Growth of Structured Education for People with Type 1 Diabetes in the UK. Joan Everett (on behalf of Diabetes Education Network)

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

UK in 1997  Patients with type 1 diabetes (and professionals!) had little knowledge about Carbohydrate content of food Carbohydrate content of food Insulin dose adjustment Insulin dose adjustment Management of hypoglycaemia and hyperglycaemia Management of hypoglycaemia and hyperglycaemia Effect of exercise and other factors on blood glucose levels Effect of exercise and other factors on blood glucose levels

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

What was the outcome?  3 teams set up DAFNE (RCT) Sheffield, Kings London, Northumbria Sheffield, Kings London, Northumbria  3 teams set up their own programmes (real life experience) Oxford, Portsmouth, Bournemouth Oxford, Portsmouth, Bournemouth

Long term data: HbA1c changes in those with poor control (HbA1c >7.5%)

Key Criteria to fulfil NICE requirements  Patient centred philosophy  Structured curriculum  Trained educators  Quality assurance  Audit

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

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

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  1 st Annual Conference (Nov 2007)  2 nd December 2008

Type 1 education: does it work in the UK?

Diabetes Education Network Audit data

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

HbAIc Baseline Mean % (SD) Numberpatients 1 year mean % (SD) p value All 8.71 (1.4) <0.001 > 7.5% <0.001

Weight Baseline mean (SD) Number 1 year mean (SD) p value Weight 75.3 Kg (15.5) Kg (14.2)n/s

Problem Area In Diabetes Baseline mean (SD) Number 1 year mean (SD) p value Problem Area in Diabetes (PAID) 29.5 (19.8) (15.5)<0.001

DKA Baseline (%) Number of patients 1 year (%) DKA episodes 36 (6%) (2%)

Hypoglycaemia Baseline (no of pts) 1 year (no of pts) Total hypos/year 410 (404) 34 (121) Hypos - paramedic 1070

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 education programmes available in 2/3 of health districts Emerging framework for quality control Emerging framework for quality control

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

Acknowledgements  Diabetes Education Network steering group Sue Cradock, Suzanne Lucas, Jonathan Roland, Sean Dinneen, Bridget Turner, Helen Loughnane, Fiona Campbell, Carole Gelder 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 Bristol, Bournemouth, Eastbourne, Gwent, Luton, Peterborough and Torquay