We offer a total package of care for those people recently diagnosed with type 2 diabetes. Referrals to this service are mainly from GPs and practice nurses.

There are three parts to this clinic. Any patient referred to the new patient clinic will automatically be given appointments for parts 1, 2 and 3. There is no need to refer separately to the diabetes specialist dietitian, for example. There is also no need to refer newly diagnosed patients to the eye screening clinic, since an eye examination will be conducted in this clinic. 

Part 1: Monday or Friday morning

Patients are seen in the diabetes centre for an initial consultation with the diabetes specialist nurse and diabetes specialist dietitian.

The diabetes specialist nurse role

The assessment will include:

• medical history
• family history
• history of symptoms
• address pre conceived ideas and anxieties
• establish existing knowledge of diabetes
• discuss general aspects of diabetes including a simple explanation of diabetes
• discuss general health
• measure blood pressure, random blood glucose, test urine for glucose, ketones and protein
• blood tests for renal, thyroid and liver function, random lipid screen, full blood count, calcium, HbA1c    
• measure visual acuity
• discuss lifestyle including alcohol intake and smoking cessation
• teach monitoring of urine or blood
  structure of diabetes care.

The diabetes specialist dietitian’s role

The assessment will include:

• weight, height and body mass index calculation
• recent change in weight
• past weight history
• assessment of current dietary intake / pattern
• discussion regarding principles of healthy eating (including alcohol and exercise)
• assessment of patient's readiness to make changes in diet and lifestyle
• agreed goals for dietary change and specific advice regarding meal planning
• agreed goals for other lifestyle changes including exercise
• review of progress, often at the final appointment.

Part 2: Monday afternoon group education

Within four weeks of the first appointment, patients are invited to attend two group education sessions, on two consecutive Mondays between 2pm and 4pm. Group education allows the patient to learn more about diabetes in an interactive environment. It is important that both sessions are attended. Various topics are discussed by the diabetes specialist nurse, diabetes specialist dietitian and podiatrist which include: 

• what is diabetes
• signs and symptoms
• prevalence of diabetes 
• principles of healthy eating for diabetes
• benefits of exercise
• tablets for diabetes
• benefits of monitoring blood glucose  (blood glucose monitoring is taught at the end of the education sessions)
• advice during acute illness
• foot care
• importance of annual review
• driving/insurance
• alcohol
• smoking cessation
• sexual health
• diabetes UK.

Part 3: Wednesday or Thursday afternoon

At the final part of the clinic, within four weeks of the last consultation we will see the patient in the diabetes centre. The doctor undertakes a medical assessment for diabetic complications and cardiovascular risk, and a review of educational issues. Eyes are examined; this does not include fundal photography. A foot assessment is made by the podiatrist.

The diabetes specialist dietitian and healthcare assistant review the patient’s progress to date, and may arrange to see them again for follow up if necessary. Any treatment changes necessary are recommended. A full letter detailing the history, physical and laboratory analysis, treatment plan and arrangements for further management is prepared by the doctor and sent to the GP. 

Follow up

Many patients are discharged back to the care of their GP and practice nurse, after the three parts of this clinic are completed, if this has been specified in the referral letter. Other patients will continue to be seen annually in the main outpatient department.