1 Jackie Elliott, 1 Simon Heller, 2Helen Hopkinson, 3Peter Mansell 1University of Sheffield, 2Victoria Infirmary, Glasgow, 3The University of Nottingham
Does duration of Type 1 diabetes affect the outcomes of structured education?
Funding & Disclaimer
*Funded by National Institute for Health Research (NIHR)
*This presentation reports independent research commissioned by NIHR under the Programme for Applied Research. The views expressed in this presentation are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Aims
*?optimal time for patients to receive structured education.
*Before inappropriate self-management strategies become ingrained
*?shorter duration, easier to adapt
*Utilised the Dose Adjustment For Normal Eating (DAFNE) research database
*Multi-centred, real word
*479 patients with Type 1 diabetes 52% female
Methods
*52% female 48% male
*Age 41.2 ± 13.9 years
* (youngest 17, eldest 74)
*Duration of diabetes 17.3 ± 15.0 years
* (shortest 1year, longest 55 years)
Baseline Demographics
Biomedical Outcomes
Baseline 12
months P-value
HbA1c (%) HbA1c (mmol/l)
8.70+1.51 71.6+16.5
8.53+1.52 69.7+16.6
0.002
Weight (kg) 76.1+15.4 76.7+15.4 0.69
BMI (kg/m2) 26.4+4.7 26.6+4.8 0.85
Systolic BP (mmHg) 131+18 130+17 0.87
Diastolic BP (mmHg) 76+11 76+10 0.31
381 pts had HbA1c>7.5% at baseline
HbA1c (%) HbA1c (mmol/l)
9.18+1.30 76.8+14.2
8.85+1.46 73.2+16.0
<0.001
Biomedical Outcomes
Baseline 12
months P-value
No. of episodes of severe hypoglycaemia in preceding 12 months
393 99 <0.001
No. of patients experiencing >1 severe episode of hypoglycaemia in previous 12 months
101 42 <0.001
No. of episodes of diabetic ketoacidosis in preceding 12 months
63 19 <0.001
No. of patients experiencing >1 episodes of diabetic ketoacidosis in preceding 12 months
45 12 <0.001
*No correlation (R2<0.01) between duration of diabetes and:
*Baseline HbA1c
*12 month HbA1c
*Change in HbA1c
*Reduction in episodes of severe hypoglycaemia
*Reduction in episodes of diabetic ketoacidosis
*Reduction in PAID score
*Increase in VAS score on EQ-5D
*Decrease in HADs anxiety or depression scores
Effect of Duration of Diabetes on Outcome
*Benefits in both biomedical and QoL measures are independent of duration
*Therefore a long duration of diabetes should not be a barrier to patient participation
*Structured education for patients with Type 1 diabetes is equally effective irrespective of the duration of diabetes
Conclusion
*DAFNE Research Project Office
*Celia Emery, Humara Afzal, Simon Heller
*DAFNE Database Team
*Gill Thompson, Susan Moore, Tim Chater, Peter Mansell, David Hopkins
*10 DAFNE centres
Acknowledgements
Cambridge
Mark Evans
Candice Ward
Sarah Donald
Charlotte Jenkins Liu
Jane Baille
Kathy Davenport
Mary Hall
J Grisoni
Allison Housden
Central Middlesex
Daniel Darko
Thea Thompson
Nina Patel
Helen Davies
Letchimie Ramsammy
Joy Wilson Sheffield
Carolin Taylor
Val Gordon
Carla Gianfrancesco
Val Naylor
Karen Towse
Pauline Cowling
Cathie Stocks
Sarah Mitchell
Nicola Scott
Nina Singaroyan
Kay Bottrell
Vanessa Whitehead
Becky Beer
Sue Beveridge
Linda Greaves
Hull
Chris Walton
Sharon Cassidy
Katrina Lucas
Louisa Pinch
Leicester
Ian Lawrence
Zin Zin Htike
Sarah Philips
Hannah Berkeley
Dawn Kitchener
Rebecca Pidcock
Gaye Duncombe
Jane Fairfield
Caroline Byard
Tracey Rengarajan
Rachel Berrington
Emma Marcus
Jacqui Troughton
Suzanne Fenn
Mandy Town
Caroline Wilkes
Liz Turrell
Kings
Stephanie Amiel
Helen Rogers
Anita Beckwih
Victoria Francis
Geraldine Gallen
Kaylee Lovie
Philippa Marks
Alison Cox
Anna Vanderpuye
Chris Cheyette
Linda East
Emma Britneff
Northampton
Anne Kilvert
Eileen Richardson
