Experiences of a
Centre
Fiona Hegarty
Diabetes Specialist Dietitian
Letterkenny General Hospital, Donegal, Ireland
DEN,10th June 2014
Background
• Acute general hospital in North West of Ireland
• Services population of 161,000
• Diabetes population
– Total - 5165
– Type two - 4414
– Type one – 751, 145 under 18yrs
• Diabetes Team
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Consultant Endocringolist
Paediatrician, interest in Diabetes
2 WTE Diabetes Specialist Nurses
0.8 Diabetes paediatric staff nurse
0.7 Diabetes Specialist Dietitian
0.1 Paediatric Dietitian
• Program commenced July 2011
• CAWT funded project – European union funded
project, Northern Ireland and border counties
• Designed locally by David Chaney, DSN’s,
Dietitian’s and Roche
• To date– Completed 14 groups
– Educated 114 children
• Project due for completion
September 2014
• Hopefully will be mainstreamed
in the future
Basics
• Delivered by Diabetes Specialist Nurse
and Diabetes Specialist Dietitian
• Delivered locally within the community
• Children/young adults with type one
diabetes 0-19 years, and their families
• Promoted as part of treatment but not
compulsory
• Group sizes 6-12
Time line of group
• Child/young adult and family opt into group
• 3 hour sessions run on 4 consecutive weeks
• Group follow up at 4 weeks, commenced on
Accu-chek Expert Bolus Advisor
– Correction mode
– Bolus advice
• Consultant led clinic appointment
• Group follow up at 6 months
• Support via e-mail/phone throughout
Week One
Week Two
Re-cap of Diabetes
Insulin Action and Injection
Healthy eating and diabetes
Carbohydrate Counting
Carbohydrate counting using
food labels
Blood Glucose Monitoring
Blood Glucose correction
Week Three
Eating out / takeaways
Week Four
Physical activity
Sick day rules
Hypoglycaemia
Insulin Adjustment
Pump Therapy
Travel
Lifestyle/long term
health
Alcohol/drugs
Program
• Follow up 4 weeks, 2-3 hour session
– Insulin to carbohydrate ratios and insulin sensitivity
reviewed
– Topics reviewed at the groups request
– Commenced on Accu-Chek Bolus Advisor
• Follow up at 6 months, 2 hour session
– Insulin to carbohydrate ratios and insulin
sensitivity reviewed
– Carbohydrate counting quiz
– Diabetes Knowledge questionnaire
What worked well
• Relaxed learning environment
• Mixed groups of all ages and lengths of
diagnosis
• Getting all family members on board
• Sharing experiences and establishing
networks
• Pace of teaching dictated by group
• Group interaction, hands on approach
Group Interaction
Hands on tasks and games
• Food models / labels
• Plate models
• Healthy eating quiz
• Travel bags
• Real Food
What worked well
• Use of flip charts and matching patient
folders
– New modules given out each week
• Getting a new meter
• Not having to keep a blood glucose diary
– Downloads
Expert Downloads
• Actual data
• Real-time
• Trends
• Hypo Frequency
• Individual tailored
advice – invaluable
Not so good…
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Evening groups
Rigid curriculum
Paperwork! Limited administrative support
Separating groups into age groups / sex
Children under 7yrs attending
the groups
• Large groups
• Patients travelling long distances
• Forgetting the kettle…
Facts and Figures
• Attendance rates
– 100% attendance at the group
– 85% attendance at 4 week follow up
– 60% attendance at 6 month follow up
• Baseline data
– At 12 months post completion,
average reduction of Hba1c =0.4%
• Hospital in-patient days
– 12mths pre-course 94 hospital days
– 12mths post course 68 hospital days
• Quality of life
(questionnaire at baseline,1mth and 6mths)
– Definite improvement in family life concerning
diabetes
Key areas of improvements
in quality of life
• Improved ability to control their
blood glucose levels
• The children/young adults feel more
able to do what they needed to in
order to look after their diabetes
• Reduction in fear regarding their
diabetes e.g. hypos
• Overall they felt an improved ability
to self manage their diabetes
Success Story
• Jason, 19 years old, diagnosed with diabetes at 5
years old
• Prior to CHOICE, 3 successive admissions with DKA
totalling 9 hospital days, HbA1c peaked at 14.2%
• Completed CHOICE in 2011, he has reduced and
maintained his HbA1c around 8% and has no
further hospital admissions
• Jason now feels in control of his diabetes,
enjoys the freedom surrounding his
food choices and family life is much improved
• Mum….wants to know why it wasn’t
available 10 years ago!
Where are we now
• Running 3 x 4 hrs groups over a 4 week
period
• Mixed groups (age/sex/length of diagnosis)
• Children under 7yrs not required to attend
• Maximum group size, 8 children and
their family members
• Ongoing amendments in accordance
with latest guidelines
• Morning sessions
• Refresher days
We are changing the way our children
and young adults think about diabetes
but we have some way to go…
Thanks
• Diabetes team, Avril
McCloskey DSN,
Anne Griffin DSN
• Roche, Rhona Keaveny,
Steve Williamson
• CAWT and CHOICE team
