Diabetes Management

Diabetes Management

in the

General Care Setting

A Training Program for Nurses,

Allied Health Professionals

and

other Health Care Providers

Published by the National Association of Diabetes Centres

Table of Contents

Acknowledgements

Background

Program Goals

Course Outcomes

Course Participants

Scope of Practice

Content of the Training Package

Program Facilitators

Evaluation and Feedback

Program Updates

Certification of Participation

Program Delivery Options

Evaluation of Program Delivery

Acknowledgements

NADC acknowledges the support of the Commonwealth Department of Health and Aged Care who provided the initial funding to develop this program. In 2013 an independent educational grant from Lilly Diabetes provided further funding was by for the current update.

The original program was developed in 2001 by a multidisciplinary, NADC expert working group: Chris Zingle (Chair), Debra Bailey, Ruth Colaguiri, Kaye Neylon & Anne Robinson.

Special thanks go to Giuliana Murfet, Nurse Practitioner, Diabetes who completed the package update in 2014.

The updated package was reviewed by an expert panel consisting of Associate Professor Sophia Zoungas, Associate Professor Margaret McGill, Associate Professor Ashim Sinha, Wendy Bryant and Natalie Wischer.

Editorial oversight: Natalie Wischer, Assoc Prof Sophia Zoungas and Assoc Prof Sof Andrikopoulos

National Association of Diabetes Centres

The National Association of Diabetes Centres (NADC) was formed as a joint initiative of the Australian Diabetes Educators Association (ADEA) and the Australian Diabetes Society (ADS) in 1994. The two incorporated professional organisations held joint responsibility for the operations of the NADC until 2014, at which time the ADS took sole responsibility for the operations.

NADC is a collective of Diabetic Centres and services across Australia who meet defined criteria for service provision. Its aim is to maintain a network of diabetes services for the common purpose of promulgating improved standards of diabetes care throughout Australia.

NADC centres have appropriately qualified staff to deliver this training program. A list of NADC centres running the course can be found at Please note that costs may be incurred in attending the training course and these may vary from one centre to another.

The NADC also facilitates the ANDA data collection that benchmarks diabetes process and outcome data across NADC centres across Australia.

For more information on the NADC:

Background

Diabetes is a chronic lifelong condition that affects over 7.5% of Australians (ie over 1 million Australians)[1]. It has been estimated that 275 Australian adults are diagnosed with diabetes each day. In addition, 16.3% of Australians have impaired glucose tolerance that puts them at high risk of developing both diabetes and cardiovascular disease[2]. Poorly controlled diabetes leads to debilitating complications such as blindness, renal failure, cardiovascular disease and lower limb amputation. The annual cost of type 2 diabetes exceeds $3 billion (including carer costs)[3].

Both diabetes and its complication can be prevented or delayed.

In recognition of the high personal cost of diabetes, its cost to the health system and potential to intervene, diabetes was included as one of Australia’s National health priority areas in 1996.

Optimal diabetes care relies on sound medical management in line with evidence based clinical management guidelines and the active involvement of the patient in their day to day management and decision making about their condition. Diabetes education is essential for effective self management.

Diabetes education focusing on self management:

is a specialty area of practice delivered by qualified diabetes educators
is a right of people with diabetes and a health service / provider responsibility
is a therapeutic intervention that is integrated with the clinical care and attainment of clinical targets
must be equitable, accessible and individualised
is an integral element of any system of diabetes health care.

NADC advocate that all people with diabetes should have access to qualified diabetes educators for diabetes education. However, they also recognise the need for all health professionals to have knowledge of best practice diabetes management and the capacity to impart accurate information and advice to people with diabetes.

This is particularly the case in the general practice setting, which is most often the first point of contact for a person newly diagnosed with diabetes. In addition, general practitioners who assume responsibility for coordination of overall patient management provide a central role in the care of people with diabetes. Accordingly, nurses working in general practice are a key target group for whom this training package is recommended.

Program Goals

This program has been developed to provide health care providers in a range of general care settings with current knowledge of diabetes clinical management and self care recommendations.

The delivery of the program has also been designed to link generalist health care providers from all disciplines to a local network of diabetes experts to facilitate open exchange, referral to specialist diabetes services for their clients as required and ongoing support and education.

