Remote insulin titrations leading to enhanced efficiency, capacity and patient care

Profile

A Specialist Diabetes Nurse in the South Tyneside and Sunderland NHS Foundation Trust has used Accu-Chek Care to perform remote insulin titrations.

With a case load of 700 patients, all receiving a 30-minute face-to-face appointment every 12 weeks, the demand on a specialist diabetes service was high.

Challenge 

Remotely titrate insulin with confidence without reliable blood glucose data

Before using Accu-Chek Care, appointments were often being postponed or missed. However, since enabling remote insulin titrations, a Diabetes Specialist Nurse working at this specialist service feels that efficiency and capacity have increased. 

Follow-up telephone calls would be scheduled 4-6 weeks after a clinic appointment; these would often be missed, or be ineffective if patients didn’t have their blood glucose readings to hand. In some cases, healthcare professionals working in the specialist service had low confidence in the patient-reported blood glucose data, and felt unable to rely on it to titrate insulin. 

This often resulted in overly cautious insulin titration advice, or titrations being left for when patients attended clinic. This delay in achieving optimal diabetes management meant that patients stayed in the service for longer - the average time taken for a patient to be discharged was estimated to be 6-12 months.

Results 

6 months after introducing Accu-Chek Care

After introducing Accu-Chek Care into the clinic, the diabetes specialist nurse has managed to make improvements in remote insulin titration. As a result, improved clinic efficiency and patient prioritisation were reported within just six months. Remote insulin titrations can now be carried out with confidence, and the nurse feels that the improved efficiency of the clinic has resulted in more effective diabetes management for their patients, reducing the time taken to discharge patients from the service.

Data is automatically transferred from patients’ blood glucose monitoring device to Accu-Chek Care in near real-time. This reduces the potential of manual logging errors and has enabled healthcare professionals at the specialist service to confidently titrate insulin remotely, providing specific advice to patients when required.

The nurse can now prioritise patients in need of titration, and contact these patients by telephone every 2 weeks, rather than every 4-6 weeks. If the patient does not answer the phone, advice is still provided by leaving a voice message or sending a message using the platform’s chat function.

The nurse was able to discharge one patient from the specialist diabetes service in the South Tyneside and Sunderland NHS Foundation Trust after just 3 months, compared with the 6-12 months that was the norm before Accu-Chek Care was implemented. After a clinic appointment to initiate treatment, the near real-time data in the platform meant the patient’s insulin was able to be titrated remotely. By the time the patient had their second clinic appointment, their blood glucose was 99% in range, and with their HbA1c in range, they were discharged back to GP care.

It is also reported that clinic capacity has been increased, due to data analysis being simpler with interactive dashboards, graphs and reports. The nurse is able to conduct clinic appointments now in 25 minutes rather than 30, allowing one extra patient to be seen in each clinic (312 extra patients seen over a 52-week year*), helping to meet the high demand on the service.

Being able to consistently view patient’s live data has allowed the nurse and her colleagues at the specialist diabetes service to prioritise patients with greater needs, ensuring the valuable appointment time is utilised in the most effective way possible.