Changing pattern of GP referrals: experience from a community diabetes clinic

The management of type 2 diabetes (T2DM) has undergone significant changes in recent years, with a shift away from the hospital setting towards community–based teams. This study aimed to investigate changes in clinical acuity and complexity of patients with T2DM referred to the Sutton Community Diabetes Service. This retrospective audit of patients with T2DM compared the first hundred patients referred in 2017, when local guidelines for referral were first introduced, with the first hundred patients referred in 2023. Demographic data, treatment modalities, diabetic complications and co- morbidities were retrieved from our EMIS database. Compared to the 2017 cohort, patients referred in 2023 were more ethnically diverse (35% South Asian vs. 18%; p<0.01), had higher mean (SD) HbA1c levels (mmol/mol at referral 90.8 [20.6] vs. 81.5 [19.9, p <0.01), higher rates of microalbuminuria (47% vs. 28%, p=0.02),and were more likely to have three or more significant co-morbidities such as co-existent cancers or cardiovascular disease. This study highlights the growing complexity of patients referred to the community diabetes service, which impacts on the entire multidisciplinary team. Commissioners and care planners need to consider the increasing complexity of patients managed in these settings.