1. Experiences of a Centre Fiona Hegarty Diabetes Specialist Dietitian Letterkenny General Hospital, Donegal, Ireland DEN,10 th June 2014

2. Background Acute general hospital in North West of Ireland Services population of 161,000 Diabetes population –Total - 5165 –Type two - 4414 –Type one – 751, 145 under 18yrs Diabetes Team –Consultant Endocringolist –Paediatrician, interest in Diabetes –2 WTE Diabetes Specialist Nurses –0.8 Diabetes paediatric staff nurse –0.7 Diabetes Specialist Dietitian –0.1 Paediatric Dietitian

3. Program commenced July 2011 CAWT funded project – European union funded project, Northern Ireland and border counties Designed locally by David Chaney, DSN’s, Dietitian’s and Roche To date- –Completed 14 groups –Educated 114 children Project due for completion September 2014 Hopefully will be mainstreamed in the future

4. Basics Delivered by Diabetes Specialist Nurse and Diabetes Specialist Dietitian Delivered locally within the community Children/young adults with type one diabetes 0-19 years, and their families Promoted as part of treatment but not compulsory Group sizes 6-12

5. Time line of group Child/young adult and family opt into group 3 hour sessions run on 4 consecutive weeks Group follow up at 4 weeks, commenced on Accu-chek Expert Bolus Advisor –Correction mode –Bolus advice Consultant led clinic appointment Group follow up at 6 months Support via e-mail/phone throughout

6. Week One Re-cap of Diabetes Healthy eating and diabetes Carbohydrate Counting Blood Glucose Monitoring Week Two Insulin Action and Injection Carbohydrate counting using food labels Blood Glucose correction Week Three Eating out / takeaways Hypoglycaemia Insulin Adjustment Pump Therapy Week Four Physical activity Sick day rules Travel Lifestyle/long term health Alcohol/drugs

7. Program Follow up 4 weeks, 2-3 hour session –Insulin to carbohydrate ratios and insulin sensitivity reviewed –Topics reviewed at the groups request –Commenced on Accu-Chek Bolus Advisor Follow up at 6 months, 2 hour session –Insulin to carbohydrate ratios and insulin sensitivity reviewed –Carbohydrate counting quiz –Diabetes Knowledge questionnaire

8. What worked well Relaxed learning environment Mixed groups of all ages and lengths of diagnosis Getting all family members on board Sharing experiences and establishing networks Pace of teaching dictated by group Group interaction, hands on approach

9. Group Interaction Hands on tasks and games Food models / labels Plate models Healthy eating quiz Travel bags Real Food

10. What worked well Use of flip charts and matching patient folders –New modules given out each week Getting a new meter Not having to keep a blood glucose diary –Downloads

11. Expert Downloads Actual data Real-time Trends Hypo Frequency Individual tailored advice – invaluable

12. Evening groups Rigid curriculum Paperwork! Limited administrative support Separating groups into age groups / sex Children under 7yrs attending the groups Large groups Patients travelling long distances Forgetting the kettle… Not so good…

13. Facts and Figures Attendance rates –100% attendance at the group –85% attendance at 4 week follow up –60% attendance at 6 month follow up Baseline data –At 12 months post completion, average reduction of Hba1c =0.4% Hospital in-patient days –12mths pre-course 94 hospital days –12mths post course 68 hospital days Quality of life (questionnaire at baseline,1mth and 6mths) –Definite improvement in family life concerning diabetes

14. Key areas of improvements in quality of life Improved ability to control their blood glucose levels The children/young adults feel more able to do what they needed to in order to look after their diabetes Reduction in fear regarding their diabetes e.g. hypos Overall they felt an improved ability to self manage their diabetes

15. Success Story Jason, 19 years old, diagnosed with diabetes at 5 years old Prior to CHOICE, 3 successive admissions with DKA totalling 9 hospital days, HbA1c peaked at 14.2% Completed CHOICE in 2011, he has reduced and maintained his HbA1c around 8% and has no further hospital admissions Jason now feels in control of his diabetes, enjoys the freedom surrounding his food choices and family life is much improved Mum….wants to know why it wasn’t available 10 years ago!

16. Where are we now Running 3 x 4 hrs groups over a 4 week period Mixed groups (age/sex/length of diagnosis) Children under 7yrs not required to attend Maximum group size, 8 children and their family members Ongoing amendments in accordance with latest guidelines Morning sessions Refresher days

17. We are changing the way our children and young adults think about diabetes but we have some way to go…

18. Thanks Diabetes team, Avril McCloskey DSN, Anne Griffin DSN Roche, Rhona Keaveny, Steve Williamson CAWT and CHOICE team