuals and key workers in the country.

Most specialties, including Diabetes and Endocrinology (D&E), have played a significant role in supporting the frontline services. The nature of training doctors in D&E with emphasis on dual training including general internal medicine (GIM) always meant that they would form an important role at the front line. That has led to cancellation of less urgent outpatient services, so that colleagues could be freed to support the front line.

ABCD, as a specialist society, has been involved in activities to support not only our members and people with diabetes, but also has ensured that we contributed to support those professional colleagues who were managing people with diabetes.

Activities of the Association have focused on:

(1) Working closely with other specialist societies to help produce appropriate new clinical guidance to aid healthcare professionals involved in the care and support of people with diabetes. These documents were widely circulated amongst all healthcare professionals and are easy to access on Diabetes UK and ABCD websites.

The documents are intended for those involved in delivering and redesigning diabetes services in the light of this pandemic. It recognises the importance of maintaining certain elements of the diabetes service which will be essential in reducing the burden on hospitals and supporting inpatient teams. We have also included a simple template based on the NHS ‘Clinical guide for the management of acute diabetes patients during the coronavirus pandemic’. A major focus of the work has been to share experiences of clinicians and clinical networks experiencing severe, acute and atypical diabetes manifestations arising from COVID-19 infections. A detailed document outlining how to maintain patient flow and patient safety across the community, particularly in inpatient areas, was made available to teams by producing a joint document with the inpatient group of Diabetes UK. This was followed by a series of joint documents with the Inpatient COVID Group team to support and advise health professionals across the country.

Maintaining acute diabetes services in response to COVID-19
Speciality template for acute diabetes services
COncise adVice on Inpatient Diabetes (COVID:Diabetes) - Front Door Guidance
COncise adVice on Inpatient Diabetes - Guidelines for managing diabetic ketoacidosis (DKA) using subcutaneous insulin
COncise adVice on Inpatient Diabetes - Guidance for managing inpatient hyperglycaemia

(2) ABCD has provided professional expertise, through the Royal College of Physicians, to the NHS on the issues facing the specialist services in D&E, to support plans for a ‘reset’ including a redesign of clinical services for people with diabetes post COVID.

(3) ABCD is planning ahead to ensure that educational needs of members for CME are met in the foreseeable future. Work is in progress to develop an ABCD app which can provide quick and easy access to important documents and resources. It will include functionalities for quick access to peer and expert advice on diabetes-related matters.

(4) ABCD plans to create virtual platforms, webinars and webcasts on important ‘hot’ topics that can be easily and conveniently accessed by the members via numerous IT system platforms during work and away from work, although some colleagues may need permissions from their IT departments.

(5) ABCD is working closely with our sponsors to ensure that their support and contribution during the COVID pandemic remain consistent and appropriately evidence-based for the membership.

(6) ABCD is currently exploring and ensuring that it is able to provide a leading view in re-booting of services and the recovery of education and training. This should involve retaining existing and newer innovations at the forefront of our minds as we move through to the ‘post’ COVID phase. This will include approaches such as remote consultations – with careful specification for the organisation, planning and IT support required to facilitate this transformation. In the following text we would explore the background, work done, need and challenges in the future in relation to recovery of various services.

(7) ABCD has surveyed its members during the pandemic. ABCD members (n=187) from across the UK have responded to this snapshot survey – ‘Life as a diabetologist during the Covid-19 pandemic’. It’s heartening to hear that, despite enormous pressures on acute Trusts, a majority feel supported by their Trust (81%). A full report on this survey will follow soon; however, the headline to share to improve patient care is that 55% of respondents have seen atypical presentations of DKA, a message that is relevant for colleagues in Accident and Emergency and Acute Medicine. In 37% of cases of atypically presenting DKA, SGLT2 inhibitors were involved.

(8) ABCD and the Society for Endocrinology (SfE) have produced a report with recommendations to inform NHS planning, in collaboration with the RCPL. This is focused on the feedback received from members and is distilled into a single document which outlines the challenges – but also the opportunities – which exist during this crisis and may shape the services in years to come.

(9) ABCD has submitted evidence to the Health Select Committee apprising them of the views of specialists in the UK to be considered when informing health policy for the recovery and future formulation of diabetes services in the UK.

Address for correspondence:
Dr Dinesh Nagi
Edna Coates Diabetes and Endocrine Unit, Pinderfields Hospital, Aberford Road Wakefield WF1 4DG, UK
E-mail: d.nagi@nhs.net

From the desk of Rebecca Reeve (Sanofi)

Coronavirus: NHS leaders call for targets to be scrapped

Parallel export banned for 80 drugs

Diabetes diagnoses increase in Scotland

Diabetes Scotland reported the number of people diagnosed with type 2 diabetes in Scotland has increased by 40% over the last 10 years. People with type 2 diabetes are 50% more likely to die prematurely than those without the condition.

GPs accept 2020/21 contract

After receiving over 4,000 responses to the January consultation on the Primary Care Network (PCN) draft service specifications from general practitioners and their representatives, NHS England announced the organisation would review the terms and conditions. Last Thursday GP representatives voted to accept the 2020/21 General Practice Contract which included changes to PCN service specification roll-out and an extra £1.5 billion to support general practice over the next four years.

NHS England has issued specialty advice for management of acute diabetes patients in the coronavirus pandemic

DUK’s latest position statement

The DUK’s latest position statement has been published in the Journal of Diabetic Medicine (https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.14225#_blank). This contains all the relevant data relating to the UK diabetes landscape and serves as a useful reference point. Here are some of the key figures:

DTN-UK Update

Sadly, the Covid outbreak meant that we had to postpone our annual DTN meeting which was due to be held in Liverpool on 23 April. We have now rescheduled this for 15th December (in Liverpool), and are working on rescheduling other regional events including an educators’ event which was originally planned for the autumn.

