1. The KICk-OFF study (Kids In Control Of Food) Progress towards a structured education programme Julie Knowles/Dr Kath Price Sheffield Children’s NHS Trust

2. Diabetes UK and Department of Health 2005
Recommendations/guidelines
Diabetes NSF 2001
NICE 2004 and 2004
Evidence based
Clear aims and objectives
To meet personal learning needs
Trained educators
Structured
Quality assured and audited
Diabetes UK and Department of Health 2005
DUK and DH highlighted a gap in the delivery of such education to children and adolescents and now provides quality standards for education programmes ………………….

3. DAFNE – Dose Adjustment for Normal Eating for Adults
5 day structured training programme
4-5 injections a day
4-5 blood tests a day
Free diet
Insulin dose to match carbohydrate intake
Reduce HbA1c
Improved QOL
DH has highlighted one programme that meets the criteria for type 1 diabetes …………

4. Paediatric KICk-OFF course research project
Phase 1 – Development of a curriculum
Funded by Sheffield Children’s Appeal
Phase 2 – Pilot courses, refinement of
curriculum
Grant from DUK
Phase 3 - Multicentre Randomised Control Trial
To be funded by DUK awaiting confirmation of start date

5. Development of the KICk-OFF curriculum
PDNS survey (Autumn 2002)
Focus groups
(Jan Comparing current
education programmes with DAFNE )
Lubeck, Germany (Jan. 2004)
School teachers

6. Working with school teachers
DAFNE to KICk-OFF
National schools curriculum
“Intellectual development” - growth in pupils knowledge understanding and skill
“ Social development” - growth in self esteem, self confidence, greater maturity
Office For Standards in Education (OFSTED)
Is it clear what the purpose of the lesson is?
Has the lesson taken into account the learners
needs?

7. Working with school teachers
Style of teaching (observation)
Lesson planning
Specific teaching skills
Presentation
Setting boundaries/learning environment
Reading age

8. Introduction to the course
Monday
Tuesday
Wednesday
Thursday
Friday
Introduction to the course
What is diabetes?
Group discusses
blood sugar levels
Hypoglycaemia
Discuss overnight
blood sugar levels.
How to adjust insulin
Discuss blood sugar
levels
Healthy eating/weight
control
Sweets, treats and
snacks
[Friends invited]
Discuss overnight blood sugar
levels.
Friends recap what is diabetes
Everyone discusses using
Kick-Off in school
Break
Signs and symptoms,
Insulin
Types of food and CP’s
CP booklet and diary
Insulin/CHO relationship
Hypoglycaemia and
Kick-off treatment
CP/insulin ratio
Work out CP’s for
packed lunch
How to manage
illness using
KICkOFF guidelines
Alcohol and social
issues
Poster display
Exercise [theory]
Managing hypos in and out of
school
Puberty awareness and control
What happens next?
Follow-up after the course
Discuss school packs
Recap weeks learning objectives
Evaluation
Lunch
Packed lunch
Lunch - buffet
Insulin/CHO
continued
Correction dose
Monitoring
Practicing counting
grams of CHO +
practical
Diabetes and long
term health
discussion
Healthy lifestyle vs
unhealthy
Exercise
Practical session.
Parents will discuss follow-up
care, discussion about the week
and continued support
Children do fun activity
Millionaire game
Recapping the days
objectives
Plan evening insulin dose.
Personal interviews
Practical session continued
Quiz
Prepare food for
parents
Recap objectives of
the day
Plan evening insulin dose
Students to plan
evening insulin dose
Free session for guest
speaker or other
activity
Continued
Presentation of quiz winners
Finish

9. Day 2, session 2. Counting grams of carbohydrate
TUESDAY
Session 2:-
Counting grams of carbohydrate
 Practical session
Learning Objectives
Continue with carbohydrate and insulin ratios
Continuing with learning the skills for counting grams of carbohydrate
Materials
Scales
Food ingredients
Recipes
Flip chart
Pens
Diaries
Work sheets
Calculators
Plates
Kitchen equipment
Digital scales
Pots and pans
Baking tins
Washing up materials
(tea towels, cloths, washing up liquid)

10. Group to split into pairs and they are each given a recipe Response:
Educator
Dietitian and nurse
Preparation
Transport children to school cookery room. Set up the work stations with foods needed for recipes.
TIME
EDUCATOR
ACTIVITY
STUDENT
MATERIALS
11am
Explain:-
This session is a practical session to learn how to work out how much CHO is in the food you prepare.
Group to split into pairs and they are each given a recipe
Response:
Split into pairs but not the same pairs as the morning
Follow recipes
Tidy up after the food is prepared
Complete work sheet
4 recipes for
fruit muffins
fruit scones jam and butter
scales
Paper plates
ingredients
utensils
Calculators
Pens
Flip charts
Worksheet for estimating CP’s in rice, pasta, potato, cereals.

11. Pilot Study 2004 8 per course, 11-13 and 14-16 yr
2 research educators and 1 local
educator
3 Paediatric centres Sheffield,
Manchester and Derby
Training the trainers course
Sheffield Hallam University
3 days (2 theory, 1 practical)

12. EVALUATION Teaching, curriculum, course format :
independent peer review
interview
daily feedback questionnaire
Effectiveness:
HbA1c pre course , 3 and 6 months
hypoglycaemia rates
BMI
Psychological outcome at 0, 2 weeks, 3 and 6 months
QoL
Satisfaction with treatment
family conflict
self management responsibility
self efficacy

14. Table 1. Mean HbA1c Values Over Time
Baseline
3-months
6-months
Mean (sd)
8.58 (1.80)
8.72 (1.98)
8.69 (1.98)
More mild hypo’s
No more moderate or severe hypo episodes
No significant change BMI

15. QOL: Diabetes QOL: Generic Children F(3,81)=8.00,p=.0001*** Parents

16. Psychosocial Outcomes for child and parent
Satisfaction with Treatment:
Greater satisfaction with diabetes treatment after the course.
Self-Efficacy:
Children more confident managing their diabetes after the course.
Family Conflict:
no significant change (minimal before and after course).
Parent-child Responsibility:
more responsibility for managing diabetes after the course.
Coping with Diabetes:
more able to cope after the course.

17. Changes to the course: Venue
Timings of difficult sessions- in the first 2 sessions
More practical sessions
Specific parent teaching – 1 day teaching course
Improved school support
Follow-up
Interactive booklet
More CHO/Ratio practice
5 day skills training programme for educators

18. Multi-centre cluster randomised controlled trial comparing
intensive education with standard education in year olds on
intensive insulin therapy.
Sponsored by DUK
36 UK paediatric diabetes clinics (576 total participants)
18 intervention/18 control – both using MDI
2 year follow-up
Control group receives skills training course and KICk-OFF curriculum
Outcomes measured at 0, 6, 12, 24 months:-
HbA1c
Psychological outcomes
Hypoglycaemia episodes
DKA
BMI
Diet related behaviours