Better Regulation Using Carbohydrate and Insulin Education: B.R.U.C.I.E Susan Diamond, Diabetes Specialist Dietitian Anne Reid, Diabetes Specialist Nurse

Objectives Primary Objective To assess if regulation using carbohydrate and insulin education will improve treatment satisfaction and quality of life for individuals with type 1 diabetes. Secondary Objectives To assess if regulation using carbohydrate and insulin education will improve biochemical parameters for individuals with type 1 diabetes including HbA1c, BMI and Waist:Hip.

Study Design This will be a randomised control study of 52 weeks A total of 36 participants will be recruited for the treatment arm of the study and 36 participants will be recruited as a control group. Descriptive statistics will be calculated for all key variables within the study. A statistical package will be used to analyse the data.

Study Population Approximately 72 participants with type 1 diabetes using an analogue insulin basal bolus regime will be recruited. 36 patients will be randomly recruited to the treatment group and 36 to the control group.

Assessments The key measures are change in treatment satisfaction and quality of life from baseline, 12 weeks and 52 weeks. Biochemical parameters will be measured. HbA1c will be analysed using DCCT aligned analysis. Waist:hip ratio and Body Mass Index will be recorded.

Methodology Treatment Group Visit 1 – one day CHO training baseline assessments for QoL/Treatment Satisfaction and clinical parameters Visit 2 – group discussion Visit 3 – group discussion, QoL/Treatment Satisfaction and clinical parameters Visit 4 – group discussion, QoL/Treatment Satisfaction and clinical parameters

Methodology Control Group Visit 1 – regular clinic visit Dietetic/DSN consultation QoL Satisfaction and clinical parameters Visit 2 – regular clinic visit (optional) Visit 3 – regular clinic visit, QoL/Treatment Satisfaction and clinical parameters Visit 4 – regular clinic visit, QoL/Treatment Satisfaction and clinical parameters

Study Materials Photographic Atlas of Food Portion Sizes B.R.U.C.I.E Carbohydrate Counting and Insulin Adjustment Workbook Stanford D. ed. (1999). The Fat, Fibre and Carbohydrate Counter: the essential guide to healthy eating. London: Murdoch Publishing. ROCHE Diagnostics Ltd Blood Glucose Diary Insulin Treatment Satisfaction (ITSQ) Questionnaire Copyright 2001 Novo Nordisk (A/S) Audit of Diabetes Dependant Quality of Life (ADDQoL) Questionnaire Prof C Bradley Patient Information and Informed Consent GP/Consultant Letter B.R.U.C.I.E Poster Patient Invitation Letter

Feedback So Far Verbal feed back from participants has been positive so far: Completely changed my life Feel liberated My expectations have been exceeded

BRUCIE Curriculum Philosophy Learning Style – Social Learning Theory (1) Lesson Plans 1. Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice Hall.

BRUCIE Philosophy To empower people living with diabetes through training and development To provide information that will allow individuals to make lifestyle choices that will have a positive impact on blood glucose To provide support and enable people to manage their lifestyles and achieve quality of life

Sample Lesson Plan (brief overview) – Insulin and Carbohydrate Process Learning Theory – Social Learning Theory Learning Objectives: 1. To understand the relationship between insulin and carbohydrate 2. To be able to identify why carbohydrate is counted 3. To be able to identify different types of carbohydrate and their effect on blood glucose

Brief Lesson Plan Insulin and Carbohydrate

Audit and Quality Self Reflection Peer Reflection Research Project Future Plans - ?? external assessment

Questions ?

Acknowledgement RECLAIM Clinic Edinburgh Royal Infirmary DAFNE Diabetes Education Network