Alphabet strategy for diabetes care: A checklist approach in the time of COVID-19 and beyond

Abstract

Chronic disease management requires achievement of critical individualised targets to mitigate again long-term morbidity and premature mortality associated with diabetes mellitus. The responsibility for this lies with both the patient and health care professionals. Care plans have been introduced in many healthcare settings to provide a patient-centred approach that is both evidence-based to deliver positive clinical outcomes and allow individualised care. The Alphabet strategy (AS) for diabetes is based around such a care plan and has been evidenced to deliver high clinical standards in both well-resourced and under-resourced settings. Additional patient educational resources include special care plans for those people with diabetes undertaking fasting during Ramadan, Preconception Care, Prevention and Remission of Diabetes. The Strategy and Care Plan has facilitated evidence-based, cost-efficient multifactorial intervention with an improvement in the National Diabetes Audit targets for blood pressure, cholesterol levels and glycated haemoglobin. Many of these attainments were of the standard seen in intensively treated cohorts of key randomized controlled trials in diabetes care such as the Steno-2 and United Kingdom Prospective Diabetes Study. This is despite working in a relatively under-resourced service within the United Kingdom National Health Service. The AS for diabetes care is a useful tool to consider for planning care, education of people with diabetes and healthcare professional. During the time of the coronavirus disease 2019 pandemic the risk factors for the increased mortality observed have to be addressed aggressively. The AS has the potential to help with this aspiration.

Keywords: Alphabet strategy; COVID-19; Care planning; Chronic disease; Diabetes care; Multifactorial interventions; Patient care

Core Tip: The alphabet strategy for diabetes care is a very useful tool for the effective long-term management of patients with diabetes. It is based on; advice on lifestyle, blood pressure targets, cholesterol targets and chronic kidney disease prevention, diabetes control, eyecare, footcare, guardian drugs where indicated. This is achieved through an approach that is similar for both health care professionals (HCP) and patients. This is achieved through care planning, HCP guidelines and specialised care plans (for Ramadan, for example). It is an evidence based, patient centred, health care professional assisted, low-cost approach for treatment of diabetes and prevention of long-term diabetes complications.