The overarching goals of the program are:

implementation of a standardised diabetes training program for generalist non-medical health care providers
enhancement of links and supporting networks between diabetes services and generalist health care providers
establishment of defined referral pathways at the local level and clarification between the role of diabetes teams, primary care teams and other providers of diabetes care.

Course Outcomes

On completing this course, participants will be able to:

identify those at risk of developing diabetes and discuss prevention strategies;
provide basic introductory education and information to people with diabetes in their care;
provide assistance with survival skills;
advise clients about available support and clinical services;
assist their peers with information on appropriate networks, supports and services; and,
identify basic problems with diabetes care and appropriate referral pathways.

Course Participants

This course may be undertaken by a variety of health care providers including:

Registered and enrolled nurses
Allied health professionals
Aboriginal health workers
Direct care / personal care assistants.

Course participants should be currently working in a general care setting (clinical, community based, primary care, domiciliary care) and providing care for people with diabetes.

Scope of Practice

The successful completion of this program does not enable health care providers to practice beyond the scope of practice of their particular discipline. Participants should be familiar with various health discipline decision-making frameworks as part of the discussion as to their roles (and limit of those roles) on successful completion of this training package. One such framework is the Nursing Decision Making Framework (ref) that describes the relationships between registered and enrolled nurses, allied health providers and direct care or personal care assistants and the decision processes involved in accepting and delegating care. Similarly the scope of Diatetic Practice Decision Tree (ref) describes the questions a dietitian needs to ask before embarking on a particular activity. Health care providers should be referred to their own profession associations and to the policies of their employing bodies when taking on new roles or activities.

Content of the Training Package

The course content has been developed with a view to addressing the issues most likely to arise for health care providers in relation to diabetes care in general care settings.

Eight core modules cover:

Prevalence, pathophysiology, detection and prevention of diabetes
Chronic complications
Lifestyle issues (nutrition and physical activity)
Oral medication and insulin therapy
Acute complications
Self monitoring
Groups with special needs
Support services and self management

The optional ninth module is specific to the management of diabetes in general practice and has been developed to meet the needs of practice nurses providing chronic disease care.

The package contains:

Module Outlines that include the Rationale, Aims, Required Teaching Resources, Suggested Activities and Case Studies.
Power point presentations for each module
A Diabetes Simulation Activity – design to develop an understanding of the personal impact of diabetes
Participant Work Plan – designed to focus participant attention on the application of their learning to their work place
Case studies
Case study answers (for facilitators)
Reporting and Evaluating tools.

Program Facilitators

A multidisciplinary team best delivers diabetes education and care, with each member contributing their discipline specific expertise. The delivery of this program should reflect the multidisciplinary team approach.

At a minimum this program should involve the following health disciplines:

Registered Nurse, Diabetes Educator
Registered Midwife, Diabetes Educator
Dietitian with experience in diabetes management
Podiatrist with experience in diabetes management

Course delivery may also involve:

Endocrinologist / Diabetologist
Practice nurse with expertise in chronic disease management in general practice
Division of General Practice staff involved in diabetes program support

Pharmacist with experience in diabetes management
Physiotherapist / Exercise Physiologist with experience in diabetes management

Aboriginal Health Worker
Ethnic liaison officers.

An ADEA Credentialled Diabetes Educator must have responsibility for course coordination including:

determining the course timetable
program promotion, participant recruitment and support
selection of session facilitators with the appropriate level of experience and expertise in diabetes management
familiarisation of session facilitators with course material
organising participant materials including Participant Manuals, the Simulation Activity, Participant Work Plans
ensuring the integrity of course learning outcomes and activities is maintained
program evaluation and reporting.

Evaluation and Feedback

Evaluation and feedback is critical to ensuring this program meets the requirement of health care providers, both those delivering and those receiving the program.

To this end we ask you to ensure the evaluation is completed and the Course Coordinator’s Report is returned to the NADC Project Manager following each delivery of this program.

The NADC will collate the evaluations returned and use these in an annual review of program materials.

In addition to the evaluation requested by NADC, sample evaluation tools have been included for local use to obtain additional feedback on local implementation.

Program Updates

NADC will maintain a providers’ list for this program and will provide annual updates and revisions made to the program as a result of the collated evaluations and changes to recommendations in clinical management.

Certification of Participation

Certificate templates will be sent to the Course Coordinator for distribution to participants.

