Transcript Introduction

Making a Young Person’s Diabetes Clinic Work
Introduction
The major toll of diabetes in terms of
morbidity, mortality and economic burden, is a
consequence of the devastating chronic
complications of the disease
Skyler, J (2004) The British Journal of Diabetes and Vascular Disease
The DCCT
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Diabetes Control and Complications Trial
(DCCT) 1983-93
Most important clinical study ever
conducted in the field of diabetes
Multi-centre trial involving 1441 patients
with Type 1 Diabetes Mellitus
The DCCT
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Age group 13-39yrs
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Participants were randomly assigned to
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Intensive insulin treatment group or
conventional insulin treatment
Elements of Intensive Therapy
Goal: to achieve normoglycaemia
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Self blood glucose monitoring (SBGM) 4-7
times/day
Four or more daily insulin injections or S/C
insulin pump therapy
Algorithms were created for adjustment of
insulin doses according to food intake and
exercise
Elements of Intensive Therapy
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Comply with a strict diet and exercise
plan
Monthly follow up by a multidisciplinary
team
Weekly telephone contact between visits
3 mthly HbA1c’s
Elements of Conventional Therapy
Goal: to maintain a clinical well being
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one/two insulin injections daily
Urine/blood glucose monitoring no more than
twice daily
Periodic dietary review
2-3 monthly clinic visits
3 mthly HbA1c’s
Findings
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The findings clearly demonstrated without
doubt that achieving blood glucose levels as
close to normal as possible slows the onset or
progression of microvascular complications
caused by diabetes……
Finding’s – HbA1c
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Intensive treatment group – 7.2%
Conventional treatment group - 9.1%
Findings
Lowering blood glucose levels reduces risk:
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Retinopathy – 76%
Nephropathy – 50%
Neuropathy – 60%
Findings
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The benefits of intensive treatment far
outweigh the risks
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Hypoglycaemia
Weight gain
A 2003 follow-up of DCCT participants also
showed that tight control reduced the risk
of atherosclerosis/CVD in type 1 diabetes
Patient centred evidence-based care
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All people with diabetes should be
informed of the DCCT findings
These findings underpin the management
of our young people with diabetes
Any improvement in their blood glucose
control is beneficial to their long-term
outcomes
Type 2 diabetes in young people
RMH Young Persons Diabetes Clinic
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Developed during mid 1980’s
Purpose
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To facilitate the smooth transition from adolescent
health care to adult health care
To educate and motivate young people to confidently
self-manage their diabetes
To reduce the risk of YP “falling through the cracks”
RMH Young Persons Diabetes Clinic
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Age group: 18-25 year olds
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Held 1st & 3rd Thursday of each month (pm)
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Multidisciplinary team: DNE, Dietitian, Drs (RMH
and RCH)
Referrals
RCH, GPs, ED, newly diagnosed type 1, newly diagnosed type 2
Issues/Barriers:
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Difficult to engage
Unfamiliar environment
Lifestyle choices
Fluctuating levels of motivation
Extended wait times in clinic
FTA rates (approximately 20%)
Aim
To effectively use the waiting time as an
opportunity to provide young adults with relevant
diabetes education and improve clinic
Re-attendance rates
Objectives
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To identify topics of interest for young adults
with diabetes
To develop educational themes based on these
topics
Encourage patients to attend future
appointments
Method
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76 young people answered a questionnaire asking
them to:
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Rate topics in order of interest
List relevant topics not included in the questionnaire
State their preferred clinic time
Text messages re-instated
Results
Outcomes - Bridging the gaps
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Education sessions addressing the areas of interest
being developed
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4 themes per year, each running for 3 months
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Provided one educational theme – Latest technology
Outcomes - Bridging the gaps
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SMS reminders being sent 2 days prior to an
appt
6 months from February 2007 to July 2007
have shown a 5% attendance improvement
compared to the same period in 2006
Assessing reminder text messages on attendance
Conclusion
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Waiting time has been used as an opportunity to
provide access to information and education
Attendance rates improved
Application of DCCT results to young adults with
type 1 diabetes remains a challenge