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An insight into structured education for people with Type 1 Diabetes

An insight into structured education for people with Type 1 Diabetes. Leah McCauley & Razia Amin DAFNE Educators Diabetes Centre NHS Grampian Grampian Diabetes Professional Conference 27 th May 2009. What is Structured Education?. Patient centred philosophy

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An insight into structured education for people with Type 1 Diabetes

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  1. An insight into structured education for people with Type 1 Diabetes Leah McCauley & Razia Amin DAFNE Educators Diabetes Centre NHS Grampian Grampian Diabetes Professional Conference 27th May 2009

  2. What is Structured Education? • Patient centred philosophy • A structured written curriculum • Trained educators • Be quality assured • Be audited NICE Guideline 60

  3. Contents • DAFNE • Inclusion Criteria & Referral form • Evidence • Timetable • The Course • Patient Comments • Other Structured Education Packages • Questions

  4. Welcome to DAFNEBackground Dose Adjustment For Normal Eating 5 day structured education for type 1 diabetes Self management, confidence and competency Started in UK in 2000 (Scotland in 2005) BMJ 2002; 325; 746-751

  5. DAFNE in Scotland • 8 Scottish centres • Aberdeen • 38 Courses since May 2005 • 286 DAFNE graduates • Currently deliver one course per month • Expanding team of DAFNE educators

  6. Inclusion Criteria • Type 1 diabetes - post ‘honeymoon’ period • Over age 17 years • HbA1c < 12% • Motivated to improve diabetes control • Able to read and converse English • Willing to test and inject at least 4 - 5 times a day • Able to attend a full 5 day course • Absence of ‘end-stage’ diabetes complications 8 participants per group

  7. Referral Form

  8. Patient Commitment • Baseline clinic visit (individual appt) • 5 day course • Follow up within 8 weeks post DAFNE • Follow up within 12 months post DAFNE • Ongoing annual review

  9. Evidence • 0.5 % reduction in HbA1c • Improvements in QoL • No increase in hypoglycaemia • No weight gain BMJ 2002; 325; 746-751 NICE Guideline 60, Diabetes UK report

  10. DAFNE Timetable

  11. DAFNE Terms • CP = Carbohydrate Portion • 1 CP = 10 g carbohydrate (CHO) • 1 CP increases BG by 2-3 mmol/l • BG = Blood Glucose • QA = Quick acting insulin • Humalog / Novorapid / Apidra • Lasts up to 5 hrs • BI = Background insulin • Ratio (QA:CP)

  12. DAFNE Targets HbA1C = 6.0 – 7.0%

  13. The Pack

  14. The Props!!

  15. “…This is a must for all diabetics.” “Fantastic – it is like a light bulb being switched on after being in the dark for the past 25 years.” “Fantastic. This week has gifted me with the tools I have been missing over the years.” “To be in control of me for the first time ..” “I understand more about diabetes now than I managed to pick up in twenty years.” “Looking forward to life now, not dreading it.” Patient Comments

  16. “This course is essential. The value of the course and it’s content cannot be underestimated.” “An amazing week, not only can I now eat what I want but I can live a normal life. Suddenly diabetes is no challenge.” “Instead of being ruled by my diabetes I will control it.” “This week has taught be how to live with diabetes rather than fighting it on a daily basis. Everyone with type 1 diabetes should have the opportunity to live a normal life.” Patient Comments

  17. Other Structured Education Packages • BERTIE (Bournemouth Education Resources for Training in Insulin & Eating) • Many similarities to DAFNE • No RCT • One day a week for 4 weeks • TIM (Tayside Insulin Management) • NEW DEAL (Forth Valley)

  18. Other Structured Education Packages • RECLAIM (Royal Infirmary of Edinburgh Carbohydrate Learning and Insulin Management) • 2 x half day sessions • CHO Counting Group Education Session • Approx 3 hrs • Don’t meet all 5 key criteria to fulfil NICE requirements of … • A patient centred philosophy • A structured written curriculum • Trained educators • Quality assurance • Audit

  19. Paediatric Services • Kick-OFF (Kids in Control of Food) • 11 – 16 yr olds • RCT commencing • X-Pert Junior • Group Education Session • CHO Counting

  20. Questions ??

  21. Leah McCauley Specialist Dietitian Diabetic Clinic Woolmanhill Aberdeen Tel: (01224) 555221 Leah.mccauley@nhs.net Razia Amin DSN Diabetic Clinic Woolmanhill Aberdeen Tel: (01224) 555471 razia.amin@nhs.net www.dafne.uk.comwww.dafneonline.co.uk

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