Transcript Intensive Management of Type 1 diabetes – more than just

Growth of Structured
Education for People with
Type 1 Diabetes in the UK.
Joan Everett (on behalf of Diabetes
Education Network)
www.diabetes-education.net
Background





In 1990 the UK abandoned carbohydrate
estimation as a tool for management of type 1
diabetes
Emphasis on healthy eating and adjusting
insulin dose according to “trends” in blood
glucose
No specific advice given on dose adjustment
Many patients stayed on 2 injections
Result: erratic control, hypoglycaemia and
high HbA1c
UK in 1997
 Patients
with type 1 diabetes (and
professionals!) had little knowledge about




Carbohydrate content of food
Insulin dose adjustment
Management of hypoglycaemia and
hyperglycaemia
Effect of exercise and other factors on blood
glucose levels
What did UK do?
4
teams visited 5 day inpatient education
programme in Dusseldorf
Sheffield, Kings London, Northumbria and
Bournemouth
 2 teams visited education programmes in
USA
Oxford and Portsmouth
What was the outcome?
3

teams set up DAFNE (RCT)
Sheffield, Kings London, Northumbria
3
teams set up their own programmes
(real life experience)

Oxford, Portsmouth, Bournemouth
Long term data: HbA1c changes in
those with poor control (HbA1c >7.5%)
9.5
DAFNE (n=135)
HbA1c
BERTIE (n=93)
DTTP (n=636)
9
8.5
8
7.5
7
Baseline
1y
2y
3y
4y
time since education
5y
6y
2001
2001
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002951
2003
2003
www.nice.org.uk/guidance/TA60
2005
2005 www.diabetes.nhs.uk/Work_areas/Patient_education.asp
Key Criteria to fulfil NICE
requirements
 Patient
centred philosophy
 Structured curriculum
 Trained educators
 Quality assurance
 Audit
Diabetes Education Network
 Founded
in 2003 to support diabetes
teams in developing programmes to meet
national guidelines
 Now over 60 centres from all parts of the
UK
Map showing Type 1 structured education in UK (60 centres)
Diabetes Education Network

Founded in 2003 to support diabetes teams in
developing programmes to meet national guidelines
 Now over 60 centres from all parts of the UK
 Regional workshops covering philosophy, learning
theory and curriculum development
 Web-based audit
 Regional meetings in N.Ireland, Scotland and Wales
 1st Annual Conference (Nov 2007)
 2nd December 2008
Type 1 education: does it work
in the UK?
Diabetes Education Network
Audit data
Diabetes Education Network
Audit data
 Collected







from 7 centres
Bristol
Bournemouth
Eastbourne
Gwent
Luton
Peterborough
Torquay
HbAIc
Baseline Number 1 year p value
Mean % patients mean %
(SD)
(SD)
All
8.71
(1.4)
267
8.43
<0.001
> 7.5% 9.13
211
8.68
<0.001
Weight
Weight
Baseline Number
mean
(SD)
1 year
mean
(SD)
p value
75.3 Kg
(15.5)
74.8 Kg
(14.2)
n/s
209
Problem Area In Diabetes
Baseline Number
mean
(SD)
Problem 29.5
Area in (19.8)
Diabetes
(PAID)
177
1 year
mean
(SD)
p value
18.3
(15.5)
<0.001
DKA
DKA
episodes
Baseline
(%)
Number of
patients
1 year (%)
36 (6%)
290
6 (2%)
Hypoglycaemia
Total
hypos/year
Hypos paramedic
Baseline
(no of pts)
410 (404)
1 year
(no of pts)
34 (121)
107
0
Summary

Education for type 1 diabetes patients has improved due
to political and clinical influence
 DEN has been successful in supporting and training
teams to deliver structured education for type 1 patients
 Audit data shows reduced HbAIc, DKA and
hypoglycaemia episodes and an improved quality of life
 Good progress has been made since 2000


education programmes available in 2/3 of health districts
Emerging framework for quality control
Next steps
 To
integrate ongoing education into long
term follow up (“educational model of care”)
 To
ensure availability of education in all
areas
 To
develop generic accreditation for
centres and educators
Acknowledgements

Diabetes Education Network steering group


Sue Cradock, Suzanne Lucas, Jonathan Roland,
Sean Dinneen, Bridget Turner, Helen Loughnane,
Fiona Campbell, Carole Gelder
Centres who entered data

Bristol, Bournemouth, Eastbourne, Gwent, Luton,
Peterborough and Torquay