Engaging to improve:
young adult diabetes service

Case study from The Royal Liverpool and Broadgreen University Hospitals NHS Trust

Achieving improved clinical outcomes in young adult diabetes care has been possible by adopting a culture of engagement, patient-centred care, flexibility and using peer support to complement clinical care.

“As our service users are the real experts, it was not surprising that we would attain improved results once we started listening to their valuable advice.”

Dr Reza Zaidi, consultant diabetologist and project lead, The Royal Liverpool and Broadgreen University Hospitals NHS Trust

This case study relates to our guidance on:

Teenage boy testing blood sugar level at home

Improving outcomes

What we did and why

Nearly 2,500 people with type 1 diabetes (T1D) live in Liverpool, with a significant number being young adults (YAD) of 19 to 25 years old. Unfortunately, this patient group is associated with frequent clinic disengagement and increased hospital admissions. At the end of 2015, Liverpool and Broadgreen's YAD clinic non-attendance and T1D-related hospital admission rates were rising steadily.

To improve care and outcomes, the trust established a number of improvements:

  • structured clinic pathway
  • joint multidisciplinary clinic appointments
  • telephone reminders of appointments
  • pre-clinic questionnaires
  • DIASEND® use in clinic for data download
  • patient leaflets, containing key team contacts and useful web links
  • database of all patients in YAD clinic
  • LIVT1D – Liverpool’s first peer-support group for people with T1D.

Outcomes and impact

In 2016, the trust saw a 4-fold rise in people achieving NICE recommended target diabetes control (HbA1c <48mmol/mol).

2015

2016

Clinical non-attendance rate

47%

32%

Financial gain

-

£3,663

Clinic non-attendance rate reduced in 2016. 65% of YAD attended 2 or more appointments in the year.

% of clinical cohort
admitted to hospital with:

2015

2016

Diabetic ketoacidosis

15%

8%

Severe hypo-glycaemia

4%

2%

Reduction in YAD hospital admissions in 2016 resulted in cost savings for the hospital of £11,336.

In December 2020, NICE reviewed the evidence and updated the recommendations on fluid therapy for children and young people with diabetic ketoacidosis in NG18. The updated recommendations should be referred to if replicating any aspect of this example.

What we learnt

Restructuring the young adult clinical service with a more flexible, patient-centred and multidisciplinary approach has brought about improvements in:

  • clinic attendance rates
  • patients achieving target average blood glucose levels (HbA1c)
  • percentage of annual checks carried out
  • reduction in admission rates of diabetes-related emergencies among our clinic cohort.

Improving the delivery of high-quality care in the future will be possible by working through the following 3 areas:

  1. Systematic quality improvement through clinical outcomes: regular data collection for complications, admissions and clinic attendances through local and national audits.
  2. Assessing expectation and satisfaction: arranging interactive opportunities for regular YAD feedback to further improve clinic
    experience and service.
  3. Broadening the programme scope and reach: sharing outcomes of peer-support with neighbouring trusts and charities to work collaboratively and use positive outcomes to influence commissioning on a wider scale.