London hospital pioneers new system to root out ‘hidden risk’ diabetes patients

George Brown, 71, has had diabetes for 48 years and was among the patients helped by the platform  (Guy’s and St Thomas’ NHS Trust)
George Brown, 71, has had diabetes for 48 years and was among the patients helped by the platform (Guy’s and St Thomas’ NHS Trust)

A London hospital has pioneered a new system to identify patients with diabetes who are at high risk of severe illness before their next hospital appointment.

The data tool, developed at Guy's and St Thomas' hospital, flags up “hidden risk” patients whose condition is deteriorating but doctors may be unaware. These patients are then given immediate treatment to stabilise their condition.

The Covid-19 pandemic led to a backlog of outpatient appointments in the NHS and there are currently 7.6 million people waiting for treatment. People with diabetes are at risk of complications which often result in hospitalisation and premature death.

While many of these complications can be prevented with prompt intervention, doctors are not always alerted to changes in a patient's condition while they are on a waiting list.

Results from a pilot study of the system showed that of more than 4,000 people on a waiting list for diabetes appointments at Guy's and St Thomas', 549 (13.6 per cent) of them were at risk of their health worsening.

Of the 101 highest-risk patients, 40 received treatments that reduced their risk and prevented their condition from getting worse.

Clinicians used data from electronic health records for 4,022 diabetes patients to create a series of risk factors. Patients' information was then run through the tool to identify those most at risk while waiting for an appointment.

Hospital administrators and doctors also created a dashboard that flags up any risk to patients since their last appointment. This enables them to urgently prioritise high-risk patients for treatment while also highlighting the patients at a lower risk who do not need to be seen.

George Brown, 71, has had diabetes for 48 years and used to check his blood sugar levels by doing regular finger-prick tests. Under the pilot project, he was flagged as of higher risk and given a digital sensor to use.

The sensor connects to a phone app which regularly monitors his levels and flags any potential issues in real-time to him and also to his clinicians.

The retired electrician, from Ladywell, said: “The sensor is much easier to use than having to prick my finger. It has an alarm which tells me if my sugar levels are too low or high, and I can better manage my diabetes at the time. The sensor and the app are very easy to use, too.”

The study also found that a disproportionate number of patients highlighted as high-risk were from minority backgrounds and lived in areas of social deprivation.

Teams at GSTT are now working on adapting the tool to benefit patients with other chronic conditions such as kidney disease, heart failure and inherited cardiac conditions, as well as being used in rheumatology and ophthalmology.

Plans are underway for the tool, developed by the Trust’s Centre for Innovation, Transformation and Improvement (CITI) with data analytics firm Factor 50, to be used more widely in south east London and beyond.

Janaka Karalliedde, a consultant in diabetes and endocrinology at GSTT and who was lead author on the study, said: “This IT tool has been invaluable in helping us look after our most vulnerable and poorly patients. By working out patients’ risks, we can make sure those who need urgent care are seen quickly while also helping us use our resources in the most strategic and efficient way.”

The project was funded by Guy's and Thomas' Charity, who have committed to further funding that will support the next phase of the programme.

Colin Kinloch, Director of Funding at Guy’s & St Thomas’ charity said: “This pilot study is a brilliant example of how funding innovative technologies can lead to significant improvements in health outcomes and a reduction in health inequalities. We are very much looking forward to building on this award-winning pilot through the next phase of our partnership with the fantastic CITI team.”