Structured Education for Type 1 Diabetes Ruth Miller Lead Diabetes Nurse Royal Free Hospital

background DCCT 1993 (Diabetes control & complications trial) Conclusions could be interpreted that higher level of educational input supported improved Hba1c

German Education Model In 1990’s Several UK centres visited Germany to see how the German diabetes education model worked. Their results demonstrated: Improved hba1c Reduced hypoglyceamia This led to DAFNE and programmes for T2DM with strong evidence base

Types of courses T1DM dafne & bertie T2DM desmond & Xpert

UCLH Have 408 patients DAFNE trained at UCLH. 2014: have trained 35 and running 11 courses.

RFH Have 350 patients trained on Type 1 Course 5 courses per year Structured education course for patients on insulin pump therapy 2 courses per year 40 patients annually

structured education courses What are they and how do they differ from one to one consultations? Curriculum Group effect and learning from peers Cost effective

objectives To create an open and non judgemental space where individuals can ask questions and learn from peers To question negative feelings associated with T1DM Teach the principles of matching insulin doses to meals by counting carbohydrate Provide real life experience to support people to manage diabetes in their own lives

RFH Audit 2012 140 patients audited Around 40 patients complete course annually 59% reduced HbA1c 6/12 post course average reduction 1.1% 19% Had no significant change in HbA1c Many patients referred to RFH with hypo unawareness

Audit continued.. Many patients reported improved hypo awareness post course 14% increase in HbA1c ( most of these had psychological barriers e.g depression, eating disorder, recent death of a relative or significant illness)  Quality of life scores showed significant improvements in well being and satisfaction with treatment

DOH/DUK key criteria Learning theory philosophy Curriculum Trained educators Quality assured (peer review) Audited QISMET ratification/validation quality institute for self management educating and training