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Managing diabetes in Bermuda’s hospital

Type 2 Diabetes once known as “the old people's disease”, is now affecting people at a much younger age. The 40-60 age groups, our working population, have the fastest rising number of diabetes diagnoses. This means that if blood glucose levels are not kept within the normal range, complications will develop at a much younger age.

A recent survey of inpatients on the wards of King Edward VII Memorial Hospital's Acute Care Wing showed that on any given day 25-40 per cent of beds were occupied by people with diabetes either as a primary or secondary diagnosis.

It has been shown that hospital inpatients with diabetes have longer hospital stays, are at increased risk of developing hospital acquired infections, have longer recovery times from surgery and have more repeated hospital admissions than those without diabetes.

This in turn means we have a sicker working population which drives up healthcare and health insurance costs and adversely affects our local economy.

Acute illness often results in a number of physiological changes in the body and people with diabetes who are hospitalised often have fluctuations in blood glucose levels. There are several reasons for this. Illness, infection and surgery can cause a rise in blood glucose levels. Additionally stress from illness and hospitalisation can cause blood glucose readings to become erratic along with changes in diet and activity levels. These patients are also at higher risk of further complications such as falls, pressure sores and dangerously high or low blood glucose swings.

Our goal for diabetics in hospital is to have them attain and continue optimal blood glucose control so that their wellbeing is maintained and their healing process can take place as quickly as possible. Achieving this aim results in reduced mortality, reduced morbidity, reduced cost of care, shorter length of hospital stay, lower inpatient complications and fewer hospitalisations.

To achieve successful management of glucose control, all people with diabetes should have access to a Diabetes Self-Management Education (DSME) Team. Research shows that DSME improves diabetes outcomes by: reducing A1C levels, reducing the onset or advancement of diabetes complications, improving lifestyle behaviours, such as eating a more healthy diet and following a regular exercise regime. DSME also helps decrease diabetes-related distress and depression.

It's also worth noting that DSME helps reduce overall healthcare costs. A joint position statement released in June 2015 by the American Diabetes Association, the American Association of Diabetes Educators and the Academy of Nutrition and Dietetics noted the cost-saving benefit as DSME reduces hospital admissions.

The Bermuda Hospitals Board has an inpatient diabetes nurse specialist, Tammoi Jarrett, who works in close collaboration with the hospitals endocrinologist. Her role is to formulate diabetes management plans for inpatients with newly diagnosed or pre-existing diabetes, as well as acting as a resource to the hospitals' team of doctors and nurses.

On discharge from hospital, patients are referred to the outpatient Diabetes, Respiratory, Endocrinology and Metabolism (DREAM) Centre where diabetes education and support is continued.

•Jane Hope is the Clinical Diabetes Manager and has worked in the Diabetes, Respiratory, Endocrinology and Metabolism (DREAM) Centre since 2004. She has a passion for helping improving the lives of all people with diabetes.

Younger people at risk: Type 2 diabetes used to be seen as an old people's disease. Now the 40-60 age group has the fastest rising number of diabetes diagnoses

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Published December 09, 2015 at 8:00 am (Updated December 09, 2015 at 1:53 am)

Managing diabetes in Bermuda’s hospital

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