Transcript Welcome to DAFNE

An insight into
structured education for
people with Type 1
Diabetes
Leah McCauley & Razia Amin
DAFNE Educators
Diabetes Centre
NHS Grampian
Grampian Diabetes Professional Conference
27th May 2009
What is Structured Education?
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Patient centred philosophy
A structured written curriculum
Trained educators
Be quality assured
Be audited
NICE Guideline 60
Contents
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DAFNE
Inclusion Criteria & Referral form
Evidence
Timetable
The Course
Patient Comments
Other Structured Education Packages
Questions
Welcome to DAFNE
Background
Dose Adjustment For Normal Eating
5 day structured education for type 1 diabetes
Self management, confidence and competency
Started in UK in 2000 (Scotland in 2005)
BMJ 2002; 325; 746-751
DAFNE in Scotland
• 8 Scottish centres
• Aberdeen
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38 Courses since May 2005
286 DAFNE graduates
Currently deliver one course per month
Expanding team of DAFNE educators
Inclusion Criteria
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Type 1 diabetes - post ‘honeymoon’ period
Over age 17 years
HbA1c < 12%
Motivated to improve diabetes control
Able to read and converse English
Willing to test and inject at least 4 - 5 times a day
Able to attend a full 5 day course
Absence of ‘end-stage’ diabetes complications
8 participants per group
Referral Form
NHS GRAMPIAN
DAFNE PARTICIPATION FORM
Participants Name: ………………………………………………………………….
DAFNE CHECKLIST
Only individuals with type 1 Diabetes Mellitus who meet all the following criteria can be
considered suitable for a DAFNE course:
Able
Able to attend for a full 5 day course and follow-up sessions
Address: ………………………………………………………………………………
Over 17 years of age
…………………………………………………………………………………………..
Type 1 Diabetes for at least 6 months (and / or post
‘honeymoon’)
………………………………………………………… Post Code: ………………..
D.O.B: ……………………………………………….. Hospital No: ………………
Willing to inject up to 5 times a day (i.e. Basal Bolus regime)
Daytime Telephone No: ………………………….. Mobile No: …………………
GP Details: ……………………………………………………………………………
Willing to monitor and record Blood Glucose Levels at
Least 4 Times Daily (long-term)
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HbA1c < 12%
What do I hope to achieve from attending DAFNE education course?
Improve my knowledge of CHO counting
Absence of Late Diabetes Complications e.g. Renal
Failure
Improve my understanding of blood glucose control
Able to communicate in English
Help with insulin adjustment e.g. coping will illness, exercise
Absence of significant psychological distress
(e.g. eating disorder would be a contraindication)
Reduce the frequency of hypos
Reduce the risk of DKA (ketoacidosis)
Education prior to consideration of insulin pump therapy
Participants Signature: .......………………………………Date………………….
Pregnancy planning
HP Signature: ……………………………………………….Date………………….
Wish to improve HbA1c (average drop of 0.5% in UK Clinical trial)
Please return completed form to Aileen McKillop-Smith, Lead DAFNE Educator, Diabetes Centre,
Woolmanhill, Aberdeen, AB25 1LD
Other reason …………………………………………………………………........
-------------------------------------------------------------------------------------------------------Office Use Only
Special Requirements i.e. dietary / mobility / barriers to learning / other:
Agreed Allocation onto DAFNE
…………………………………………………………………………………………..
Employers Letter Required:
Able to Attend at Short Notice:
Original Referral Source Re: Outcome
Yes / No
Yes / No
Letter to Patient
Yes / No
Patient Commitment
• Baseline clinic visit (individual appt)
• 5 day course
• Follow up within 8 weeks post DAFNE
• Follow up within 12 months post DAFNE
• Ongoing annual review
Evidence
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0.5 % reduction in HbA1c
Improvements in QoL
No increase in hypoglycaemia
No weight gain
BMJ 2002; 325; 746-751
NICE Guideline 60, Diabetes UK report
DAFNE Timetable
Monday
Tuesday
Wednesday
Thursday
09.15-10.30
Group Discussion:
Individual blood glucose levels
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09.15-10.30
Group Discussion:
Individual blood glucose levels
09.15-10.30
Group Discussion:
Individual blood glucose levels
09.15-10.30
Group Discussion:
Individual blood
glucose levels
10.45-11.00 Coffee
10.30-10.45 Coffee
10.30-10.45 Coffee
10.30-10.45 Coffee
10.30-10.45
Coffee
11.00-12.30
NUTRITION 1
Identify carbohydrates
10.45-12.30
NUTRITION 2
Putting carbohydrate
estimation into practice
10.45-12.30
NUTRITION 3
Food Packaging
Recipes
10.45-12.30
NUTRITION 4
Alcohol
Eating out
Healthy eating/ weight
control
THEORY OF GOAL
SETTING
10.45-12.00
ANNUAL REVIEW
AND SCREENING
12.30-13.30 Lunch
12.30-13.30 Lunch
12.30-13.30 Lunch
12.30-13.30 Lunch
13.00 – 14.30
Lunch
13.30-15.00
SELF MONITORING
13.30-15.00
DAFNE INSULIN
ADJUSTMENT
13.30-15.00
HYPOGLYCAEMIA
(Relatives/partners welcome)
13.30-15.00
PHYSICAL ACTIVITY
Walk – weather depending.
