The introduction of community-based diabetes nurse specialist posts has given nurses a key role in the ongoing care of patients with this chronic condition.
Specialist diabetes nurses have long been key players in the overall management of diabetes and their contributions have already had a major impact on the quality of patient care across the UK. This has led to the increasing recognition that there is a need for more of these nurses to be based in primary care.
'During the past five years, diabetes nurse specialists have continued to become much more common in primary care as a result of the massive increase in type 2 diabetes being managed in the community,' says Gwen Hall, diabetes nurse specialist, at Guildford and Waverley PCT.
'The role has changed too,' she continues. 'We are not just responsible for adjusting insulin, but also for the full gamut of cardiovascular disease risk reduction, including blood pressure, lipids, weight and exercise. The team approach is imperative ' I don't think that any one person can manage diabetes.'
By 2010 three million people could be living with diabetes, according to the charity Diabetes UK, and the majority of them will have type 2.
More than 100,000 people are diagnosed with type 2 diabetes in the UK annually. This is due in part to the rising number of obese and overweight people and an ageing population.
The comprehensive and multidisciplinary approach to diabetes management supported by Ms Hall is reflected in the first global recommendations, launched at the end of last year by the Global Partnership for Effective Diabetes Management ' a multidisciplinary task force of internationally respected diabetes experts.
The partnership's '10 practical steps' aim to help management teams overcome common barriers to achieving recommended treatment goals for diabetes management. The guidelines essentially break down into four key areas: achieving good glucose control, targeting the underlying pathophysiology of type 2 diabetes, providing earlier and intensive treatment with combination therapies, and using a multidisciplinary team.
'It is reassuring that these guidelines promote a holistic approach,' says Ms Hall. 'The emphasis is not just on controlling glucose ' it is also on looking at the total impact of diabetes, which I would consider the focus of my job.'
The task force that developed the new guidelines emphasised that diabetes nurse specialists can be a critical link in patient communication and education, a view shared by Ms Hall.
'It is very important that patients fully understand how diabetes and its complications can affect them,' she explains. 'In a recent survey of people with diabetes and heart disease, about 90 per cent of the patients were not aware of the link between these two diseases.
'If you involve patients in their care they are also more likely to be open and proactive. Recently I spoke to a patient about the link between diabetes and sexual dysfunction and, although he initially said he was not affected, he returned with his wife a week later, wanting to know everything about it.'
She adds that the more patients become involved in their own care, as appropriate, the better the outcome. 'One teenage boy needed to change his lifestyle dramatically after being diagnosed with diabetes,' she recalls. 'I thought this was going to be a mammoth challenge, but he made drastic changes and most importantly, he has managed to get his diabetes under control.
'He needed a great deal of support, but ultimately I only gave him the tools he needed to put to use. It is enormously satisfying to see that level of transformation.'
Even though Ms Hall believes that primary care should be responsible for a large proportion of diabetes care management, she still feels it is critical to forge strong links with secondary care. 'We are fortunate that we have very supportive consultants in this area and I organise quarterly 'shared care' meetings between primary and secondary care. These meetings are always well attended and we all find them enormously helpful.'
Formulating ideas and putting forward suggestions in this way is at the heart of Ms Hall's role. She has also been able to mould and adapt her role based on local needs.
'One of the absolute joys of this job is that it is not rigid and I can make decisions without going through committees. There is definite scope to develop the role and many of us who have gone into primary care have been able to set the agenda. The people who employ us are not diabetes experts, so we can advise them on what we need.'
Ms Hall gained her expertise in diabetes care over 19 year- period working as a practice nurse. After completing a course on diabetes, she began to specialise in the condition within her role, while also taking on new responsibilities.
She then became a diabetes facilitator and health trainer for her local health authority, and has been a dedicated diabetes nurse specialist for the past three years. She is also an advanced leader for the University of Warwick Certificate in Diabetes Care and a trainer for the British Heart Foundation.
'It is possible for diabetes specialist nurses to focus on specific areas of diabetes care,' she enthuses. 'While my interest is in education, my colleague's is in research, so she is currently undertaking a PhD. This is one job where nurses can really take an active role in driving forward the necessary changes at PCT level, while also improving their own skills and specialties.'
How do I become a primary care diabetes nurse specialist?
This could be for you if: you are interested in holistic care of people with chronic conditions and working predominantly with older people.
You need to be good at: working autonomously, being adaptable and communicating with different professionals.
You need to have: some knowledge and experience of diabetes care, including some certificated training from a recognised university or college.
You don't need to have: a background in hospital diabetes nursing or a district nursing qualification.
Other similar jobs you could consider: working in a diabetes outpatient clinic or centre, practice nursing or district nursing.