Royal Infirmary of Edinburgh Carbohydrate Learning And Insulin Management (RECLAIM) Structured education programme for patients with insulin requiring diabetes Debbie Anderson – Dietitian Joan Allwinkle – DSN

Royal Infirmary of Edinburgh Large teaching hospital (7,000 people with diabetes) Approximately 1,500 Type 1 Many patients referred for education (1 to 1) New tools to improve control – analogues,better devices,etc Increasing evidence for structured education and CHO counting – DAFNE, BERTIE National guidelines – Scottish Diabetes Framework & Diabetes Action Plan

Reasons for referral convert to basal bolus regimen teach better matching of insulin to food provide more flexibility avoid extremes of BG levels provide an update of education

Learning in groups

RECLAIM Process Weekly group session, 7 hours 8 patients invited along Type 1 & Type 2 DSN & Dietetic led Education programme – topics covered (see handout), resources provided-based on BERTIE Follow-up 3 months – HbA1c & reflective review

RECLAIM Aims To improve diabetes management through better matching of insulin and CHO intake To enable independence and confidence in the matching of CHO foods to the insulin required To empower participants with regards to dietary freedom

RECLAIM – Audit (2005) – 38 Patients studied –Type 1 –Patient selected on: Nocturnal Hypo/erratic control –Mixed therapy (BD Mix, BD Analogue mix, free mixing, NPH and soluble/short acting analogue bolus). –Questionnaire completed at baseline and after 8 week –HbA1c baseline and 8 week.

Audit results – Clinical Pre RECLAIM 20% had HbA1c < 8% compared with 45% post RECLAIM Mean HbA1c at baseline was improved by 0.4% at 8 weeks

Audit results – Q of L Patients felt less worried about the thought of having a hypo and rarely or never ran their blood sugars higher to prevent hypos compared with pre education. Post education, patients reported more confidence in adjusting insulin for CHO & planning of meals was less obtrusive in daily life

Conclusion Our audit results show that our structured education (RECLAIM) appears to help participants manage their diabetes with more confidence resulting in better glycaemic control and offering more flexibility in lifestyle

5 years on………… Approx 900 patients seen Now reduction in numbers referred Different group being referred More referrals for re-education Further audit to be done