Quality Standards for Diabetes Care Toolkit

Implementation advice

People with diabetes who have advancing, advanced and/or severe complications most commonly require access to specialist expertise. Adequate service provision across the range of subspecialty services is essential to ensure people receive the care that is required, within appropriate timeframes and by those with the right level of expertise.
Workforce recommendations for specialist services are articulated in the Introduction to the Toolkit. Local decisions about how service provision for these high-risk population groups occurs should be determined via clinical governance groups with the relevant clinicians, consumers and managers present.
As described in Standard 3, care-planning consultations should be available to all people with diabetes and should reflect the information and technical and emotional support needed to enable the person with diabetes to make the best decisions about their care (Diabetes UK et al 2008; National Institute for Health and Care Excellence [NICE] 2011). The person with diabetes is more likely to undertake action if it is related to decisions they have made, rather than decisions made for them (Diabetes UK et al 2008).
People with diabetes need to be orientated to the care planning approach and what to expect. Health professionals should undertake further training in developing patient-centred interventions if required (Scottish Intercollegiate Guidelines Network 2010). If the patient agrees, families/whānau and carers should have the opportunity to be involved in decisions about treatment and care and given the information and support they need (NICE 2009).
At each care planning consultation, time should be allowed to share information about issues and concerns; share results of biomedical tests; discuss the experience of living with diabetes; and address the management of obesity, food and physical activity. The person with diabetes should receive help to access support and services and agree to a plan for managing diabetes that incorporates individual priorities and goals. These should be jointly agreed, including setting a goal for HbA1c. Specific actions are in response to identified priorities that include an agreed timescale (Diabetes UK et al 2008; Joint Department of Health and Diabetes UK Care Planning Working Group 2006; NICE 2011).