When it comes to the care of people with type 2 diabetes, communication between healthcare professionals is often fragmented, particularly between primary and secondary care settings, but also between different members of multidisciplinary teams in hospitals, according to a white paper on the condition.

The paper has been launched by the Cross-Party Parliamentary Group on Diabetes, which works to improve the standards of care and services for people with diabetes in Ireland.

Type 2 diabetes is a chronic condition characterised by high blood glucose levels due to abnormal insulin production levels or insulin resistance (the body does not fully respond to insulin). It currently affects over 200,000 people in Ireland.

The white paper incorporated interview input from Type 2 diabetes patient advocates, researchers and academics, as well as a national patient survey of Diabetes Ireland members.

It identified six key themes and specific interventions to support improved outcomes, emphasising the importance of preventative actions and early intervention to reduce the impact of diabetes and its complications.

One of these themes is ‘optimising the care pathway’. The paper notes that the HSE’s Model of Integrated Care for Patients with Type 2 Diabetes outlines an effective three-tier approach to integrating primary and secondary care. These are:

 -Uncomplicated patients with no issues should be managed at GP level 


-If complications develop patients should be referred to secondary level 


-Patients should then be reverted to GP once complications are dealt with, with complex cases remaining at acute level.

However, the paper notes that the successful implementation of this care model faces a number of “significant hurdles”, including:

-Patients being incorrectly referred to acute settings, which in turn results in too many cases at acute level, driving delays in securing an appointment

-Poor communication between primary and secondary practitioners combined with a lack of adequate resources.

The paper makes a number of recommendations in this area, including better resourcing at community level to handle larger patient numbers, expanding the Chronic Disease Management Programme as soon as possible to include all patients with diabetes and consideration of the role of telemedicine.

Another theme highlighted by the white paper is the role of education, which is described as “paramount to empowering the patient to improve their self-management and to allow healthcare professionals to make the most appropriate decisions for their patients’ individual care”.

Patient survey responses reveled that 51% of type 2 patients were not offered structured education and as a result, patients often do not understand the implications of the disease and how best to manage it.

The paper states that patient education should be offered in a more structured and regular manner. It should be made accessible to all and tailored to individual patient journeys

Other themes include tackling complications and diabetes prevention.

Speaking about the patient experience, Dr Deidre Fitzgerald Hughes, a senior lecturer at RCSI University of Medicine and Health Sciences, emphasised that living with type 2 diabetes “is not just about managing your blood glucose”.

“People living with the condition have to manage the fear and anxiety of a complication that could potentially turn your life, your family, your career, upside down. Avoiding, delaying or dealing with complications is relentless, an exhausting schedule of multiple appointments, often with mobility issues, while juggling the other demands of family or work or both,” she commented.

According to Fianna Fáil TD and chairperson of the Cross-Party Parliamentary Group on Diabetes, Cormac Devlin, this paper highlights the need for a “coordinated policy and strategic approach for preventing and managing type 2 diabetes”.

“Type 2 diabetes is a complex condition therefore significant intervention is needed to reduce occurrences of the condition and development of associated complications. The paper makes clear that there is major scope to improve quality of care provided to people with type 2 diabetes in Ireland,” he said.

The white paper can be viewed here.