Program Delivery Options

The course design allows for flexible delivery and enables delivery either as a block or over a period of time. Recommended time allocations are made for each module. The total delivery time of the program is 3 days. If particular modules have greater local or participant group significance, extra time may be allocated to individual modules.

It is recommended that the maximum number of participants for a program is 25.

The course may be delivered face to face with a person traveling to a central location or audio-conferencing or video-conferencing to remote locations. Special attention to visual teaching resources, facilitator and participant ease with the technology and adequate time for participants to review course materials prior to the program will be required in order to ensure a worthwhile learning experience.

Distance, cost and time away from the work place are all areas that will influence the delivery option selection. Each option has been trialed and achieved the desired outcome for both facilitators and participants in rural and remote locations.

The options for program delivery:

Block Delivery

The program is delivered over 3 consecutive days in a central location. Participants are required to travel to this location.

Half or One day a week

The program is delivered in a central location with participants meeting for either half or full day a week. More than one day or half day may be chosen for delivery of the program.

Module by Module

This option has been developed to enable health professionals to undertake the program who would otherwise be disadvantaged by their isolation and distance from a central location. The program is delivered to participants in their workplace with the aid of audio-conferencing or video conferencing, case studies and videos. Programs delivered using this method require skillful coordination, facilitation and often require additional resourcing. Sample programs for each of these options follow.

Sample program content Time frames for Single Module Delivery

Module / Time
(Min) / Topic
1 / Overview of Diabetes Mellitus / 60 / Pathophysiology
60 / Body Link simulation
2 / Chronic Complications of Diabetes Mellitus / 60 / Chronic Complication
60 / Foot care
3 / Lifestyle Issues / 60 / Nutrition
30 / Physical Activity
30 / Enhancing Self Care
4 / Medication / 30 / Glucose Lowering Agents
90 / Insulin
5 / Acute complications of
Diabetes Mellitus / 30 / Hypoglycaemia
45 / Hyperglycaemia/Emergencies
30 / Sick Day Management
30 / Diabetes Care during Fasting procedures
6 / Self monitoring of Diabetes Mellitus / 60 / Blood Glucose Testing
15 / Ketone Testing
7 / Groups with special needs / 30 / Aboriginal & Torres Strait Islanders
30 / CALD / Ethnic
30 / Children & Adolescents
30 / Pregnant Women
30 / Elderly
8 / Support Services and Self Management / 30 / Support Services
30 / Rights and Responsibilities
30 / Education Guidelines
9 / Diabetes Management in General Practice / 60 / Government Incentives for Chronic Disease Management
60 / Creating and Managing Diabetes Registers for Annual Cycle of Care
10 / Evaluation / 60 / Course Evaluation

Sample of a three day program format (excluding optional Module 9)

Day 1 / Day 2 / Day 3
0830 / Overview of Diabetes / 0830 / Medications - Glucose Lowering Agents / 0830 / Ketone Testing
0900 / 0900 / Medications - Insulin / 0900 / Aboriginal & Torres Strait Islanders
0930 / Body Link Simulation / 0930 / 0930 / CALD/Ethnic
1000 / 1000 / 1000 / Pregnant women
1030 / MT / 1030 / MT / 1030 / MT
1100 / Chronic Complications / 1100 / Hypoglycaemia / 1100 / Activity
1130 / 1130 / Hyperglycaemia / 1130 / Children & Adolescents
1200 / Foot care / 1200 / 1200 / Elderly
1230 / 1230 / Lunch / 1230 / Lunch
1300 / Lunch / 1300 / 1300
1330 / 1330 / Sick Day Management / 1330 / Support Services & Self Management
1400 / Nutrition / 1400 / Diabetes Care during Fasting procedures / 1400 / Rights & Responsibilities
Simulation Debriefing
1430 / 1430 / Activities / 1430
1500 / AT / 1500 / AT / 1500 / AT
1530 / Physical Activity &
Enhancing self care / 1530 / Blood Glucose Testing / 1530 / Evaluation
1600 / 1600 / 1600
1630 / 1630 / 1630

Sample of a three day program format (including optional Module 9)

