Progress Report!

At Midwest Diabetes Advocacy Group we work continuously to ensure people with diabetes in the Midwest have access to the services which they need to live their life fully with diabetes.

We started out in 2019 through peer support groups. We noticed that a lot of people were experiencing the same barriers to care and soon a group was formed. While we could have written an entire shopping list of items which needed to be implemented, we decided to start by trying to get University Hospital Limerick (UHL) to provide DAFNE carbohydrate counting courses to those living with type 1 diabetes in the Midwest.

We encountered a number of barriers along the way. These included staffing and training. At the time UHL had zero diabetes specialist dieticians, 0.5 endocrinologist post shared between 3 hospitals and 4.4 nurses. Without the necessary staff, including access to specialist dietitians, DAFNE could not be implemented.

We are happy to say that staffing and training were acquired. Some people in the Midwest have received DAFNE training through UHL this year, which is fantastic news. We are continuing to monitor staffing to ensure that the DAFNE programme continues in UHL and have new goals to reach for (which we will talk about in other posts).

If you have received DAFNE training in UHL, let us know how it went. What would your next goal for improving diabetes services in the Midwest be?

Limerick Hospitals Groups struggles to recruit diabetes services staff.

People with diabetes from Clare and Limerick have launched a campaign in advance of World Diabetes Day, 14th November, to highlight the lack of services provided by University of Limerick Hospitals Group (ULHG) for those over age 18 years of age and are calling on ULHG to address these issues urgently.

It is of utmost concern that one year after seeking national funding, ULHG still cannot fill positions in the outpatient adult diabetes clinic and therefore cannot provide specialist type 1 diabetes education or offer insulin pump technology to prevent developing long-lasting complications such as amputation, kidney dialysis or vision loss. In addition to these issues, there is at least a five-year waiting list to access the diabetes outpatient clinic.

Specialist education for adults with type 1 diabetes such as DAFNE (Dose Adjustment For Normal Eating) is the cornerstone to good diabetes management. The National Clinical Guidelines for adults with type 1 diabetes states that DAFNE training for people with diabetes reduces the number of severe low and high blood sugars hospital admissions and reduces long-term complications. There are currently 12 DAFNE accredited centres in Ireland with a plan for six additional centres to implement the National Clinical Guidelines. Limerick hospital looks set to be excluded from the DAFNE expansion as it cannot recruit the necessary staff to undertake the DAFNE educator training.

Additionally, Midwest Diabetes Group’s concern is that there is no provision of insulin pumps for people with diabetes over 18 years of age. Yet, there are currently 51 adults attending the clinic who use insulin pumps with only one member of staff trained in supporting them. An insulin pump offers greater flexibility for people with diabetes as the user can adjust insulin more precisely than with injections and in much smaller doses. Insulin pump therapy should be offered as a treatment option when health outcome targets are not being reached using injections or when the individual is extremely sensitive to insulin and requires very small doses. One of the barriers identified with insulin pump access is the lack of a pump specialist nursing staff. Thus, the group is calling on UL Hospitals Group to request funding at a national level to secure a minimum of one full-time diabetes specialist pump nurse to initiate insulin pumps to those aged over 18 years.

The third concern is the five-year waiting list to be seen by a consultant endocrinologist in the Limerick diabetes outpatient clinic. 663 people are waiting on their first appointment to UL hospital’s outpatient diabetes clinic, with over half of those on the list 24 months or longer. This situation is unacceptable and will lead to increases in the number of people with diabetes developing related complications such as foot ulcers, amputations, and kidney dialysis.

Furthermore, Midwest Diabetes Advocacy calls on the ULHG to ensure the hospitals group’s inclusion in the current national rollout of DAFNE structured education in 2021; to request funding at a national level to put in place a diabetes insulin pump nurse specialist to offer insulin pump therapy as a treatment option, and implement the necessary resources in the outpatient diabetes clinic to reduce the five-year waiting list.

A public demonstration to highlight these diabetes service issues organised by Midwest Diabetes group will take place on Sunday 14th November, World Diabetes Day, between 1pm - 3pm outside UL hospital, Dooradoyle, Limerick. For more information about the event, Midwest Diabetes Advocacy group and

#AccessToCare campaign visit: https://www.crazyaboutdiabetes.com/midwestdiabetes

or email: midwestdiadvocacy@gmail.com