3 Dimensions of Care for Diabetes: integrating diabetes care into an individual's world

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3DFD (3 Dimensions of Care for Diabetes) is an award winning gold-standard model of integrated care, which was developed and evaluated as a sustainable service for improving glycaemic control and reducing diabetes complications in South London's multi-ethnic, socio-economically disadvantaged and growing diabetes population. This service is fully integrated into the diabetes services across Lambeth and Southwark boroughs. It consists of a liaison psychiatrist who provides clinical leadership and psychiatric interventions, psychologists and two third-sector social support workers who provide social care in the community, working directly with the diabetes teams across the sectors.3DFD has completed two consecutive pilot phases during which the components of the service have been refined and effectiveness demonstrated. We found high levels of mental illness and unmet need, and effected improvements in glycaemic control, psychological status and health service use. We have produced outcomes which compare favourably with new antidiabetic medications to the market and to the outcomes of the local intermediate teams. We believe this provides the best possible model of care for patients with persistent poor diabetes control despite implementing standard pathways.The full economic evaluation is in progress and preliminary analyses indicate that there will be an annual saving of £33 000, based on the reduction in HbA1c from the first pilot. Copyright © 2015 John Wiley & Sons.

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