Diabetes advocate highlights deficits in service

THE lack of access for people with diabetes to their specialist care teams is creating additional anxiety during the Covid-19 pandemic, according to a local diabetes advocate.

Gráinne Flynn, who has Type One Diabetes, has expressed grave misgivings about the contents of a national HSE press release in relation to diabetes.

In fact, the Ennis-based diabetes blogger admitted she was very upset by it as members of the Clare and Limerick Adults with Type One diabetes group have been expressing concerns about the adult diabetes service provided by UL Hospitals’ Group well before Covid-19 and have now been elevated to serious and extremely worrying.

“This press release is completely tone deaf to the fact that it is the service that is continuously cancelling diabetes appointments since the service resumed in July.

“The service seems to be operating only as face to face consultations. We can only assume that the staffing levels don’t allow for telephone consultations as many of the other clinics are doing.

“I have had two telephone consultations from my clinic in Galway since March. Many of our community have reported that their appointments have been repeatedly cancelled and rescheduled. “People with diabetes should have appointments every four to six months, the concern resulting from extended periods without appointments also comes the postponement of blood work and lab results to determine how well people are managing their diabetes and to detect the early signs of diabetes complications.

“An additional concern comes from the fact that 95% of diabetes management is done by the person living with diabetes, which places a lot of burden on our mental health.”

In view of the fact people with diabetes are 50% more likely to suffer from mental health issues, she asked how can the diabetes team know how they are really doing if they are not in contact with those who are living with this condition.

Before Covid-19, Gráinne recalled the diabetes services in Clare, Limerick and Tipperary, all provided by UL Hospitals’ Group, was the most understaffed hospital group in Ireland, and members of the diabetes community group were already incredibly frustrated and angry that UL adult diabetes service doesn’t provide a wide range of services.

Diabetes self-management education, a cornerstone of diabetes management proved to improve quality of life and reduce the risk of developing diabetes complications such as foot amputations, blindness, kidney disease, has been available in all other hospital groups in Ireland since 2009.

Insulin Pump Therapy is a treatment option which has been available in the paediatric diabetes service in UL Hospitals’ since 2014, is not provided in any of the UL hospitals to adults.

The pre-Covid-19 waiting time to see the diabetes specialist consultant was a minimum of four years and Gráinne wondered “who knows what that is now”.

“Diabetes services in counties Clare, Limerick and Tipperary have been neglected by the Department of Health for too long and people with diabetes are now demanding a collective effort by their TDs and county councillors to help them get the same service as is available in Galway, Cork or Dublin,” she outlined.

A spokesman for the UL Hospitals’ Group acknowledged there is is currently one whole time equivalent (WTE) Consultant Endocrinologist in the UL Hospitals’ Group (ULHG) and a further one WTE Consultant Endocrinologist is due to commence in ULHG in October 2020.

This consultant endocrinologist has a commitment to Ennis Hospital one day a month, however, patients from the Clare region also attend UHL.

The service is supported by a dedicated team of clinical nurse specialists and staff nurses. There is diabetes nurse support in St John’s, Ennis and University Maternity Hospital Limerick (UMHL). There are currently two diabetes clinical nurse specialist posts in UHL, 0.5 is shared with Nenagh Hospital. There are also three specialist diabetes staff nurse positions within the diabetes unit.

The group admitted the service is unable to commence adult patients on insulin pumps due to staffing deficits.

The groups accepts patients established on pumps from elsewhere and these patients are managed under the care of the consultant endocrinologist. The largest group of these patients are those who have transferred from the Paediatric Diabetes Service in University Hospital Limerick (UHL). All of the group’s insulin pump patients are seen in UHL.

Outpatient diabetes clinics take place in UHL, Ennis, Nenagh and St John’s Hospital. Pre Covid-19 there was an average of two diabetes clinics per week across the group and plans are underway to resume these clinics in line with Medicine’s Covid-19 re-emergence plan.

There are two consultants and a specialist dietitian working with paediatric diabetes patients. However, there is currently no specialist dietitian in post for adults with Type One Diabetes. Patients are seen by a ward dietician as in-patients but there is no specialist care or out-patient appointments for diabetes patients in UHL.

Approval is required nationally before the group can progress recruitment for this post. The group has identified this as a significant gap in its service and are committed to addressing this deficit.

Dan Danaher