Poster Abstracts from Diabetes in Scotland 2006 Conference

POSTER ABSTRACTS FROM DIABETES IN SCOTLAND 2006 CONFERENCE

Poster Competition Winners

Diabetes and Cardiovascular Research:

Poster 24 – Vitamin D Improves Markers Of Vascular Health In Patients With Type 2 Diabetes In Scotland

J A Sugden, J I Davies, MC Witham, A D Morris, A D Struthers

Service Development:

Poster 43 – Hypoglycaemia Requiring In Patient Specialist Review: Oral Hypoglycaemic Therapy Is As Important As Insulin, Especially In Elderly Patients

L Clark, M Still, H Yule, M Douglas, S Philip, K McKardy

Innovation:

Poster 47 – Development Of A Packet Smartcard To Aid Self Management In The Prevention Of Diabetic Ketoacidosis

S MacRury, G Farmer, L Grant, P N O’Neill

Patient Involvement and Empowerment:

Poster 56 – Montrose Diabetes Day: Organising A Patient Participation Event

R Guild, G Kramer, G MacKintosh

Diabetes Education:

Poster 59 - Developing Structured Group Education In East Kilbride Locality

L Danks, A Galbraith, H McLure, B Moran

P-1DEVELOPMENT OF A PHYSICAL ACTIVITY BEHAVIOUR CHANGE INTERVENTION FORPEOPLE WITH TYPE 2 DIABETES.

Barnett J1, Kirk A1, Leese G2, Mutrie N3

1 Institute of Sport and Exercise, University of Dundee

2 Diabetes Centre, NinewellsHospital and MedicalSchool

3 Department of Sport, Culture and the Arts, University of Strathclyde

Development Of A Physical Activity Behaviour Change Intervention For People With Type 2 Diabetes
Background: Within current diabetes care physical activity promotion is restricted by lack of time and resources. The Time 2 ACT study is a randomised controlled trial investigating the effectiveness of written materials and person delivered physical activity consultation and standard care for promoting physical activity. Changes from baseline in physical activity, physiological, biochemical and psychological variables will be examined over six and twelve months. In addition cost analysis will be conducted to determine which intervention is the best buy for current diabetes care.
Aim: To develop a written delivered, self instructional physical activity intervention, based on physical activity consultation, which can easily be delivered within current diabetes care.
Methods: The intervention is guided by the principles of the Transtheoretical model (TTM), which proposes individuals move through five stages when changing behaviour. Each intervention pack is structured to cover key components of the TTM and include evidence based strategies to support physical activity. Intervention packs for people in a contemplation or preparation stage (i.e. people who are inactive but considering doing more physical activity) cover strategies such as enhancing motivation, overcoming barriers and developing a physical activity plan. Intervention packs for people in an action or maintenance stage (i.e. currently meeting physical activity recommendations) focus on prevention of relapse back to sedentary behaviour and improving long term maintenance of physical activity.
Conclusions: These materials may provide useful resources for promoting physical activity in diabetic care. The time 2 ACT trial will provide information on their effectiveness.

P-2DIABETES MELLITUS TYPE 2 – COMPETENCY BASED CONTINUING PROFESSIONALDEVELOPMENT (CPD) WORKBOOK FOR PHARMACEUTICAL CARE

Power A1, McKellar S2, Hudson S A2

1 NHS Education for Scotland (Pharmacy), Glasgow

2 Department of Pharmaceutical Care, University of Strathclyde

Diabetes Mellitus Type 2- Competency Based Continuing Professional Development (CPD) Workbook For Pharmaceutical Care
Introduction
Community pharmacists’ contributions to the care of patients with diabetes mellitus are being extended in Scotland alongside a new NHS contract for community pharmacies. The objectives of the research were: To apply consensus building methods to identify agreed contributions of community pharmacists to patients in primary care. To produce a competency based CPD workbook to support development of these new services.
Methods
A Delphi questionnaire was designed based on a validated multidisciplinary model of care with type 2 diabetes mellitus in primary care. Seventy pharmacists already participating in a voluntary unpaid Scottish Executive initiative to evolve a structured delivery of pharmaceutical care to patients with diabetes were sent an initial questionnaire. Thirty-seven participants agreed to enter two further rounds; response rates (Delphi 2) 22/37 (59%) and (Delphi 3) 18/22 (82%).
A Community Pharmacy focus group (n=7) facilitated mapping of these agreed activities with national competencies1 , resulting in a competency based CPD workbook.
Results
Most proposed pharmaceutical care activities reached consensus suggesting a desire to deliver a comprehensive service. Care activities that failed to reach Delphi consensus involved ‘adjusting doses of insulin’ and ‘ensuring appropriate foot care’.
A competency based CPD workbook was developed largely using 5 of the 6 national competency areas with the focus group developing 7/ 59 activities.

Conclusions

This study facilitated development of a workbook linking consensus agreed pharmaceutical care activities with nationally agreed multidisciplinary competencies.

