Diabetic foot disease can affect patients with diabetes, and without proper foot care can lead to infection, ulceration, tissue problems and amputation. This can affect patients physically, mentally, socially and economically.
King’s Health Partners Diabetes, Obesity and Endocrinology have established a Multidisciplinary Diabetic Foot Network across South-east London to ensure patients are seen by a specialist immediately after referral. The aim of the project is to significantly reduce amputation rates, which is often caused by delayed access to specialist services. Since the Network’s launch, Multidisciplinary Diabetic Foot Teams, (MDFTs), have been developed in Greenwich, Sidcup and Bromley, and services have been advanced in Kings College Hospital, Lewisham University Hospital and Guys and St Thomas'.
Dr Natasha Patel, Consultant Diabetologist at Guys and St Thomas’s NHS Foundation Trust, is a lead within the Network and is currently working with colleagues across King’s Health Partners to secure funding for a joint diabetic foot and mental health/wellbeing project. The project will look at how socio-economic factors and mental health impact outcomes for patients and whether focusing on these areas can support the reduction of the re-occurrence of foot ulcers in diabetes foot patients.
Geraldine Gallen is a Type 1 Service Lead, Senior Diabetes Specialist Nurse at Kings College Hospital.
The IDEO One Team Programme is seeking to deepen collaborative working between KCH and GSTT diabetes, endocrinology, and obesity services. The plan is to build on existing strengths, and the long-term ambition will be to deliver a single service across multiple sites, supported by a joint management structure. This works sits within a broader collaborative landscape and see clinical and operational teams playing a key role in shaping and developing the One Team model. The One Team Programme will enhance our capacity to deliver excellent patient care, cutting edge translational research, world class education and ensure all staff can maximise their potential.”
1. What does ‘One Team’ working mean to you?
"It means patients receive the same high-quality care regardless of where they receive treatment. It is the provision of a world leading diabetes service where research, technology and psychology are embedded throughout every aspect of the patients’ journey."
2. What were your initial impressions of the ‘One Team’ idea?
"I saw it had huge potential and strength to improve collaborative working in a manner that would really make a difference to staff, patients, and the communities we serve."
3. Have there been any quick wins since this new style of working across sites has been introduced?
"The first was getting teams across sites together to start discussions around recovery, clinical needs, and future aspirations in relation to the COVID-19 pandemic."
4. Any further comments/highlights of the One Team approach so far?
"The approach and dedication of One Team members to this way of working is enabling me to see the potential of how the ‘One Team’ Programme will lead to a strengthening of integrated ways of working across current organisational boundaries, leading to coordinated care pathways and improved outcomes for patients and staff."
The Effects of using Liraglutide for Tier 3/4 Weight Management Services
Georgios, (George) Dimitriadis, Consultant Endocrinologist and Bariatric Medicine Lead Physician at Kings College Hospital NHS Foundation Trust presented findings on a recent study. The study detailed the experience of using Liraglutide in tier 3/4 weight management services alongside a low-calorie diet, and increased physical activity (exercise). Liraglutide is an anti-diabetic medication used to treat type 2 diabetes, obesity, and chronic weight management.
The patients involved had either a BMI of 27kg/m2 and higher with complications, or a BMI of 30kg/m2 without any complications. After 12 weeks of a maintenance dose of 3mg daily, if patients had not lost at least 5% of their body weight they would be considered poor responders and would have to discontinue treatment.
After six months of treatment with Liraglutide those who lost more than 5% of body weight were labelled ‘responders’, and those who lost 10% or more of their initial weight were labelled as ‘super responders’.
88.7% of the participants were women, 12.3% were men. The majority of participants were White, a number were Asian and one was Afro-Caribbean. Around 42% of the patients were found to be non-responders, 38% responders and 20% super responders. This meant there was a 58% response in treatment.
At the beginning of the treatment, there were fewer patients with normal concentrations of glucose. At the end of the intervention there were more patients with normal glucose concentrations. The average weight loss for patients was 9.9% (12.85kg).
Although some of the secondary endpoints for the study could not confirm that the use of Liraglutide per se and not weight loss induced the observed changes, the study has shown all participant categories lost some percentage of body weight.
Next steps will involve collecting a broader set of data with more patients across southeast London to create a real-world cohort using Liraglutide. This will enable comparison with other standard diet interventions and bariatric surgery.
Education and Training
Course spotlight: Addressing obesity in a consultation & How will recent developments in obesity management change obesity services (webinar)
Certificate upon completion |3 hours | Online | English | Beginner Level
Obesity is one of the most pressing public health issues, but many healthcare professionals don’t feel they have the time or confidence to address weight loss with their patients. Through this course you will learn how to broach weight-loss sensitively and effectively with patients and devise a patient-centred action plan to improve dietary or exercise habits. The course includes interactive case examples to enable you to build skills in the following areas:
Module 1: Developing attitudes and addressing barriers