1. Leah McCauley & Razia Amin DAFNE Educators Diabetes Centre NHS Grampian Grampian Diabetes Professional Conference 27 th May 2009 An insight into structured education for people with Type 1 Diabetes

2. What is Structured Education? Patient centred philosophy A structured written curriculum Trained educators Be quality assured Be audited NICE Guideline 60

3. Contents DAFNE Inclusion Criteria & Referral form Evidence Timetable The Course Patient Comments Other Structured Education Packages Questions

4. Welcome to DAFNE Background Dose Adjustment For Normal Eating 5 day structured education for type 1 diabetes Self management, confidence and competency Started in UK in 2000 (Scotland in 2005) BMJ 2002; 325; 746-751

5. DAFNE in Scotland 8 Scottish centres Aberdeen –38 Courses since May 2005 –286 DAFNE graduates –Currently deliver one course per month –Expanding team of DAFNE educators

6. Inclusion Criteria Type 1 diabetes - post ‘honeymoon’ period Over age 17 years HbA 1 c < 12% Motivated to improve diabetes control Able to read and converse English Willing to test and inject at least 4 - 5 times a day Able to attend a full 5 day course Absence of ‘end-stage’ diabetes complications 8 participants per group

7. Referral Form

8. Patient Commitment Baseline clinic visit (individual appt) 5 day course Follow up within 8 weeks post DAFNE Follow up within 12 months post DAFNE Ongoing annual review

9. 0.5 % reduction in HbA 1 c Improvements in QoL No increase in hypoglycaemia No weight gain BMJ 2002; 325; 746-751 NICE Guideline 60, Diabetes UK report Evidence

10. DAFNE Timetable MondayTuesdayWednesdayThursdayFriday 09.15-09.45 INTRODUCTION 09.15-10.30 Group Discussion: Individual blood glucose levels ` 09.15-10.30 Group Discussion: Individual blood glucose levels 09.15-10.30 Group Discussion: Individual blood glucose levels 09.15-10.30 Group Discussion: Individual blood glucose levels 09.45-10.45 WHAT IS DIABETES? 10.45-11.00 Coffee10.30-10.45 Coffee 11.00-12.30 NUTRITION 1  Identify carbohydrates 10.45-12.30 NUTRITION 2  Putting carbohydrate estimation into practice 10.45-12.30 NUTRITION 3  Food Packaging  Recipes 10.45-12.30 NUTRITION 4  Alcohol  Eating out  Healthy eating/ weight control THEORY OF GOAL SETTING 10.45-12.00 ANNUAL REVIEW AND SCREENING 12.00-13.00 QUESTIONS FOR THE DOCTOR GOAL SETTING 12.30-13.30 Lunch 13.00 – 14.30 Lunch 13.30-15.00 SELF MONITORING 13.30-15.00 DAFNE INSULIN ADJUSTMENT 13.30-15.00 HYPOGLYCAEMIA (Relatives/partners welcome) 13.30-15.00 PHYSICAL ACTIVITY Walk – weather depending. 14.30-15.00 QUIZ 15.00-15.15 Coffee 15.00 – 15.15 Coffee 15.15-16.15 ALL ABOUT INSULIN 15.15-16.15 INSULIN INJECTION TECHNIQUE 15.15-16.15 SICK DAY RULES 15.15-16.15 SOCIAL ASPECTS (Contraception and pregnancy – optional) 15.00-15.30 EVALUATION AND FOLLOW UP 16.15-17.00 Group Discussion: Individual blood glucose levels 16.15-17.00 Group Discussion: Individual blood glucose levels 16.15-17.00 Group Discussion: Individual blood glucose levels 16.15-17.00 Group Discussion: Individual blood glucose levels

11. DAFNE Terms CP = Carbohydrate Portion –1 CP = 10 g carbohydrate (CHO) –1 CP increases BG by 2-3 mmol/l BG = Blood Glucose QA = Quick acting insulin –Humalog / Novorapid / Apidra –Lasts up to 5 hrs BI = Background insulin Ratio (QA:CP)

12. DAFNE Targets Target Blood Glucose Levels (mmol/l) Before Breakfast5.5 – 7.5 Before Other Meals 4.5 – 7.5 Before Bed6.5 – 8.0 HbA 1 C = 6.0 – 7.0%

13. The Pack

14. The Props!!

15. “…This is a must for all diabetics.” “Fantastic – it is like a light bulb being switched on after being in the dark for the past 25 years.” “Fantastic. This week has gifted me with the tools I have been missing over the years.” “To be in control of me for the first time..” “I understand more about diabetes now than I managed to pick up in twenty years.” “Looking forward to life now, not dreading it.” Patient Comments

16. “This course is essential. The value of the course and it’s content cannot be underestimated.” “An amazing week, not only can I now eat what I want but I can live a normal life. Suddenly diabetes is no challenge.” “Instead of being ruled by my diabetes I will control it.” “This week has taught be how to live with diabetes rather than fighting it on a daily basis. Everyone with type 1 diabetes should have the opportunity to live a normal life.” Patient Comments

17. Other Structured Education Packages BERTIE (Bournemouth Education Resources for Training in Insulin & Eating) –Many similarities to DAFNE –No RCT –One day a week for 4 weeks –TIM (Tayside Insulin Management) –NEW DEAL (Forth Valley)

18. Other Structured Education Packages RECLAIM (Royal Infirmary of Edinburgh Carbohydrate Learning and Insulin Management) –2 x half day sessions CHO Counting Group Education Session –Approx 3 hrs Don’t meet all 5 key criteria to fulfil NICE requirements of … –A patient centred philosophy –A structured written curriculum –Trained educators –Quality assurance –Audit

19. Paediatric Services Kick-OFF (Kids in Control of Food) –11 – 16 yr olds –RCT commencing X-Pert Junior Group Education Session –CHO Counting

20. Questions ??

21. www.dafne.uk.com www.dafneonline.co.uk Leah McCauley Specialist Dietitian Diabetic Clinic Woolmanhill Aberdeen Tel: (01224) 555221 Leah.mccauley@nhs.net Razia Amin DSN Diabetic Clinic Woolmanhill Aberdeen Tel: (01224) 555471 razia.amin@nhs.net