Improving Diabetes Care in the Mid West

A recent audit of a full year of data from nurse-led diabetes clinics across four Integrated Disease (Chronic Care) networks in Limerick has shown promising results for people living with Type 2 Diabetes.

The review of 175 patients, all discharged from the service in 2024, found that most experienced meaningful improvements in their health. The key highlights of the 2024 audit included:

• Better Blood Sugar Control:
  Nearly 80% of patients saw improvements in their HbA1c levels—a key measure of blood sugar control. Impressively, 71% had reductions of more than 11 mmol/mol, and 44.6% saw drops greater than 21 mmol/mol. These changes are linked to lower risks of diabetes complications and fewer hospital visits.
• Medication and Lifestyle Support:
  80% of patients audited had their medications adjusted to better manage their condition, while all patients made some form of lifestyle change during their time with the service.
• Safe and Appropriate Discharges:
  Of the patients discharged, 26% were referred to secondary care, including those on insulin therapy, in line with national guidelines. This ensures patients receive the right level of care for their needs.
• Evidence-Based Impact:
  The audit supports findings from major studies like the UKPDS and STENO-2 trials, which show that early, targeted interventions can improve long-term health and reduce cardiovascular risks.

The results underscore the importance of the Diabetes Clinical Nurse Specialist (CNS) service in the region’s Integrated Care for Chronic Disease network of hospital-based and community-based care. The CNSs provide holistic assessments, support lifestyle changes, and help patients manage their medications effectively. This proactive approach improves health outcomes and helps reduce pressure on hospitals and outpatient services.

The four Limerick networks in the 2024 audit are covered by two Diabetes CNSs. With a third CNS responsible for East Limerick and North Tipperary, Brid Collins and Karen Guico host county outpatient clinics at Newcastle West, Croom and Kilmallock, and in the city and outskirts at Ballynanty, Kings Island, Barrack View and Dooradoyle.

Both nurses say the results affirm the value of nurse-led diabetes care, with early and effective support not only improving quality of life for patients, but also reducing the need for emergency intervention.

Brid points out the positives from bringing the service out of hospitals and closer to the people.

Karen explains: “We comprehensively go through the following with the patients: their blood sugar, blood pressure, cholesterol levels, medications, diet, exercise and lifestyle. We also educate them on use of blood sugar monitors and sensors that we monitor remotely in real time, and follow up with them by phone regularly. We either discharge patients back to their GPs, or to other service experts on the Integrated Care (Chronic Disease) team.”

ICCD services will be further developed in the coming months with the appointment of an integrated care consultant endocrinologist, an additional diabetes clinical nurse specialist, a dietician, two podiatrists and the opening of a Chronic Disease Hub on the St Joseph’s campus, Mulgrave Street, Limerick, allowing for the care of more diabetes patients in community settings.

Brid concludes: “The results of the audit are extremely positive for the diabetes nursing element of the service alone, showing how the work is delivering tangible outcomes for patients. Ultimately, it is about Making Every Contact Count.”