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UK in 1997 Patients with type 1 diabetes (and professionals!) had little knowledge about Carbohydrate content of food Carbohydrate content of food Insulin dose adjustment Insulin dose adjustment Management of hypoglycaemia and hyperglycaemia Management of hypoglycaemia and hyperglycaemia Effect of exercise and other factors on blood glucose levels Effect of exercise and other factors on blood glucose levels
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Growth of Structured Growth of Structured Education for People with Education for People with
Type 1 Diabetes in the UK.Type 1 Diabetes in the UK.
Joan Everett Joan Everett (on behalf of Diabetes (on behalf of Diabetes Education Network)Education Network)
www.diabetes-education.netwww.diabetes-education.net
BackgroundBackground
In 1990 the UK abandoned carbohydrate In 1990 the UK abandoned carbohydrate estimation as a tool for management of type 1 estimation as a tool for management of type 1 diabetesdiabetes
Emphasis on healthy eating and adjusting insulin Emphasis on healthy eating and adjusting insulin dose according to “trends” in blood glucosedose according to “trends” in blood glucose
No specific advice given on dose adjustmentNo specific advice given on dose adjustment Many patients stayed on 2 injectionsMany patients stayed on 2 injections Result: erratic control, hypoglycaemia and high Result: erratic control, hypoglycaemia and high
HbA1cHbA1c
UK in 1997UK in 1997
Patients with type 1 diabetes (and Patients with type 1 diabetes (and professionals!) had little knowledge aboutprofessionals!) had little knowledge about Carbohydrate content of foodCarbohydrate content of food Insulin dose adjustmentInsulin dose adjustment Management of hypoglycaemia and Management of hypoglycaemia and
hyperglycaemiahyperglycaemia Effect of exercise and other factors on blood Effect of exercise and other factors on blood
glucose levelsglucose levels
What did UK do?What did UK do?
4 teams visited 5 day inpatient education 4 teams visited 5 day inpatient education programme in Dusseldorf programme in Dusseldorf Sheffield, Kings London, Northumbria and Sheffield, Kings London, Northumbria and BournemouthBournemouth
2 teams visited education programmes in 2 teams visited education programmes in USA USA Oxford and PortsmouthOxford and Portsmouth
What was the outcome?What was the outcome?
3 teams set up DAFNE (RCT)3 teams set up DAFNE (RCT) Sheffield, Kings London, NorthumbriaSheffield, Kings London, Northumbria
3 teams set up their own programmes 3 teams set up their own programmes (real life experience)(real life experience) Oxford, Portsmouth, BournemouthOxford, Portsmouth, Bournemouth
Long term data:Long term data: HbA1c changes in HbA1c changes in those with those with poorpoor control (HbA1c control (HbA1c >7.5>7.5%)%)
7
7.5
8
8.5
9
9.5
Baseline 1y 2y 3y 4y 5y 6ytime since education
HbA1c DAFNE (n=135) BERTIE (n=93) DTTP (n=636)
20012001
2001 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002951
20032003
2003 www.nice.org.uk/guidance/TA60
20052005
2005 www.diabetes.nhs.uk/Work_areas/Patient_education.asp
Key Criteria to fulfil NICE Key Criteria to fulfil NICE requirementsrequirements
Patient centred philosophyPatient centred philosophy Structured curriculumStructured curriculum Trained educatorsTrained educators Quality assuranceQuality assurance AuditAudit
Diabetes Education NetworkDiabetes Education Network
Founded in 2003 to support diabetes Founded in 2003 to support diabetes teams in developing programmes to meet teams in developing programmes to meet national guidelinesnational guidelines
Now over 60 centres from all parts of the Now over 60 centres from all parts of the UK UK
Map showing Type 1 structured education in UK (60 centres)
Diabetes Education NetworkDiabetes Education Network
Founded in 2003 to support diabetes teams in Founded in 2003 to support diabetes teams in developing programmes to meet national guidelinesdeveloping programmes to meet national guidelines
Now over 60 centres from all parts of the UKNow over 60 centres from all parts of the UK Regional workshops covering philosophy, learning Regional workshops covering philosophy, learning
theory and curriculum development theory and curriculum development Web-based audit Web-based audit Regional meetings in N.Ireland, Scotland and WalesRegional meetings in N.Ireland, Scotland and Wales 11stst Annual Conference (Nov 2007) Annual Conference (Nov 2007) 22ndnd December 2008 December 2008
Type 1 education: does it work Type 1 education: does it work in the UK?in the UK?
