Growth of Structured Education for People with Type 1 Diabetes in the UK.

1
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

2
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

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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

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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

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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

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Long term data HbA1c changes in those with poor
control (HbA1c gt7.5)
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2001
2001 www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/DH_4002
951
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2003
2003 www.nice.org.uk/guidance/TA60
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2005
2005 www.diabetes.nhs.uk/Work_areas/Patient_educa
tion.asp
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Key Criteria to fulfil NICE requirements

• Patient centred philosophy
• Structured curriculum
• Trained educators
• Quality assurance
• Audit

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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

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Map showing Type 1 structured education in UK (60
centres)
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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

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Type 1 education does it work in the UK?
16
Diabetes Education NetworkAudit data

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Diabetes Education NetworkAudit data

• Collected from 7 centres
• Bristol
• Bournemouth
• Eastbourne
• Gwent
• Luton
• Peterborough
• Torquay

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HbAIc
Baseline Mean (SD) Number patients 1 year mean (SD) p value
All 8.71 (1.4) 267 8.43 lt0.001
gt 7.5 9.13 211 8.68 lt0.001
19
Weight
Baselinemean (SD) Number 1 year mean (SD) p value
Weight 75.3 Kg (15.5) 209 74.8 Kg (14.2) n/s

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Problem Area In Diabetes
Baselinemean (SD) Number 1 year mean (SD) p value

Problem Area in Diabetes (PAID) 29.5 (19.8) 177 18.3 (15.5) lt0.001
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DKA
Baseline () Number of patients 1 year ()
DKA episodes 36 (6) 290 6 (2)

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Hypoglycaemia
Baseline (no of pts) 1 year (no of pts)
Total hypos/year 410 (404) 34 (121)

Hypos -paramedic 107 0

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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

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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

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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