During the Covid outbreak we worked closely with manufacturers to make sure that we had communications around staying safe and preventing stockpiling that would allow supply chains to function. We are pleased to report that there are no reported issues with supplies, and we are in close communication with all manufacturers to keep an eye on this. As teams move into a recovery phase, we are working on providing guidance that may help you with tasks such as technology upgrades, maintaining choice and safety, and supporting patients to get access to technology in a way similar to that which they would have prior to the challenges placed on us by Covid.

We are really pleased to see the uptake of the CGM education modules which we launched earlier this year, and these along with the Libre videos have been used by a number of teams to support ‘virtual’ technology starts.

Finally, we are really pleased to be able to formally announce our collaboration with Diasend to develop a healthcare education platform which will use the videos we have already created for Libre and CGM, but add to it modules on sensor augmented pumps, hybrid closed loops, insulin pumps, virtual clinics and connected pens. This will allow HCPs to learn key tips on how to support their patients in the use of diabetes tech, but also certify their competence in this area. We hope that this becomes a valuable tool for appraisals and for supporting trainees, specialist nurses and dietitians in providing evidence to support their clinical skills.

Dr Pratik Choudhury adn Dr Alistair Lumb
Diabetes Technology Network UK
Contact: pratik.choudhary@kcl.ac.uk

YDEF NEWS Young Diabetologists logo

The COVID-19 Pandemic: The Opportunity Arising from Restoration of Specialty Training

The COVID-19 pandemic has created unexpected and unprecedented challenges to the healthcare workforce internationally. Trainees across grades and specialties have been redeployed to meet the challenge, working in sometimes unfamiliar environments and with unfamiliar structures. For those training in Diabetes & Endocrinology (D&E), this has been no different. The experience of these trainees is important to recognise as, undoubtedly, it will have an impact both on their future training and future careers.

D&E trainees in most regions in the UK continue to work on General Internal Medicine (GIM) rotas throughout their specialty training years. Protected specialty training time is rare, unlike some other specialties. This has meant that D&E trainees have been particularly useful in supporting COVID-19 admissions and ward-based care for patients in the medical registrar role. As a cohort of trainees we have a wide breadth of GIM experience and are in a good position to provide leadership. Many trainees therefore have had much reduced specialty experience focusing almost entirely on GIM-based ward cover and COVID-19 support. In many settings this has involved working alongside other clinicians who are working in unfamiliar environments and thus providing a supporting role, often with flattening of traditional hierarchies.

These experiences will provide trainees with substantial additional leadership, general medicine, education and mentoring skills. It is important these are recognised. Through these ward-based experiences, trainees will also continue to have significant diabetes exposure, given the nature of the disease as one that seems to particularly affect people with diabetes and those with uncontrolled blood sugars. Conversely, the cancellation of clinics and move of many clinics to (often consultant-held) virtual clinics has significantly reduced exposure to other areas of the specialty. This is combined with cancellation of educational events, perhaps most notably the Diabetes UK Professional Conference, alongside a number of events including those planned by the YDEF Committee and regional-based study days. It is right that these events were cancelled to protect the NHS, patients and the potential delegates; however, the loss of educational opportunity should not be overlooked. The emergence of virtual events is important to provide ongoing educational opportunities, but these do not necessarily allow the networking and ‘soft skills’ development that would typically occur at face-to-face events. It is also important to note the cancellation or possible postponement of the Specialist Certificate Examination (SCE). For many trainees this will prove stressful as the SCE can be seen as a barrier to progression to the award of CCT. It is already challenging enough for trainees to revise for an examination held only once a year, alongside nights and other requirements of the continual GIM rota.

The COVID-19 pandemic has occurred at an interesting and important time in higher specialist training. The introduction of Internal Medicine Training (IMT) and launch of a new curriculum may shorten the period of specialty training and introduce essential new learning requirements, perhaps around topics such as genetics and technology. Many hospitals have moved their clinic-based services virtually, and whilst the need for face-to-face clinics will always be there, it is likely trainees will need to learn new ways of working in virtual clinics and blended clinic models. The virtual clinic consultation will need as much training and learning as traditional clinic consultations taught and assessed in detail throughout medical school and postgraduate training. This will undoubtedly require a significant degree of focus and intensity to ensure genuine, high quality, world leading training in D&E going forward.

There will be long-lasting changes to the way we work and live long after the COVID-19 pandemic has settled. We do not feel specialty medical training should be exempt from such changes. We would argue that the contribution of D&E trainees to the COVID-19 rotas, the loss of educational opportunity, potential reduction in length of specialty training and increased curriculum and learning needs all argue for the need of specialist trainees to have protected specialist time during their training to focus on their D&E skills and knowledge, should they so wish. It would seem particularly logical for this to be timed immediately prior to the first SCE examination on a rolling basis across specialty years. Perhaps it is just possible that, in the restoration of services and training following this awful pandemic, this long wished for ambition amongst trainees may finally be recognised.

Please do check our website for full details (http://www.youngdiabetologists.org.uk/about/). Perhaps the most important event this year will be the YDEF Day with the themes of technology, fertility and gender identity.

Dr Tim Robbins on behalf of YDEF Committee
University Hospitals Coventry & Warwickshire NHS Trust, UK
Contact: drtrobbins@gmail.com

From the desk of the Chairman, Dinesh Nagi