Day 1 / Day 2 / Day 3
0830 / Overview of Diabetes / 0830 / Medications - Glucose Lowering Agents
Medications - Insulin / 0830 / Aboriginal & Torres Strait Islanders
0900 / 0900 / 0900 / CALD / Ethnic
0930 / Body Link Simulation / 0930 / 0930 / Pregnant Women
1000 / 1000 / 1000 / Children & Adolescents
1030 / MT / 1030 / MT / 1030 / Elderly
1100 / Chronic Complications / 1100 / Hypoglycaemia / 1100 / MT
1130 / 1130 / Hyperglycaemia / 1130 / Support Services & Self Management
1200 / Foot care / 1200 / 1200 / Rights & Responsibilities
1230 / 1230 / Lunch / 1230 / Lunch
1300 / Lunch / 1300 / 1300
1330 / 1330 / Sick Day Management / 1330 / Annual Cycle of Care
1400 / Nutrition / 1400 / Diabetes Care during Fasting procedures / 1400
1430 / 1430 / Activities / 1430 / Diabetes Registers
1500 / AT / 1500 / AT / 1500
1530 / Physical Activity &
Enhancing self care / 1530 / Blood Glucose Testing / 1530 / AT
1600 / 1600 / 1600 / Evaluation
1630 / 1630 / Ketone Testing / 1630

Sample of a 4 Week – Half Day Sessions - (excluding optional Module 9)

Week 1 / Week 2
0830 / Overview of Diabetes Mellitus / 0830 / Lifestyle Issues Nutrition
0900 / 0900
0930 / Bodylink activity / 0930 / Lifestyle Issues – Physical Activity
Enhancing Self Care
1000 / MT / 1000
1030 / Chronic Complications / 1030 / Glucose Lowering Agents
1100 / 1100 / Medications Insulin
1130 / Foot Care / 1130
1200 / 1200
1230 / Finish / 1230 / Hypoglycaemia
1300 / Finish
Week 3 / Week 4
0830 / Hyperglycaemia / 0830 / Aboriginal & Torres Strait Islanders
0900 / 0900 / CALD/Ethnic
0930 / Sick Day Management / 0930 / Pregnant Women
1000 / MT / 1000 / Children & Adolescents
1030 / Diabetes Care during Fasting procedures / 1030 / Elderly
1100 / Blood Glucose Testing / 1100 / Support Services
Rights & Responsibilities
1130
1200 / Ketone Testing / 1200 / Activity
1230 / Finish / 1230 / Evaluation
1300 / Finish

Sample of a 4 Week – Half Day Sessions - (including optional Module)

Week 1 / Week 2
0830 / Overview of Diabetes Mellitus / 0830 / Lifestyle Issues – Physical Activity
0900 / 0900
0930 / Body Link Activity / 0930 / Glucose Lowering Agents
1000 / MT / 1000 / MT
1030 / Chronic Complications / 1030 / Insulin therapy
1100 / 1100
1130 / Foot Care / 1130 / Hypoglycaemia
1200 / 1200 / Hyperglycaemia
1230 / Lifestyle Issues Nutrition / 1230
1300 / 1300 / Sick Day Management
1330 / Finish / 1330 / Finish
Week 3 / Week 4
0830 / Fasting procedures / 0830 / Support Services & Rights & Responsibilities
0900 / Blood Glucose Testing / 0900 / Activity
0930 / 0930 / Annual Cycle of Care
1000 / Ketone Testing / 1000
1030 / MT / 1030 / Diabetes Register
1100 / Aboriginal & Torres Strait Islanders / 1100
1130 / CALD/Ethnic / 1130 / Evaluation
1200 / Pregnant Women / 1200
1230 / Children & Adolescents / 1230 / Finish
1300 / Elderly / 1300
1330 / Finish / 1330

Evaluation of Program Delivery

Course Coordinator Evaluation

To allow ongoing evaluation of the program, please complete and forward the following:

A list of participants’ names disciplines and work settings
A list of all Health Professionals, including the Course Coordinator involved in delivering the program
A summary of the participants’ program evaluation results
Copies of facilitators feedback

Please send to:

Facilitator Evaluation

All facilitators are asked to complete an evaluation for each module(s) that they have delivered

Participant Evaluation

All participants are asked to complete an evaluation for the course.
An additional Participant Evaluation Form is included in the local evaluation purpose only. This should not be forwarded to the NADC.

[1] Diabetes: Australian Facts. AIHW, 2011

[2] AusDiab 2005. IDI, 2006

[3] Diabetes Australia, 2013