Kathy Hall
Lynne James
Kate Smith
Lorraine Campey
Pauline McKenzie
Sally March
Amanda Diggins
Christine Hemmington
Northumbria
Simon Eaton
Chris Strey
Stuart Bennett
Karen Jones
Leigh Aitchison
Anne Rodgers
Erin Pringle
Lindsay Oliver
Jackie Rollingson
Jane Morgan
Sandra Fleming
Derby
Rustam Rea
Judith Eisenberg
Isobel Shorrock
Siobhan Ashton-Cleary
Jane Hannah
Elaine Cooper
Nottingham
Laura Fenn
Nicole Maude
Janet Evans
Sophie Taylor
Karen Nunnick
5x1 RCT Update
More time to practice skills, but less strong peer support and higher drop-out rate?
A more flexible option in terms of work / childcare – but as effective?
The objectives:
*To explore whether the outcomes of a structured education programme with identical contact time are comparable whether delivered over 1 or 5 weeks.
*To examine the cost effectiveness of a DAFNE course delivered either over 1 or 5 weeks.
*To calculate how many patients choose to receive structured education programmes over 1 or 5 weeks, by conducting a preference survey.
*The aims of the qualitative sub-study were
*Help understand and interpret any differences and similarities in biomedical and psychological outcomes between patients attending DAFNE courses delivered one day a week over 5 weeks and over 5 consecutive days.
* Identify any logistical problems and unanticipated issues arising from the adaptation and delivery of DAFNE as a course spread over 5 weeks.
*Provide recommendations for the timing, content and delivery of future DAFNE courses.
Glasgow
Norwich
UCLH
Leicester Cambridge
Northumbria
East Lancs
5x1 Centres
Courses Commenced
June 2010
Courses completed May 2011
12 month follow-up complete June 2012
Data analysis
complete Sept 2012
Timeline
DAFNE 5X1 PLANNER Blackburn Cambridge Glasgow Leicester Northumbria Norwich UCLH
2010 M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T
June 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
July 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Aug 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Sept 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Oct 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Nov 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Jan 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2011
Feb 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Mar 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Apr 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
May 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
5x1 Courses
*
213 Randomised across 7 centres
188 completed baseline data collection
180 attended 30 courses
168 graduated 80 on 1 week course 88 on 5 week course
Recruitment and Courses
•Recruitment
•Running the courses
•Data collection
•Database – pros and cons
•Analysis of the results, SAP
•Qualitative study – David Rankin & Julia Lawton
Issues Encountered During the Trial
*Curriculum adapted, same content
*Well attended, similar rate of graduates
*<5% of participants missed a day
*Similar profile of patients attending, ? shorter duration of diabetes
*Results hopefully available Sept 2012
Key Points - 5 week DAFNE
Cambridge
Mark Evans
Candice Ward
Allison Housden
Goher Ayman
East Lancs
Shanez Ramtoola
Helen Loughnane
Adine Logan
Gillian Whalley
Anne Baron
Norwich
Keten Dhatariya
Liesl Richardson
Tracey Gray
Denise Unsworth
Suzie Hamblin
Louise Jones
Leicester
Ian Lawrence
Sarah Philips
Hannah Berkeley
Liz Turrell
Rebecca Pidcock
Glasgow
Helen Hopkinson
Hiliary Peddie
Margaret Kyle
Carol McMaster
Northumbria
Simon Eaton
Leigh Aitchison
Karen Jones
UCL
Steve Hurel
Liz Kamps
Caroline McWhinney
