DIABETES in the YOUNG Research Programme University of Dundee

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DIABETES in the YOUNGResearch ProgrammeUniversit
y of Dundee
Tayside Childrens Diabetes Team
Vicky Alexander Sue Bluff Katie Duncan Victoria
Franklin Alexandra Greene Stephen Greene Val
Ramsay Christine Sturrock Scott Wilson
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Diabetes in the Young

• Type 1 Diabetes
• SSGCYD UK Diabetes Research Network
• Digital Diabetes
• Support Network
• Foetal / Infant Origins of Adult Health
• Vascular function and lifestyle of children
• Growth of children and metabolic syndrome

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Diabetes in the Young Research Programme
Tayside, Scotland 1988-2005

• Epidemiology
• Scottish Study Group for the Care of the Young
  with Diabetes
• Diabetes Management
• SIGN
• NICE
• Clinical Care
• DiabNet (Managed Clinical Network)
• DIABAUD (National Quality Assurance Audit)
• Technology - Digital Diabetes
• CSII CGMS
• Complications
• Vascular function oxidative stress
• Concordance
• DUK Centres Study
• Telephone
• Sweet Talk

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Diabetes Research Programme UK International
1988-2005

• Research Collaboration
• ISPAD
• Under 5s Project
• 4th Annual Science School 2003
• Hvidøre Study Group
• GRID
• Pharmaceutical Companies and Industry
• Novo Nordisk
• Disetronic Medtronic Abbot
• Neurocrine Biosciences Inc
• Librae
• Diabetes UK
• Scottish Executive / QIS DIABAUD

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Scottish Study Group for the Care of the Young
with Diabetes (SSGCYD)
Age-standardised incidence rate per 100,000 by
Health Board 1984-2000
Standardised incidence rates during 1989-94 for
EURODIAB registers
Diabetologia 1983 24 238-43 Diabet Med 1988 5
160-5 Arch Dis Child 1997 77 210-3
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SSG Opportunities

• Epidemiology
• Mortality
• SSG Pregnancy
• SSG Record linkage
• Intervention Studies

Imperial College / Oxford Consortium bid for
Diabetes Research Network Coordinating Centre
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Concordance
www.st-andrews.ac.uk/nexus
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Strategy for T1 Diabetes
Trend Diabetes
Digital Diabetes
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Tayside Childrens ClinicPump Insulin Therapy
Analysis February 2005
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Pump Therapy 2000-2005
Average HbA1c 8.9 to 8.3 114 patient years
Continuing CSII
Stopped CSII
Median Min-Max 25-75
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Concordance
x
Reciprocity Matching Health Beliefs Communication
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Sweet Talk

• Innovative combination of psychological
  intervention delivered by means of IT
• Classical motivation goal setting theory
• Automated message scheduling, based on patient
  profile
• Intervention delivery using text messages - an
  integral part of teenage culture

Message SchedulingGoal based Individualised by
patient profiling Patient can create personal
messages
For further information contact
v.franklin_at_dundee.ac.uk
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Diabetes IT Network
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Diabetes IT Support Network
SUPPORT
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Developing Support Network for Diabetes with
Digital Technology

• Web Technology
• www.childrenwithdiabetes.tayside
• Information and Knowledge
• Deliver in various modalities
• Web Telephone Mobile Handheld TV
• Digital Motivation / Support
• Innovation
• Evaluation
• Quantitative and Qualitative

Content Design Platform
Cyber DARTS
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Digital Diabetes
Dialogue Diabetes
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Foetal / Infant Origins of Adult Health All
Change Study

• Vascular function and lifestyle of children
• Physiology / Lifestyle / Behaviour
• Medicine Child Health / Nutrition / Social
  Science
• Jill Belch Steve Greene Annie Anderson Alex
  Greene
• Started Sept 2004
• 4 Schools P5 Classes (Angus)
• What is the effect of Maximum lifestyle
  enhancement on vascular function?

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Foetal / Infant Origins of Adult Health Growth of
children and metabolic syndrome

• Does the Rate of Change of Body Mass Index in
  Childhood Predict Adult Metabolic Syndrome?
• CSO Application
• ISD Collaboration

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(No Transcript)
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History of the SSG Register

• Started 1984
• Aims to record all cases of diabetes in Scotland
  in children lt15 years

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SSG Register
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SSG Register

• Consent
• Following recent changes to the law, it is only
  possible to maintain the Scottish Study Group
  register (and other similar registers) with the
  explicit consent of the patients. We would be
  grateful if you would sign overleaf to indicate
  your consent.
• We hope you will join with us in trying to
  understand diabetes better, and improve the care
  we offer. If you wish to discuss this further,
  please speak to your consultant.
• The Scottish Study Group Register.
• Name
• Address
• Date of Birth
• Hospital Number
• I agree that my details be held on the Scottish
  Study Group Register, and used for the research
  purposes which have been outlined to me.
• Signature of patient (where appropriate)
  
• Signature of parent/guardian
• Date

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SSG Register - data

• 6922 patients
• 3703 males, 3218 females
• Forms of Diabetes
• Type 1
• Type 2
• CF related
• Others
• 53 deaths

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SSG Register - Uses

• DIABAUD audits
• Other studies
• Mortality Study
• Genetics study
• Seasonality of birth
• Incidence rate
• Workload

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Age-standardised incidence rate per 100,000 by
Health Board 1984-2000

• Greater Glasgow 22.6 (660)
• Dumfries Galloway 22.8 (106)
• Borders 23.3 ( 74)
• Tayside 23.5 (287)
• Lothian 24.4 (551)
• Fife 24.4 (279)
• Forth Valley 24.9 (223)
• Ayrshire Arran 25.3 (315)
• Grampian 25.9 (438)
• Lanark 26.2 (510)
• Argyll Clyde 27.9 (402)
• Shetland 30.5 ( 26)
• Highland 33.4 (234)
• Western Isles 36.7 ( 37)
• Orkney 39.1 ( 26)

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Regional rates of type 1 diabetes in UK children
(lt15 yr)
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Standardised incidence rates during 1989-94 for
EURODIAB registers
Standardised rate (per 100,000)
lt7.0
7.0 - 8.9
9.0 - 11.9
12.0 - 14.9
15.0 - 19.9
gt 20.0

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Distribution of Glycated Haemoglobin across
Scotland
Patients n1609
DIABAUD2
6
11
12
13
14
8
9
10
7
HbA1c
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Insulin Adherence
Morris et al, MEMO/DARTS 1997
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Digital Era IT Developments

• WWW
• Telephone
• SMS
• GMS
• MMS
• Linked systems

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Text Messaging Support

• Innovative combination of psychological
  intervention delivered by means of IT
• Motivation and Goal Setting Theory
• Automated message scheduling, based on patient
  profile
• Intervention delivery using text messages an
  integral part of teenage culture

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Creating a Support Network

• Knowledge

?

• Contact
• Reciprocity
• Matching Health Beliefs

How in the Resource Driven NHS?