Effective diabetes service models should be commissioned to reduce diabetes admissions

Sphere full of words to do with diabetes and health care.

This document is aimed at clinical commissioning groups, health care planners, hospital senior managers, and clinical teams in primary and secondary care. It is an amalgamation of good practice examples where diabetes services have improved, with bed occupancy and costs being reduced. There is a specific focus on elderly, diabetic patients, and other similarly vulnerable groups, and covers primary and secondary care health services.

Patients lying in their beds during a ward round.

“About 1 in 6 hospital beds in England are occupied by someone with diabetes”

Bed occupancy

Written on behalf of Diabetes UK, Association of British Clinical Diabetologists, Diabetes Inpatient Specialist Nurses UK Group, Primary Care Diabetes Society, and the Welsh Endocrine and Diabetes Society, this is an important document because according to the National Diabetes Inpatient Audit, “about 1 in 6 hospital beds in England are occupied by someone with diabetes”. So it is of particular relevance to commissioners of diabetic services. Although it is not a guideline, it does refer to best evidence, including NICE guidelines and quality standards throughout.

Effective models

The document looks at the financial implications of commissioning ineffective diabetes services, makes a number of very specific recommendations, covering the following areas:

  • Hospital admission and readmission rates and their variability
  • Day case surgery
  • Commissioning care
  • Primary, acute, and specialist care
  • Out of hours support
List of recommendations

There are some clear and explicit recommendations for commissioners to follow


The recommendations for commissioners include:

  • Obtaining benchmarking data to see how your area is comparing to the rest of the nation
  • Reviewing existing services and admission figures
  • Commissioning a realistic estimate of what are avoidable admissions
  • Evaluating the benefits of employing an appropriate number of diabetes inpatient specialist nurses
  • Identifying individuals who are frequent readmissions
  • As half of diabetic ketoacidosis (DKA) emergency admission rates are people with Type 1 diabetes, think about commissioning a service that will lower the incidence of DKA
  • Identifying people at risk of type 1 diabetes who come from dysfunctional families
  • Commissioning a diabetes foot care service, informed by NICE guidance
  • Making sure there is a diabetes network in your area, led by a clinician
  • Developing with the Ambulance Trust, a hypoglycaemia management pathway
  • Providing education and training about existing local diabetes guidelines for health professionals
  • Providing education to patients about diabetes and foot care, as prevention and good management will reduce admissions
  • Helping primary care staff “to deliver best practice care
  • Developing out of hours support for people with diabetes

    Amalgamation of good practice examples where diabetes services have improved, with bed occupancy and costs being reduced

    Amalgamation of good practice examples where diabetes services have improved, with bed occupancy and costs being reduced


This document is really useful because it can be used to make the business case for changing and improving clinical service delivery. The recommendations are very clear and explicitly describe what should be done. Within your teams, it would be worth going through each of the recommendations to see if you are already implementing them, whether it is appropriate for you to be implementing them, and if you are not implementing them, thinking about how you can do so, to improve the service delivered to your diabetic patients. This document shows that the benefits will not only apply to the patients but also to the health service as a whole.


Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical teams (PDF)
B Allan, M Sampson
Joint British Diabetes Societies for Inpatient Care
December 2013

Related documents

Best practice for commissioning diabetes services: An integrated care framework (PDF)

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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