14.30-15.00
QUIZ
15.00-15.15 Coffee
15.00-15.15 Coffee
15.00-15.15 Coffee
15.00 – 15.15 Coffee
15.15-16.15
ALL ABOUT INSULIN
15.15-16.15
INSULIN INJECTION
TECHNIQUE
15.15-16.15
SICK DAY RULES
15.15-16.15
SOCIAL ASPECTS
(Contraception and
pregnancy – optional)
16.15-17.00
Group Discussion:
Individual blood glucose levels
16.15-17.00
Group Discussion:
Individual blood glucose levels
16.15-17.00
Group Discussion:
Individual blood glucose levels
16.15-17.00
Group Discussion:
Individual blood glucose levels
09.15-09.45
INTRODUCTION
09.45-10.45
WHAT IS DIABETES?
Friday
12.00-13.00
QUESTIONS FOR
THE DOCTOR
GOAL SETTING
15.00-15.30
EVALUATION
AND FOLLOW UP
DAFNE Terms
• CP = Carbohydrate Portion
– 1 CP = 10 g carbohydrate (CHO)
– 1 CP increases BG by 2-3 mmol/l
• BG = Blood Glucose
• QA = Quick acting insulin
– Humalog / Novorapid / Apidra
– Lasts up to 5 hrs
• BI = Background insulin
• Ratio (QA:CP)
DAFNE Targets
Target Blood Glucose Levels
(mmol/l)
Before Breakfast
5.5 – 7.5
Before Other
Meals
4.5 – 7.5
Before Bed
6.5 – 8.0
HbA1C = 6.0 – 7.0%
The Pack
The Props!!
Patient Comments
• “…This is a must for all diabetics.”
• “Fantastic – it is like a light bulb being switched on after being in the
dark for the past 25 years.”
• “Fantastic. This week has gifted me with the tools I have been missing
over the years.”
• “To be in control of me for the first time ..”
• “I understand more about diabetes now than I managed to pick up in
twenty years.”
• “Looking forward to life now, not dreading it.”
Patient Comments
• “This course is essential. The value of the course and it’s content
cannot be underestimated.”
• “An amazing week, not only can I now eat what I want but I can live a
normal life. Suddenly diabetes is no challenge.”
• “Instead of being ruled by my diabetes I will control it.”
• “This week has taught be how to live with diabetes rather than
fighting it on a daily basis. Everyone with type 1 diabetes should have
the opportunity to live a normal life.”
Other Structured
Education Packages
• BERTIE (Bournemouth Education
Resources for Training in Insulin & Eating)
– Many similarities to DAFNE
– No RCT
– One day a week for 4 weeks
– TIM (Tayside Insulin Management)
– NEW DEAL (Forth Valley)
Other Structured
Education Packages
• RECLAIM (Royal Infirmary of Edinburgh
Carbohydrate Learning and Insulin Management)
– 2 x half day sessions
• CHO Counting Group Education Session
– Approx 3 hrs
• Don’t meet all 5 key criteria to fulfil NICE requirements of …
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A patient centred philosophy
A structured written curriculum
Trained educators
Quality assurance
Audit
Paediatric Services
• Kick-OFF (Kids in Control of Food)
– 11 – 16 yr olds
– RCT commencing
• X-Pert Junior
• Group Education Session
– CHO Counting
Questions ??
www.dafne.uk.com
www.dafneonline.co.uk
Leah McCauley
Specialist Dietitian
Diabetic Clinic
Woolmanhill
Aberdeen
Tel: (01224) 555221
Razia Amin
DSN
Diabetic Clinic
Woolmanhill
Aberdeen
Tel: (01224) 555471
[email protected]
[email protected]