The Enfield Community Diabetes Service provides education, management support and advice to people living with diabetes, their carers, and healthcare professionals.
 
The service offers:

• management of tolerance issues with anti-hyperglycaemic agents
• management of patients on the maximum tolerated dose of three oral anti-hyperglycaemic agents with a HBA1c >65mmol/mol and EGFR >40 requiring insulin initiation/other injectables
• house bound patients with Type 1 diabetes and EGFR <40
• hypoglycaemia management
• steroid-induced diabetes
• diabetes and PEG feed management
• palliative care
• diabetes care in nursing/residential care homes
• education sessions for those newly and ongoing Type 2 diabetes diagnosis (HbA1c ≥48 mmols/mol)
• health and wellbeing coaching sessions for behaviour change interventions
• specialist dietetics input for dietary management of diabetes
• diabetes neurovascular clinics 

Choice of delivery includes:

• telephone
• face to face
• home visits 

Structured education Type 2 diabetes

The education sessions are interactive and include:

• patient's concerns about their new diagnosis and getting answers to their questions
• self-management of Type 2 diabetes
• supports  patients in making  healthy choices about their diet
• provides support available about the local health services

Choice of delivery includes:

• face to face – group session (DESMOND)/1:1 or home visits
• home visits/telephone/video sessions- bespoke diabetes education
• myDESMOND Education App

Please note: Consent must be gained from the patient before refering them to receive structured education. 

Eligibility Criteria

Inclusions

For diabetes management

• 18 years old and over
• registered with an Enfield GP
• living with diabetes

Please note: Patients meeting the exclusion criteria need to be referred to secondary care or monitored via the GP.

For structured education Type 2 diabetes

• Type 2 diabetes within 12 months of diagnosis 
• ongoing Type 2 diabetes diagnosis
• registered with an Enfield GP 

Please note: Consent must be gained from the patient to refer them to receive structured education. 

Exclusions

For diabetes management

• under 18 years old
• with type 1 diabetes (non-housebound patients)
• with type 2 diabetes and EGFR below 40 (needs to be referred via e-RS to secondary care)
• with type 3c diabetes
• with gestational diabetes
• with mature onset diabetes of the young (MODY)
• with monogenic diabetes
• with pre-diabetes

For structured education Type 2 diabetes

• under 18 years old
• with type 1 diabetes
• with type 2 diabetes and EGFR below 40 (needs to be referred via e-RS to secondary care)
• with gestational diabetes
• with mature onset diabetes of the young (MODY)

How to Refer

Locations

Forest Primary Care Centre