DIABETES
estimated to have Type 2 diabetes, but do not know it
·· every day 48 people learn they have diabetes.
• Another 500,000 people in Scotland are at high risk of developing Type 2 diabetes, and that number is rising every year.2 1.1 million people are at increased risk of developing Type 2 diabetes as a result of their waist circumference or being overweight. That’s 1 in 5 adults.3
• According to current trends by 2035 more than 480,000 people in Scotland will be living with diabetes.4 80% of NHS spending on diabetes is invested in treating avoidable complications.5 As a result of this, managing diabetes accounts for around 10% of the annual NHS Scotland budget. This is almost £1 billion a year, or £100,000 every hour.6
DIABETES EDUCATION: THE MISSED OPPORTUNITY People with diabetes spend only three hours a year with a healthcare professional on average. For the remaining 8,757 hours they manage their diabetes themselves7
diabetes well is challenging and demands constant commitment.
People need to have the skills and confi dence to manage their condition throughout their lives.
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Diabetes education is key to successful day-to-day diabetes management and can be life-changing for those with the condition. Yet few people are offered high quality education courses in a persuasive way due to myths that diabetes education does not really work, is never going to be attended by many people and is expensive.
WHAT IS DIABETES EDUCATION? People learn about their condition in different ways. One way of understanding diabetes education, already used in Scotland8 levels:
, is in three
• Level one: Information and one-to- one advice.
• Level two: Ongoing learning that may be quite informal, perhaps through a peer group.
• Level three: Structured education that meets nationally-agreed criteria (defi ned by SIGN9
), including an
evidence-based curriculum, quality assurance of teaching standards and regular audit.
. Managing
While all three levels are important for people with diabetes, this article focuses on level three education for adults. For more information about other levels of education go to
www.diabetes.org. uk/self- management-education
In Scotland there is currently no reliable national data on access
to diabetes education, but local intelligence suggests there are considerable gaps in provision. The Diabetes Improvement Plan identifi es access to “consistent, high quality education” as a national priority10
.
PREVENTING COMPLICATIONS A recent systematic review of group- based education for people with Type 2 diabetes assessed 21 randomised controlled trials. It concluded that group-based education improves a range of clinical, lifestyle and psychosocial outcomes – including signifi cant improvements in:
• glycaemic control (signifi cantly reduced fasting blood glucose levels and HbA1c, the latter by 0.46 percentage points at one year)
• self-management skills • diabetes knowledge • self-effi cacy/empowerment • patient satisfaction • body weight at 12 months11
shown to support weight loss and smoking cessation, improve people’s understanding of diabetes and reduce depression at 12 months13
– although
evidence suggests that the programme needs to continue for improvements to be sustained14
.
CALLS TO ACTION Healthcare professionals should:
• promote the benefi ts of diabetes education courses to their patients
• fi nd out what courses are available locally, be familiar with referral pathways and consider attending a taster session.
Local decision makers should:
• put plans in place to ensure that all people with diabetes have the skills and confi dence to manage their condition by 2020
.
In the UK, an audit of the X-PERT diabetes programme found that the course increases people’s diabetes self-management skills and confi dence, improves HbA1c (by 0.5 percentage points at one year) and reduces cardiovascular risk factors12
.
Another UK-based course, the DESMOND programme, has been
• commission or provide accessible ‘level 3’ diabetes education courses (meeting
NICE/SIGN criteria3 ) for all adults with Type 1 and Type 2 diabetes
• review the uptake of education programmes, identify and address local barriers, and assess the effectiveness of education programmes through quality assurance and audit. •
REFERENCES: 1 Based on growth in prevalence of diabetes compared with other major health conditions
2
http://www.yhpho.org.uk/resource/view.aspx?RID=213523 This fi gure is calculated against PHE data 3 ibid 4 ibid 5 Kerr, M (2011). Inpatient Care for People with Diabetes – the Economic Case for Change
6 H ex, N. et al (2012). Estimating the current and future costs of Type 1 and Type 2 diabetes in the United Kingdom. Diabetic Medicine 29 (7) 855–862
7 Department of Health (2007). Working together for better diabetes care. Clinical case for change: Report by Sue Roberts, National Director for Diabetes 8 Diabetes Education Scotland (2013).
www.diabeteseducationscotland.org.uk/Patient.aspx 9 NICE (2011). QS6: Diabetes in adults quality standard. Quality statement 1 – structured education. In Scotland: SIGN (2010). 116: Management of diabetes. A national clinical guideline 10 Scottish Government (2014). The Diabetes Improvement Plan
11 Steinsbekk A, Rygg LO, Lisulo M et al (2012). Group based diabetes self-management education compared to routine treatment for people with Type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Services Research 12; 213
12 Deakin T (2011). The diabetes pandemic: is structured education the solution or an unnecessary expense? Practical Diabetes 28 (8); 1–14
13 Davies MJ, Heller S, Skinner TC et al (2008). Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed Type 2 diabetes: cluster randomised controlled trial. British Medical Journal 336; 491–95
14 Khunti K, Gray LJ, Skinner TC et al (2012). Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed Type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care. British Medical Journal 344; e2333
18 - SCOTTISH PHARMACIST
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