There is a concern that patients with diabetes are presenting to hospital later because of the current pandemic. Paul Mulholland speaks to Clinical Lead, National Clinical Programme for Diabetes, Prof Sean Dinneen about the challenges of providing care during the current crisis
The Covid-19 pandemic has had significant ramifications for patients with chronic conditions, such as diabetes. Like other parts of the health services, traditional diabetes clinics were paused in the early months of the crisis. During this time, consultations began taking place virtually, with healthcare practitioners providing advice around self-management of the condition.
However, as normal services resume, some patients with diabetes are still reluctant to attend their hospital appointments as they are in an ‘at-risk’ group in terms of Covid-19 infection. This has led the HSE and Diabetes Ireland to issue a call, urging people with concerns about their diabetes to seek medical advice from their pharmacist, GP, or hospital diabetes team.
Speaking to the Medical Independent (MI), Prof Sean Dinneen, Consultant Endocrinologist at Galway University Hospital (GUH) and Clinical Lead of the HSE National Clinical Programme for Diabetes, said it was important that patients with diabetes were aware of the availability of support and care, despite the pandemic.
“We’ve noticed that patients are not always keen to come to hospital,” stated Prof Dinneen.
“There is a fear of contracting the virus, perhaps reduced in recent weeks, but I suspect starting to ramp up again now. And it is trying, I suppose, to walk that tightrope between providing care and getting services back up and running, and at the same time trying to get people to focus on health management of their diabetes.”
One positive factor of the lockdown, Prof Dinneen said, is that many people have been more proactive in terms of managing their condition. However, he added that his “strong impression” from talking to colleagues around the country is that patients are presenting at a later stage with complications arising from their diabetes.
“Patients are not coming at the appropriate time,” he told MI.
“And what we are seeing is later presentations of problems that could have been more easily dealt with, if they presented earlier. Diabetic foot is a good example. If you don’t come early, the problem can get worse and be more difficult to manage. I think that ophthalmologists are also concerned about patients with visual symptoms presenting later.”
In the absence of a national register for diabetes, Prof Dinneen said it was difficult to specifically say what impact the pandemic has had on people with the condition.
“One of my bugbears is a lot of our colleagues across Europe have a better handle of their diabetes population than us,” he commented.
“Without a national diabetes registry, we are really missing out on the opportunity to track how people are doing. If you said to me, what impact did Covid-19 have on people with diabetes in Ireland, the honest answer is I don’t know.”
A Sláintecare-funded project to establish such a registry has been paused as the team behind its development, which mainly consisted of public health doctors and specialists, were redeployed as a result of the pandemic.
“We need to know who has it and what sort of burden of complications and what sort of burden of illness, are we dealing with. And we have the wherewithal now, because we have RetinaScreen up and running. RetinaScreen is aware of somewhere in the region of 180,000 people with diabetes in Ireland. So we can build on that. And there is also the new chronic disease management GP contract. The plan we have for the Sláintecare project is to merge those two sources of data, and try to establish a proper national diabetes registry over the next few years. I think Covid has highlighted that need even more.”
The redeployment of healthcare staff from various parts of the health service to assist in the fight against the pandemic has impacted on diabetes teams, according to Prof Dinneen. He said HSE management has been informed about the need for staff to return to diabetes services.
“And I think that message has gotten across,” he said.
“However, we still don’t have a full complement of our community podiatrists here in CHO 2” [Community Healthcare Organisation, Area 2, which covers Galway, Roscommon, and Mayo].
Prof Dinneen said that his department in GUH reached out to all patients who were booked to have a face-to-face appointment. “Not every department around the country was able to do that, but we did, mainly by phone,” he said.
“We are only beginning to embrace the world of video conferencing with our patients. I know other departments have already got up and running with that function. We have used it mainly for our own internal meetings. And teaching and things like that are resuming now, with Zoom and Microsoft Teams. But in our own case here in Galway it is mainly phone contact with patients that we’ve used. Attend Anywhere and other HSE-supported software are coming into the frame now and people are beginning to use that telemedicine or video conferencing with patients.”
Telemedicine consultations are more suitable for patients who have previously attended the clinic, according to Prof Dinneen. He added that younger patients, in particular, value this type of consultation.
“We would have a very high non-attendance rate in our young adult clinics in general. For whatever reasons they don’t turn up,” he said. “We had almost zero non-attendance because we could connect in with them remotely. And they love it.”
However, he said for patients attending for the first time, or for complicated cases, face-to-face interactions were vital, even if telemedicine had the potential to “change practice”.
“If it is a straightforward visit, we should and we will in the future, do it remotely,” he said.
“The challenge is identifying the straightforward visit. Because sometimes a visit you think will be straightforward turns out to be anything but.”