Diabetes Education NetworkDiabetes Education NetworkAudit dataAudit data
Diabetes Education NetworkDiabetes Education NetworkAudit dataAudit data
Collected from 7 centresCollected from 7 centres BristolBristol BournemouthBournemouth EastbourneEastbourne GwentGwent LutonLuton PeterboroughPeterborough TorquayTorquay
HbAIcHbAIc
BaselineBaselineMean % Mean % (SD)(SD)
NumberNumberpatientspatients
1 year 1 year mean % mean % (SD)(SD)
p valuep value
AllAll 8.71 8.71 (1.4)(1.4)
267267 8.438.43 <0.001<0.001
> 7.5%> 7.5% 9.139.13 211211 8.688.68 <0.001<0.001
WeightWeight
BaselineBaselinemean mean (SD)(SD)
NumberNumber 1 year 1 year mean mean (SD)(SD)
p valuep value
WeightWeight 75.3 Kg75.3 Kg(15.5)(15.5)
209209 74.8 Kg74.8 Kg(14.2)(14.2)
n/sn/s
Problem Area In DiabetesProblem Area In Diabetes
BaselineBaselinemean mean (SD)(SD)
NumberNumber 1 year 1 year mean mean (SD)(SD)
p valuep value
Problem Problem Area in Area in DiabetesDiabetes(PAID)(PAID)
29.5 29.5 (19.8)(19.8)
177177 18.318.3(15.5)(15.5)
<0.001<0.001
DKADKA
Baseline Baseline (%) (%)
Number of Number of patientspatients
1 year (%)1 year (%)
DKA DKA episodesepisodes
36 (6%)36 (6%) 290290 6 (2%)6 (2%)
HypoglycaemiaHypoglycaemia
BaselineBaseline(no of pts)(no of pts)
1 year1 year(no of pts)(no of pts)
Total Total hypos/yearhypos/year
410 (404)410 (404) 34 (121)34 (121)
Hypos -Hypos -paramedicparamedic
107 107 00
SummarySummary
Education for type 1 diabetes patients has improved due Education for type 1 diabetes patients has improved due to political and clinical influenceto political and clinical influence
DEN has been successful in supporting and training DEN has been successful in supporting and training teams to deliver structured education for type 1 patientsteams to deliver structured education for type 1 patients
Audit data shows reduced HbAIc, DKA and Audit data shows reduced HbAIc, DKA and hypoglycaemia episodes and an improved quality of lifehypoglycaemia episodes and an improved quality of life
Good progress has been made since 2000Good progress has been made since 2000 education programmes available in 2/3 of health districtseducation programmes available in 2/3 of health districts Emerging framework for quality control Emerging framework for quality control
Next stepsNext steps
To integrate ongoing education into long To integrate ongoing education into long term follow up (“educational model of care”)term follow up (“educational model of care”)
To ensure availability of education in all To ensure availability of education in all areasareas
To develop generic accreditation for To develop generic accreditation for centres and educatorscentres and educators
AcknowledgementsAcknowledgements
Diabetes Education Network steering groupDiabetes Education Network steering group Sue Cradock, Suzanne Lucas, Jonathan Roland, Sue Cradock, Suzanne Lucas, Jonathan Roland,
Sean Dinneen, Bridget Turner, Helen Loughnane, Sean Dinneen, Bridget Turner, Helen Loughnane, Fiona Campbell, Carole GelderFiona Campbell, Carole Gelder
Centres who entered dataCentres who entered data Bristol, Bournemouth, Eastbourne, Gwent, Luton, Bristol, Bournemouth, Eastbourne, Gwent, Luton,
Peterborough and TorquayPeterborough and Torquay