- What is diabetes education
- DAFNE in brief
- DAFNE in detail
- XPERT none-insulin users
- XPERT insulin users
- A patients story...link
- a buddy
Diabetes is a big challenge if you want to achieve good control. The NHS and experts around the world recommend that everyone in diabetes understands their condition, and understands how to prevent complications. They need to know what to do is something goes wrong, and how to adjust their insulin is they use it.
|Diabetes education courses|
These are very very important programs that should be made available by GPs. Very few general practices provide such training. The NHS diabetes framework strongly advises such a course is made available to patients, and I believe patients should insist they attend one. Eventually they should be available to all people with diabetes near home. Ophthalmologists should be involved. Only 1/100 patients have attended a structured education program such as DAFNE or DESMOND, despite this being an NSF target from about 2005 (Liverpool 2007). UK diabetic paediatric clinics generally have much worse blood results than those such as Yale. Good communiciation is important BMJ 2012ed.
Diabetes education courses can be very helpful
DAFNE is a way of managing Type 1 diabetes and provides people with the skills necessary to estimate the carbohydrate in each meal and to inject the right dose of insulin.
improvement in HbA1c after attending a DAFNE program
DAFNE is based on:
- 2 injections of long-acting (Background) insulin each day
- Injecting quick-acting insulin each time you eat
- Testing your blood sugar level before each injection
- details on this site
DAFNE involves attending a 5-day training course (9am to 5pm Monday to Friday) plus a follow-up session around 8 weeks after the course and yearly half-day top-up sessions. The structured teaching program is delivered to groups of 6-8 participants and covers topics including carbohydrate estimation, blood glucose monitoring, insulin regimens, hypos, illness and exercise.
The DAFNE course
is about learning from experience. During the week you practice the skills
of carbohydrate estimation and insulin adjustment under the supervision of
DAFNE-trained nurses and dietitians.
Most of the training is built around group work, sharing and comparing experiences with other people with Type 1 diabetes. However, there are opportunities for each person to speak to a doctor, nurse or dietitian individually.
DAFNE allows people to fit diabetes into their lifestyle, rather than changing their lifestyle to fit in with their diabetes.
The aim of DAFNE is to help you lead as normal a life as possible, while controlling your blood glucose levels, hence reducing the risk of long-term complications related to diabetes.
It is described in detail DAFNE. If you use insulin and want good diabetic control, insist you can attend such a course. This site teaches you to count your carbohydrates, so you can work out your insulin dose (you need to register and log in).
Many people have benefitied tremendously, see "The DAFNE course absolutely blew me away".
- see www.xperthealth.org.uk
- Available in nearly all parts of the UK
- for type 2 diabetes patients who have been diabetic some time
- With other people, you learn about diabetes, weight management, and glucose control. You learn from others, they learn from you, and you learn to take control of your diabetes.
- as expert above, but suitable for inslulin users
- DESMOND is aimed at newly diagnosed type 2 patients
- detail also see diabetes BMJ 2010 BMJ 2012 BMJ 2012ed
- it provides 6 hours of nurse lead group education
- there is a formal curriculum
- groups consist of 6-10 people newly diagnosed with Type 2 diabetes
- each person a can choose to be accompanied by a partner, family member or friend
If you are diabetic and want good diabetic control, insist you can attend one of these four courses. Find a course and ask if your GP if you can attend.
"If you enrol with Birmingham OwnHealth®, our innovative telephone-based approach ensures that you play a much bigger role in the delivery of your care and that you are never more than a phone call away from all the information, support and encouragement needed to improve your health and well being in the way which is best suited to you." See.
Essentially patients are advised about their diabetic control over the phone
once a month. Such patients should have attended the relevant diabetes education
program as above beforehand. They are advised what to do if the sugars are
high etc over the phone.
This program has just started. At present it does not address the weight issues of diabetes, and may not tackle changes in insulin regimes (eg from twice daily to more intensive control). The program is developing, and will hopefully address these issues.
This is available in parts of the UK. "The Buddy Service is a group of trained volunteers in Lothian who have personal experience of the life changes required to live with diabetes successfully. They all have diabetes or are looking after partners, parents or children with diabetes and come from different backgrounds.
A buddy's job is to listen to and talk with others in the same situation and to give help whenever possible. Buddies don’t give any medical advice, that is provided by experienced doctors and nurses. Buddies can share the practical problems of living with diabetes, day in, day out." See.
From here the 5 As in diabetes education
Advice has to list to patients problems, and tailor the goals accordingly. There are many strategies, (p115) , including the Care Ambassador program & here. Such strategies should be used. (P126) as below, describes an office based intervention.
A Primary care plan (p126)
See BMJ 2008. The central role of a healthy diet and lifestyle is recognised by many religions and religious leaders. There is no cultural 'fatalism', that is leaving everything to God. The individual should adopt a healthy diet and should exercise.