#26 Advance Care Planning in Diabetes Management with Dr David Strain

22.08.2022

#26 Advance Care Planning in Diabetes Management with Dr David Strain

In this episode I talk with Dr David Strain about Advance Care Planning for a person living with diabetes. We discuss the health implications of diabetes and how this impacts care and planning ahead. David explains why it is so important to start conversations early and gives fabulous examples of how important conversations are integral to care from the beginning of a diagnosis.

Novo Nordisk supplied sponsorship to produce this episode.  Novo Nordisk has had no influence in the creation, development or content of this podcast and full control remains the responsibility of Clare Fuller.

Key messages from guest

  • David reflects on the professional interest shown in Advance Care Planning and End of life Care when we presented at the 2022 Diabetes Professional Care Conference, and acknowledges these are subjects shied away from.

  • Advance Care Planning should be about every patient that we see

  • A person living with diabetes has a higher risk of dementia, renal impairment and infections which can impact quality of life and could be considered in Advance Care Planning

  • Knowing what complications can come down the road helps us to focus on the here and now and make sure when that arrives we are prepared for it

  • Advance Care Planning is part of the role of clinicians working to support patients with Long Term Conditions.

  • David describes conversations as Welcome Conversations rather than Difficult Conversations

  • David describes the importance of interpreting statistics or data into something that is meaningful to patients.

  • A Frailty Assessment (available for every patient over the age of 70) is an ideal opportunity to begin Advance Care Planning conversations

  • David discusses the optimisation of Diabetes management aligned to goals of care, stressing this isn’t withdrawing care but is about avoiding medication complications. 

  • David shares how he has started his own Advance Care Planning or planning for the future and that since our first meeting he has his Lasting Power of Attorney in Place.

Resource

Dr David Strain Senior Clinical Lecturer University of Exeter Medical School, UK.

Dr David Strain is a Senior Clinical Lecturer at the University of Exeter Medical School. Prior to this, he studied at Liverpool University before completing his Doctorate in Medicine on ‘The ethnic difference in the effects of insulin resistance on the vasculature’ at the International Centre for Cardiovascular Health, Imperial College, London.

Dr Strain’s main focus is the health of older adults with diabetes, ensuring the right patient gets the right treatment. This includes research exploring the mechanism that some medications give benefits for people with diabetes beyond their effect on sugar and blood pressure, to determine if we can better select the medication for each patient. He has performed the only study to date demonstrating the feasibility of individualising targets for older adults across Europe. This has informed the new UK guidance document for the management of older adults with diabetes and frailty, of which he was lead author, and has recently led to a change in the NICE guidance and primary care contract.

Since April 2019, he has also been running a COVID service as clinical lead in COVID for Exeter, been involved in the NHS Long COVID taskforce, and is part of the collaboration that is establishing underlying causes and potential cures.

 

 

What one thing will you do?

It would be great to share what resonated with you from this episode, what is the one thing you will do differently? Head to Twitter, Facebook or LinkedIn to continue these important conversations.

Thanks to all my guests for working with me to share their knowledge, experience and stories about Advance Care Planning. I hope you enjoyed listening and have insights to take away; I love hearing your reflections on the series and look forward to reviews on Spotify where you can also subscribe to the series.

Clare

Important Conversations about Important Conversations.