Former Minister for Health, Leo Varadkar and former Minister for Primary Care, Social Care and Mental Health, Kathleen Lynch, officially launched the new diabetes cycle of care scheme.

Under this scheme patients with type 2 diabetes who have a medical card or a GP visit card can attend participating GP practices for two diabetes review visits per annum.

While it is unfortunate that this scheme is not available to all patients with type 2 diabetes  (those without a medical card or a doctor visit card will have to pay for  their GP visits or continue to attend secondary care services), it is a welcome start in ensuring  patients have regular reviews of their diabetes.

In the near future, it is hoped that ‘The National Diabetes Clinical Care Programme Model of Integrated Care for Type 2 Diabetes’, will be resourced properly. This will mean that all patients with uncomplicated type 2 diabetes, have three review visits per year with their GP or practice nurse, and those with complicated type 2 diabetes, will  have an annual review visit with the specialist diabetes service and two review visits per year with their GP or practice nurse.
Regular review visits are key in the prevention and early detection of complications in diabetes. At the review visit, patients will have an assessment of educational needs in the management of their diabetes. A review of their: glycemic control; cardiovascular risk factors (BP/cholesterol/smoking status/BMI); renal function; medication and feet.

Referrals will be made to structured education programmes (XPERT/DESMOND/CODE), dietitians and a podiatrist, if indicated. Patients who are not already registered for the national retinopathy screening programme will be registered. Patients flu and pneumococcal vaccination status will be checked and vaccinations administered as indicated.

The diabetes cycle of care has been broadly welcomed by key stakeholders and 66,000 patients were registered by the beginning of February 2016.
In announcing the new service, former Minister Varadkar says: “This is a major step forward in expanding the scope of general practice into chronic disease management. It allows patients with type 2 diabetes to be managed in the community, by their own GP or practice nurse, rather than in a hospital clinic where they might have to queue for hours to see a different doctor each time. This is better for patients and it also frees up hospital resources for more complex cases. I hope that the diabetes cycle of care service will be used as a model for more chronic diseases to be looked after in the community, including COPD, asthma and heart failure”.

At the  ‘National Diabetes Clinical Care Programme Conference’, in Galway on the 13th November, 2015, Dr.Velma Harkins, Chair of the ICGP Diabetes Task Group, who established a structured care programme in the Midlands in 1998, welcomed the announcement of new diabetes cycle of care, firmly placing diabetes care in a general practice setting.

Dr. Harkins advised that to achieve the best practice leading research supports, patients should have three reviews per year, therefore an additional visit is required.

Dr. Harkins also stated: The cycle of care lacked co-ordination with the ‘National Diabetes Clinical Care Programme’ and made no reference to the already agreed national model for integrated care. That there is no agreement of care pathways for patients who become complicated and require specialist input and for those who are uncomplicated and are attending specialist services. The scheme is limited to GMS patients only, which excludes approximately 57 per cent of patients with type 2 diabetes.

Dr Harkins advised that the programme needs to be extended to all patients with type 2 diabetes, and patient referral pathways for CNS (diabetes), podiatry and dietetics, need to be confirmed to ensure that all patients have access to these services.

Author Katie Murphy Diabetes Nurse Facilitator