HNY Policy and Pathway Repository - Humber

A clinical service that brings together diabetes, eating disorders and mental health care under one team. The aim of the service is to help patients with Type 1 diabetes and an eating disorder to manage their diabetes safely while engaging in treatment for their eating disorder and at the same time improve their mental health.

Referral should be made for people over 18 with T1D who present with all 3 criteria:

1. Intense fear of gaining weight, or body image concerns, or fear of insulin promoting weight gain.
2. Recurrent inappropriate direct or indirect* restriction of insulin (and/or other compensatory behaviour**) to prevent weight gain.
3. Presenting with a degree of insulin restriction, eating or compensatory behaviours that cause at least one of the following: 
   • harm to health 
   • clinically significant diabetes distress 
   • impairment on daily functioning. 

* Indirect restriction of insulin refers to reduced insulin need/use due to significant carbohydrate restriction. 
** Dietary restriction, self-induced vomiting, laxative use, excessive exercise, over-use of thyroid hormones, over-use of diabetes medication believed to avoid weight gain or promote weight loss.

Guidance on Recognising and Managing Medical Emergencies in Eating Disorders (Annexe 3) college-report-cr233---annexe-3.pdf (rcpsych.ac.uk)

Signs and Symptoms which may indicate T1DE:

• Increase in HbA1c or erratic blood glucose levels
• Multiple diabetic ketoacidosis (DKA) or near DKA Episodes
• Dietary restriction or binge eating
• Secrecy about diabetes management
• Weight loss history or fear of weight gain
• Disengagement from services
• Diabetes distress
• Fear of hypoglycaemia
• Depression and anxiety
• Concerns about body image

Exclude Red Flag symptoms

Exclusion criteria:

• Type 2 diabetes
• Under 18
• Pregnant (managed under Diabetes Maternity Clinic at Women and Children’s Hospital)

DO NOT REFER

Don’t refer if patient has Type 2 diabetes.

If not diagnosed with Type 1 Diabetes, don’t refer to T1DE.

Eating disorders: recognition and treatment (NG69): https://www.nice.org.uk/guidance/ng69

Guidance on Recognising and Managing Medical Emergencies in Eating Disorders college-report-cr233-medical-emergencies-in-eating-disorders-(meed)-guidance.pdf (rcpsych.ac.uk)

Guidance on Recognising and Managing Medical Emergencies in Eating Disorders (Annexe 3 – Type 1 Diabetes and Eating Disorders) college-report-cr233---annexe-3.pdf (rcpsych.ac.uk)

You can contact the T1DE service via phone or email for advice and guidance if you are concerned about a patient or unsure if they meet criteria.

Patients can find out further information: https://www.chcpcic.org.uk/chcp-services/evolve/pages/t1de 

Referrals to the T1DE service are only accepted from:

• Evolve Eating Disorder service
• East Riding Diabetes team
• Hull Diabetes team
• Self referral via online form, for patients who have a Hull or East Riding GP

If patient meets criteria for T1DE (or is suspected), refer to Evolve service or relevant Diabetes service and mark as T1DE.

Referral criteria:

• Over 18
• Registered with a GP in Hull or East Riding
• Not pregnant
• Have Type 1 Diabetes and all of the following symptoms:

1. Intense fear of gaining weight, or body image concerns, or fear of insulin promoting weight gain.

2. Recurrent inappropriate direct or indirect* restriction of insulin (and/or other compensatory behaviour**) to prevent weight gain.

3. Presenting with a degree of insulin restriction, eating or compensatory behaviours that cause at least one of the following:

• harm to health

• clinically significant diabetes distress

• impairment on daily functioning.

* Indirect restriction of insulin refers to reduced insulin need/use due to significant carbohydrate restriction.

** Dietary restriction, self-induced vomiting, laxative use, excessive exercise, over-use of thyroid hormones, over-use of diabetes medication believed to avoid weight gain or promote weight loss.

Information to Include

• Eating Disorder behaviours
• medical risk information
• mental health risk information
• any medications
• any other services involved
• diabetes complications or risks
• patient consent to referral

MSCOFF

T1DE external referral pathway

T1DE Service patient process

Guidnce on recognsing and Managing Medival Emergencies

T1DE SERVICE PROMO LEFLET

You can contact the T1DE service via phone or email for advice and guidance if you are concerned about a patient or unsure if they meet criteria for T1DE. chcp.t1deservice@nhs.net Address: Evolve, The Calvert Centre, 110A Calvert Lane HU4 6BH; Telephone 01482 344083

Patients can be seen in a variety of settings: The Allam Diabetes Centre, at home, Evolve Eating Disorder service (Calvert Centre), in community locations

Patients may receive treatments face to face, by video, or telephone depending on choice

Patients may see a number of different clinicians at the same time, depending on their need or choice.

For patients under the T1DE service their medical monitoring of their eating disorder and diabetes will be held by the T1DE service and this will be communicated back to the GP.