The Intermediate Diabetes Specialist Service (IDSS) supports diabetes patients in the community where primary care requires specialist input to manage more complex care.

The IDSS consists of a team of diabetes specialist nurses (DSNs), diabetes specialist dietitians, healthcare assistants and diabetes consultants. The service works with patients to ensure management of the three-treatment targets (HbA1c, blood pressure and cholesterol) and support self-care. The nine care processes are recorded and patient's GP is alerted if there are any overdue tests or patients referred to other services were possible.

EMIS records

The service uses EMIS community, enabling direct access to the patient's EMIS record; this helps to inform clinical decision-making. It is important to receive explicit patient permission for the sharing of the patient record. The IDSS team have 'read-only' access to EMIS, so cannot input data themselves, but they require the patient permission in order to view the record. 

Triage

All referrals will be clinically triaged by the service within 72 hours. The outcomes following triage are:

• management by the Intermediate Diabetes Specialist Service
• referral back to primary care with advice or treatment plan.

Clinics

• patients are offered a choice of face-to-face, telephone or video consultations
• diabetes clinics usually take place at a variety of locations throughout Islington depending on where the patient lives.

Appointments are offered at the following sites:

• Hornsey Rise Health Centre
• River Place Health Centre
• Holloway Road Health Centre

Housebound patients

All district nurse teams are allocated a diabetes nurse who reviews all patients living with type 2 diabetes under the district nurse caseloads on Insulin or GLP1s. GPs do not need to refer district nurse patients as they are already under a diabetes nurse.

Eligibility Criteria

Inclusions

Patients registered with an Islington or Haringey GP (this includes patients who reside in other boroughs but are registered with an Islington or Haringey GP) who:

• have type 2 diabetes requiring initiation of insulin or GLP1 who are on three maximum tolerated oral hypoglycaemic agents with raised HbA1c >7.5% (>59mmol/mol)
• are on insulin and requiring review for: 
  • hypoglycaemia
  • change in the type of insulin regimen
  • HbA1c raised >7.5% (>59mmol/mol) despite insulin titration
• have type 1 diabetes who disengage or DNA hospital care.

Exclusions

• please do not refer to the service if the patient is being managed in secondary care
• housebound patients who reside outside of Haringey or Islington, despite being registered with a Haringey or Islington GP practice
• housebound patients who are already on the district nursing team caseload
  • they will already be covered by the diabetes nurse that is allocated to their district nursing team.

• patients requiring basic annual review, i.e. uncomplicated care including foot checks

  • this should be managed in primary care

• patients with multiple complex comorbidities

• patients with type 1 diabetes, including the need for structured education, e.g. DAFNE or WINDFAL

• initial diagnosis is unclear (e.g., maturity onset diabetes of the young, ketosis prone)

• children and young people under 19 (type 1 and type 2)

• people with significant diabetic nephropathy (CKD 4 and 5) and need to attend joint renal clinics

• insulin pumps/continuous subcutaneous insulin infusion management

• patients requiring pre-conception counselling

• pregnant patients with type 1 or type 2 diabetes and gestational diabetes

• protracted vomiting in patients with diabetes

• patients with acute foot ulcers who require referral to the multidisciplinary foot clinic.

How to Refer

Locations

Hornsey Rise Health Centre

River Place Health Centre

Holloway Road Health Centre