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