Views from the frontline: beating diabetes through technology

6 July 2017

There are over four million people with diabetes in the UK. It is the fastest growing health threat and an urgent public health issue. Diabetes education is, or should be, offered to all people with newly-diagnosed diabetes, but not everyone attends. Part of this non-attendance problem is the inconvenience of having to attend the education sessions rather than these being brought to the patient.

Some years ago, we were seeing diabetic patients who were started on insulin and not told how to use the injection devices correctly. Some were given doses of insulin so high that most hospital consultants would shudder. I have seen patients on combinations of insulins and medications that have left both senior physicians and diabetes nurses perplexed. The problems were not necessarily confined to the patients who were seeing health professionals outside hospitals. Erroneous dosing, inappropriate insulin injection timing and unfamiliarity of the nursing staff with the insulin pens is seen in hospitals too.

Let us consider the possible causes of sometimes imperfect diabetes care. While every effort has been made to simplify diabetic care with guidelines, pathways, education and medications, the diabetes market itself has become phenomenally complex. More than 10 injection devices (pens) are used to inject some 20 types of insulin. Depending on the license and/or evidence, these insulins can be combined with about 25 medications in six or seven classes of drugs.

The myriad of devices is difficult for medical professionals to navigate making the delivery of diabetes care very complicated. I abandoned the teaching of diabetes on a course whereby after two or three days of lectures, health professionals were to start ten patients on insulin over a six-month period to classify themselves as insulin prescribers or doctors/nurses with a special interest in diabetes. I concluded that there was a better way to educate staff and patients on diabetes. Rather than ask everyone to attend courses, frontline staff should be supported to offer reasonable care or advice to these patients and technology holds the key.

I am a consultant endocrinologist rather than an IT developer and I wanted to simplify access to information and support for both frontline staff and patients with diabetes. I have designed an app to address this. It is open to all, costs £6.99 to download and gives diabetic patients, and those caring for them, advice managing diabetes.

After about two years of work, my app, “Diabetes Nurse” saw the light of day and appeared in both Apple and Google Play stores. The app gives advice on how to inject insulin (and other injectable medications used for treating diabetes), treat diabetic emergencies, test glucose levels and manage diabetes more generally. Most of the advice is given in the format of videos and lectures. I hope that nurses, GPs and patients with diabetes will benefit from this format of diabetes education. So far patients and clinicians in the UK are downloading the app and I have had interest from American hospitals who plan to offer the it to all their nurses.

Nemanja Stojanovic, Consultant Endocrinologist, Barking, Havering and Redbridge University Hospitals NHS Trust

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