Quality standard
Quality statement 6: Support to self-manage diabetes during inpatient admissions
Quality statement 6: Support to self-manage diabetes during inpatient admissions
Quality statement
Adults with type 1 diabetes admitted to hospital are supported to self-manage their diabetes. [2011, updated 2023]
Rationale
Adults with type 1 diabetes may be admitted to hospital for conditions related or unrelated to diabetes. This can disturb daily routines, affecting carbohydrate intake and insulin therapy, and special regimens may be needed in preparation and response to procedures that affect the usual management of diabetes. A specialist multidisciplinary team with expertise in diabetes can help the person and the team caring for them to adapt the management of their diabetes when in hospital. They should do this while still respecting the person's expertise in managing their own diabetes. The specialist multidisciplinary team should support the person to continue to self-manage their diabetes and administer their own insulin if they are willing and able and it is safe.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
a) Evidence that organisations have a dedicated multidisciplinary team of specialist diabetes inpatient practitioners.
Data source: National data are collected in the National Diabetes Audit's inpatient safety audit.
b) Evidence that organisations have and promote a self-management policy, which supports people who want to self-manage their type 1 diabetes to safely do so while in hospital, as clinically appropriate.
Data source: National data are collected in the National Diabetes Audit's inpatient safety audit.
Process
Proportion of hospital admissions for adults with type 1 diabetes in which they received support from a specialist multidisciplinary team with expertise in diabetes.
Numerator – the number in the denominator in which the person received support from a specialist multidisciplinary team with expertise in diabetes.
Denominator – the number of hospital admissions for adults with type 1 diabetes.
Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Outcome
Patient satisfaction that they were able to self-manage their diabetes while in hospital.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient surveys. National data on a number of areas, such as staff knowledge of diabetes, overall care for diabetes and ward staff respecting wishes around diabetes care are collected in the National Diabetes Inpatient Safety Audit.
What the quality statement means for different audiences
Service providers (inpatient secondary care providers) ensure that adults with type 1 diabetes in hospital are supported to self-manage their diabetes, including receiving advice from a specialist multidisciplinary team with expertise in diabetes. They ensure that a multidisciplinary team with expertise in diabetes is available and that members of ward staff know how to make them aware when adults with diabetes are admitted.
Healthcare professionals (such as ward staff and members of the multidisciplinary team with expertise in diabetes) ensure that the specialist multidisciplinary team with expertise in diabetes is made aware when inpatients with diabetes are admitted. They work with the multidisciplinary team to ensure they support 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.
Integrated care systems ensure that services are available in which adults with type 1 diabetes in hospital are supported to self-manage their diabetes, including receiving advice from a specialist multidisciplinary team with expertise in diabetes.
Adults with type 1 diabetes who are admitted to hospital receive advice and support 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 cannot eat or are having an operation that affects blood glucose levels).
Source guidance
Type 1 diabetes in adults: diagnosis and management. NICE guideline NG17 (2015, updated 2022), recommendation 1.13.7
Definitions of terms used in this quality statement
Support to self-manage diabetes
This includes the specialist multidisciplinary team with expertise in diabetes providing advice to the adult with type 1 diabetes, and the team caring for them, to manage their own diabetes and this advice being incorporated into routine ward-based blood glucose monitoring. It should also include support for adults with type 1 diabetes to make their own food choices based on their personal knowledge of their dietary needs, except when illness or medical or surgical intervention significantly disturbs those requirements. [Adapted from NICE's guideline on type 1 diabetes in adults: diagnosis and management, recommendations 1.13.8 and 1.13.9]
Equality and diversity considerations
Adults with type 1 diabetes with communication difficulties may find it hard to express their needs to ward staff or to explain that they are able to self-care for their diabetes needs. Ward staff should ensure that adults with communication difficulties are helped and supported to express and communicate their preferences and needs.
Adults with type 1 diabetes should also have access to an interpreter or advocate if needed so that they can communicate with the multidisciplinary team.
Adults with type 1 diabetes who have a physical, mental health or learning disability may need extra assistance in maintaining management of their blood glucose while they are an inpatient. Ward staff and the multidisciplinary team should ensure that they offer additional assistance to these people.