The role of diabetes specialist nurses in secondary care settings

Within secondary care, diabetes specialist nurses (DSNs) often have responsibilities in both inpatient and outpatient settings, as part of a wider multidisciplinary team (MDT). With the diabetes prevalence increasing, along with the complexity in diabetes presentation, the role of DSNs is more crucial than ever.

Precise routines will vary, but DSNs will review referrals made by ward-based staff, and triage these, so that some will be reviewed by doctors and others by nurses. The types of referrals cover the spectrum of the inpatient journey, from admission to discharge. Referrals at the admission stage include patients presenting with a new diabetes diagnosis, with diabetic ketoacidosis (DKA), with hypoglycaemia, in hyperosmolar hyperglycaemic state (HHS) or with suboptimally controlled diabetes. During an admission, patients can be referred due to persistent hyper- or hypoglycaemia, for advice on insulin dose titration, more complex issues such as feed or steroid-related hyperglycaemia, including checkpoint-inhibitor related diabetes, and support for using an insulin pump. Referrals can be about pre-operative advice and end-of-life diabetes care and towards the end of the patient journey, they may require education prior to discharge.