There are around 24,000
people in Lambeth and Southwark with diabetes and an estimated
further 16,000 with undetected diabetes. The number of deaths
attributed to diabetes in 2008 was 10 per cent in Lambeth and 6 per
cent in Southwark, compared with 5.7 per cent nationally . Earlier
detection and better management of diabetes is known to prevent
future complications, including amputations and the development of
renal failure and retinopathy, which can lead to
The Charity awarded the Diabetes
Modernisation Initiative (DMI) £4.5 million in November 2010 to
develop an excellent system of diabetes care. Its vision is to
enable people to 'live well with diabetes' through consistent and
accessible services designed with patients; by offering the right
balance of support and independence; and by applying state of the
art treatment and care approaches.
The DMI works with clinical champions, health service staff and
other professionals, as well as people living with
diabetes. The initiative has already had a significant impact
on the health and quality of life for people with diabetes in
Lambeth and Southwark, in the following ways:
It aimed to increase detection of diabetes from 64 per cent to
82 per cent - by indentifying an additional 7400 people with
undiagnosed diabetes, (so that 33,800 people were receiving
diabetes care locally). Between 2009 - 11 the programme had
detected an additional 2, 000 patients.
Better control of blood sugars
HbA1c is a blood test which indicates blood glucose levels over
a two to three month period. HbA1c can indicate diabetes, and
blood sugar control. The aim was to increase the number of
people with an HbA1c under 8 from 67 percent to 75 per cent, which
equates to 1950 more people. By 2011 the programme had
achieved this in 1,650 patients, well on their way to
achieving their goal during the programme.
Care in the right place
The aim was to increase patients receiving care in an
appropriate setting, avoiding hospital visits / admissions where
possible. This has involved working with GPs, community and
hospital teams to provide care closer to home. As a result,
Lambeth diabetes community services has seen an increase in
their patient numbers of 43 per cent between January and May
2012. Additionally, the number of people seen in hospital only once
or twice, had fallen by 9 per cent during 2010 -12.
The programme also set out to reduce emergency admissions by 20
per cent, by December 2013. By autumn 2012 the number of avoidable
emergency admissions had fallen by 4 per cent since the same time
the previous year.
Over 350 local diabetes patients involved in activities to
improve their care. This work includes a thriving Patient Forum and
a training programme to develop the skills of service users who are
working alongside clinical leads and the DMI team to redesign
The programme has established a parent support group, links with
local faith groups and developed culturally specific education
programmes for local patients.
The Diabetes MI team are bringing together paediatric teams and
families to design and develop the Paediatric Diabetes Network
of Excellence across the Evelina Children's Hospital (part of Guy's
and St Thomas' NHS Foundation Trust), King's College Hospital
NHS Foundation Trust and Lewisham Healthcare NHS Trust.
The DMI is also sharing knowledge with the Integrated Care
Programme on a number of areas of service improvement, such as peer
support, workforce training and the integration of
primary/community and specialist services.