• diabetes;
  • health care commissioning;
  • admissions avoidance;
  • diabetes specialist nurse;
  • telemedicine


This study aimed to describe a diabetes specialist nurse (DSN) telemedicine advice service in a university hospital diabetes service in terms of the payment by results (PbR) tariff costs, potential admissions avoidance and casemix.

The source, purpose, duration, outcome and patient age were recorded prospectively over 12 months for every patient-initiated, diabetes-related telephone consultation.

In all, 5703 patient-initiated telephone consultations were recorded. Of these, 3459 (60.7%) involved insulin dose management for those receiving insulin therapy for longer than six months. In contrast, 530 (9.3%) consultations covered dose adjustment for individuals started on insulin therapy within the previous six months. A total of 235 (4.1%) consultations involved managing insulin, food and fluid intake during intercurrent illness (‘sick day’ advice) – 103 (1.8%) with ketonuria and 132 (2.3%) without ketonuria. Of these, only 17 required referral to their general practitioner for review for a hospital admission, representing 218 potentially avoided admissions over the study period. Individuals over 60 years of age accounted for 3610 (63.3%) consultations. The PbR tariff for each telephone consultation was £23 ($37.66; €26.10), with an estimated annual cost of £131 169 ($214 781; €148 908). The national average unit costs (for 2008–09) for an emergency long-stay admission related to dysglycaemia range from £846 ($1384; €961) to £2634 ($4311; €2991), representing potential cost savings of between £179 414 ($293 759; €203 715) and £569 198 ($932 008; €646 400) for these 218 avoided admissions.

In conclusion, DSNs provide hundreds of hours of telephone advice annually that improve ongoing diabetes care and represent a cost-effective method of reducing the number of acute hospital admissions. Copyright © 2012 John Wiley & Sons.