Professionally speaking – by Andy Broomhead


Andy-Broomhead-150x150You might be aware that I attended both the Young Diabetologist (YDEF) and Diabetes UK Professional Conferences (DPC) in Glasgow last week.  I was fortunate to have been speaking at both, but also covering the latter as a blogger for Diabetes UK.

I’ve written a few blogs about different aspects of DPC which I’ll link to at the end of this post, but I wanted to talk briefly about a few of the things that haven’t made it into those other posts.

The conference is a big event, and gives diabetes professionals the opportunity to network, listen to new bits of research, see how others operate in different parts of the country, and to share best practice.  Understandably a lot of professionals want to be part of that!

I sat in on 33 talks over the three days – a couple of which were very much in the ‘clinical science’ camp, and whilst I could probably explain the essence of the talk, I couldn’t walk you through the slides!  Others focused on basic science, whilst some looked at the more qualitative aspects of diabetes care (backed up with some sound evidence).  And then there were a few which included patient voices too.  Judging by the reaction on Twitter, those talks in particular seemed to have a profound effect on a number of healthcare professionals and really brought home the reality of living with diabetes.

So to a couple of points I possibly didn’t articulate that well during the frantic live-tweeting last week… The first was a fascinating session about how a multidisciplinary approach can help with those being admitted (and specifically re-admitted) for diabetic ketoacidosis (DKA).  Now I’m fortunate enough not to have experienced DKA myself, but I’m completely aware of how horrible it must be.  This session had three speakers, each talking about different aspects of how those DKA admissions are managed.

What was immediately obvious, was that repeat DKA admissions need to be handled in a very different manner to other kinds of admissions.  Often people being admitted in these circumstances are particularly vulnerable and need not just physical support, but specialist psychological or mental health support too.  Whilst I won’t go into too many details, Clare Shaban from Bournemouth shared some truly heartbreaking stories about how individuals came to be admitted and gradually, were given the support they needed to be able to deal with the aspects of their lives that lead to DKA admissions.

David Simmons talked about how they’d looked at the cause of admissions and subsequently implemented a case management approach in Cambridgeshire.  Issues around funding meant that was curtailed early, but the data he presented, showed there was clear benefit to be had.  The idea of integrated care has been long talked about, and for about 90 minutes, you could see what’s possible.  It was an emotional session to sit in on, but being able to see how a multidisciplinary approach can benefit those most in need.

The other point I wanted to touch on was about data.  Iain Cranston from Portsmouth gave a great talk about data and its value.  We can look at a set of individual finger-prick test results and make inferences, but a large part of what drives that data is set in what an individual’s motivation to test is.

2016-03-03 13.06.12
Why do you test?

I went through a period where I only really tested when I was low, so whilst my meter may have shown one thing, my HbA1c would have shown a different picture.  Using technology like CGM/FGM allows us to build those points in time to a bigger picture (though I’ll leave the issue around funding and availability for a different time).  He made a great point that you wouldn’t try and read an ECG based on one small segment, so why would we do the same for blood glucose data.

 

Ambulatory Glucose Profile (AGP)
Ambulatory Glucose Profile (AGP)

 

We can go to see our team for support, but they don’t always have the answers.  As Dr Cranston confessed, “Sometimes hardest thing to say is “I’m sorry – I don’t know what’s going on”“.   The more information we have, allows us (and healthcare professionals) to make more informed self management/clinical decisions about diabetes.

Using things like ambulatory glucose profiles (above) which show median values (thin blue line), and where 50% of our readings lie (darker shaded area) can be a lot more effective if they’re available.  Equally, even a clinic having access to something like diasend to allow BG meters to be uploaded creates a bigger picture than simply writing down four tests a day in a diary.

This isn’t to say, of course, that we should all be clamouring for a CGM device – I think that misses part of the point.  I think we need to be more aware of reasons why we test, and be more conscious of what the results of our tests tell us.  I think we need to be more active in our discussions with our healthcare team and understand that sometimes, no-one can know it all.  We have to work together to try and get the results that are right for us as individuals.

Finally, as promised, the links to other blogs I wrote during (and immediately after) #DPC16 – hopefully you’ve found some of this useful!

Blog 1 – DPC16 – Impressions from Day 1

Blog 2 – Taking education to the masses

Blog 3 – Individual care

Blog 4 – The future’s bright

Blog 5 – It’s not the end, it’s a new beginning

Blog 6 – Some personal highlights

Blog 7 – Transforming Transition

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