Experiences of a Centre

Fiona Hegarty Diabetes Specialist Dietitian Letterkenny General Hospital, Donegal, Ireland DEN,10 th June 2014

Background

• Acute general hospital in North West of Ireland • Services population of 161,000 • Diabetes population – Total - 5165 – Type two - 4414 – Type one – 751, 145 under 18yrs • Diabetes Team – Consultant Endocringolist – Paediatrician, interest in Diabetes – 2 WTE Diabetes Specialist Nurses – 0.8 Diabetes paediatric staff nurse – 0.7 Diabetes Specialist Dietitian – 0.1 Paediatric Dietitian

• Program commenced July 2011 • CAWT funded project – European union funded project, Northern Ireland and border counties • Designed locally by David Chaney, DSN’s, Dietitian’s and Roche • To date – Completed 14 groups – Educated 114 children • Project due for completion September 2014 • Hopefully will be mainstreamed in the future

Basics

• Delivered by Diabetes Specialist Nurse and Diabetes Specialist Dietitian • Delivered locally within the community • Children/young adults with type one diabetes 0-19 years, and their families • Promoted as part of treatment but not compulsory • Group sizes 6-12

Time line of group

• Child/young adult and family opt into group • 3 hour sessions run on 4 consecutive weeks • Group follow up at 4 weeks, commenced on Accu-chek Expert Bolus Advisor –

Correction mode

–

Bolus advice

• Consultant led clinic appointment • Group follow up at 6 months • Support via e-mail/phone throughout

Week One Re-cap of Diabetes Healthy eating and diabetes Carbohydrate Counting Blood Glucose Monitoring Week Three Eating out / takeaways Hypoglycaemia Insulin Adjustment Pump Therapy Week Two Insulin Action and Injection Carbohydrate counting using food labels Blood Glucose correction Week Four Physical activity Sick day rules Travel Lifestyle/long term health Alcohol/drugs

Program

• Follow up 4 weeks, 2-3 hour session – Insulin to carbohydrate ratios and insulin sensitivity reviewed – Topics reviewed at the groups request – Commenced on Accu-Chek Bolus Advisor • Follow up at 6 months, 2 hour session – Insulin to carbohydrate ratios and insulin sensitivity reviewed – Carbohydrate counting quiz – Diabetes Knowledge questionnaire

What worked well

• Relaxed learning environment • Mixed groups of all ages and lengths of diagnosis • Getting all family members on board • Sharing experiences and establishing networks • Pace of teaching dictated by group • Group interaction, hands on approach

Group Interaction

Hands on tasks and games

• Food models / labels • Plate models • Healthy eating quiz • Travel bags • Real Food

What worked well

• Use of flip charts and matching patient folders – New modules given out each week • Getting a new meter • Not having to keep a blood glucose diary – Downloads

Expert Downloads

• Actual data • Real-time • Trends • Hypo Frequency • Individual tailored advice – invaluable

Not so good…

• Evening groups • Rigid curriculum • Paperwork! Limited administrative support • Separating groups into age groups / sex • Children under 7yrs attending the groups • Large groups • Patients travelling long distances • Forgetting the kettle…

Facts and Figures

• Attendance rates – 100% attendance at the group – 85% attendance at 4 week follow up – 60% attendance at 6 month follow up • Baseline data – At 12 months post completion, average reduction of Hba1c =0.4% • Hospital in-patient days – 12mths pre-course 94 hospital days – 12mths post course 68 hospital days • Quality of life (questionnaire at baseline,1mth and 6mths) – Definite improvement in family life concerning diabetes

Key areas of improvements in quality of life

• Improved ability to control their blood glucose levels • The children/young adults feel more able to do what they needed to in order to look after their diabetes • Reduction in fear regarding their diabetes e.g. hypos • Overall they felt an improved ability to self manage their diabetes

Success Story

• Jason, 19 years old, diagnosed with diabetes at 5 years old • Prior to CHOICE, 3 successive admissions with DKA totalling 9 hospital days, HbA1c peaked at 14.2% • Completed CHOICE in 2011, he has reduced and maintained his HbA1c around 8% and has no further hospital admissions • Jason now feels in control of his diabetes, enjoys the freedom surrounding his food choices and family life is much improved • Mum….wants to know why it wasn’t available 10 years ago!

Where are we now

• Running 3 x 4 hrs groups over a 4 week period • Mixed groups (age/sex/length of diagnosis) • Children under 7yrs not required to attend • Maximum group size, 8 children and their family members • Ongoing amendments in accordance with latest guidelines • Morning sessions • Refresher days

We are changing the way our children and young adults think about diabetes but we have some way to go…

Thanks

• Diabetes team, Avril McCloskey DSN, Anne Griffin DSN • Roche, Rhona Keaveny, Steve Williamson • CAWT and CHOICE team