6 It has taken a long time in gestation because of the breadth of areas needed to be covered, the need to integrate with other guidance, and the changing landscape of the NHS. Belinda Allan, Mike Sampson and colleagues are to be congratulated in producing a summary of the evidence-based economic arguments that are needed to convince the many non-clinical managers who make most of the decisions on how to run and prioritise

care in today’s NHS. In particular, the authors focus on several aspects of variations and inequalities in diabetes care across England that lead to these increased costs. Prior Obeticholic Acid solubility dmso to the introduction of the other JBDS guidelines, there was often a variation in the care offered to people with diabetes between hospitals admitted for the same condition. JBDS has produced guidelines that have reduced these variations in care (all freely available at www.diabetologists-abcd.org.uk/JBDS/JBDS.htm).

At the Diabetes UK Annual Professional Conference in 2013, Mike Sampson presented data that showed that almost every diabetes team knew of the suite of JBDS guidelines and that most trusts had either adopted them or adapted them. This was in large part because teams agreed with their contents and (with the exception of the perioperative guideline) were relatively easy to implement. It is hoped that the widespread adoption of the guidelines standardises and improves the care people receive. In this respect, the current admissions avoidance document is somewhat similar to those that have Dinaciclib mouse preceded it in that it aims to reduce these variations in care. The previous guidelines were, however, clinical. They were aimed at helping those ‘at the front door’ manage the common conditions occurring on the wards on a daily basis. The new guidelines in development – managing steroid induced hyperglycaemia, the use of variable rate intravenous insulin infusions in medical inpatients, and discharge planning selleck screening library – continue this

trend. This is where the current admissions avoidance guideline differs. It is not clinical, but collates data from numerous sources to highlight variations in practice and, where the evidence exists, highlights examples of care that have successfully helped to avoid admissions. Importantly, the document also speaks in a language less familiar to clinical teams, but very understandable to commissioners – cost and money. The current guideline is aligned with the document produced by Diabetes UK earlier in 2013 that was designed to give commissioners all they needed to know about what the components of an integrated diabetes service should be.7 That document, which had great support from several of the relevant bodies involved, summarised the components of the ‘whole systems approach’ to diabetes care.