References

1. NHS Education for Scotland. A competency framework for the care of a person with diabetes. Edinburgh, 2003.

P-3ROYAL INFIRMARY OF EDINBURGH CARBOHYDRATE LEARNING AND INSULINMANAGEMENT (RECLAIM) – ARE WE DOING ENOUGH?

Anderson D, Maxwell H

Royal Infirmary of Edinburgh, Edinburgh

Royal Infirmary Of Edinburgh Carbohydrate Learning And Insulin Management (RECLAIM) - Are We Doing Enough?
Group education sessions were set up to provide structured education for Type 1 patients starting on a basal bolus insulin regimen and to learn carbohydrate (CHO) counting. The aim was to improve diabetes management through better matching of insulin and carbohydrate intake.
Patients were invited to attend two half-day group education sessions, which were led, by a Diabetes Specialist Nurse and Dietitian. Patients were given an insulin to CHO ratio and a correction dose, they were taught how to count CHO and lifestyle issues were discussed.
Thirty-eight people with Type 1 diabetes were asked to complete a questionnaire prior to attending the group session and then repeat the questionnaire 8 weeks following this session. HbA1c were performed at baseline and 8 weeks also.
Results showed an improvement in HbA1c at week 8 with an average reduction in HbA1c of 0.4%. All participants felt more confident about adjusting their insulin depending on their CHO intake, at week 8 compared to baseline. All participants felt planning meals interfered less in their life at 8 weeks compared to baseline and by week 8 participants appeared to be more confident with blood glucose management and hypoglycaemia.
In conclusion our group education sessions appear to help participants manage their diabetes with more confidence resulting in better glycaemic control and offer more lifestyle flexibility, which is in line with the DAFNE programme.

P-4PEDOMETERS FOR EXERCISE IN DIABETES STUDY (PEDS)

Allwinkle J, Brewin E,Watson E

NHS Lothian, Edinburgh

Pedometers For Exercise In Diabetes Study (PEDS)
Adopting a more active lifestyle is well recognised as an effective treatment for Type 2 Diabetes. For several years a multidisciplinary group from the Royal Infirmary of Edinburgh has carried out education sessions for newly diagnosed Type 2 patients at the local leisure centre with representation from an exercise specialist.
In partnership with South Edinburgh Healthy Living Initiative, a pilot study using pedometers as a means of increasing activity levels in these patients was carried out.
The aim of the pilot was to motivate patients to improve their activity levels and to assess the impact of using a pedometer on HbA1c and weight over a 12-week period.
Ten newly diagnosed Type 2 patients were recruited on a voluntary basis. They completed a questionnaire on current exercise levels and their weight and HbA1c were recorded. Each patient was issued with a pedometer and a diary to chart the number of steps completed. At the end of 12 weeks, a repeat HbA1c and weight check was done and a second questionnaire was completed.
The study showed that HbA1c results, if normal at the start of the pilot, remained normal and 50% of patients HbA1c results improved. 87% of patients lost weight during the 12-week period. From comparison of the questionnaires it appeared that the pedometer did not have a significant impact on exercise levels. In conclusion several things could have compounded changes in weight and HbA1c and a more structured follow-up programme would be required to make the use of pedometers effective.

P-5YOU’RE NICKED!

Barclay J I P

Royal Infirmary of Edinburgh

You’re Nicked!
Background
Diabetes in Police custody is a topic not commonly discussed. There are little guidelines for Police when dealing with people entering their custody. People were ending up in accident and emergency department at the Royal due to mismanaged diabetes while in police custody. This included hypoglycaemia and hyperglycaemia. There was a lack of diabetes training among custody officers and a lack of appropriate equipment.
Aims
The aims of the project were to bring together custody sergeants and the diabetes specialist nurse to identify issues and suggest improvements looking after those with diabetes in custody.
Method
Identify current issues
Suggest improvements
Training offered to custody nurses, custody officers and link custody sergeants identified
Blood glucose monitoring was the issue highlighted to be the highest priority as all staff could be trained in monitoring.
Conclusions
There has been a strong connection made between Lothian and Borders Police and the Department of Diabetes. All custody staff have been trained in blood glucose monitoring with a supplement of treating hypoglycaemia. There have been less telephone calls from accident and emergency regarding patients in custody. Further plans are being made to cascade training to other police officers in the field.

P-6UNDERSTANDING STEROIDS AND DIABETES – A PATIENT INFORMATION BOOKLET

Barrow L, MacKay L

LothianUniversityHospital Division, Edinburgh

Understanding Steroids And Diabetes – A Patient Information Booklet
Glucocorticoids (steroids) influence the function of most body cells. As a drug therapy, they are important in the treatment of many specific diseases such as inflammatory and autoimmune conditions, endocrine disorders and malignancies. It is well documented that prolonged use of oral or injected steroids may precipitate Steroid Induced Diabetes or hyperglycaemia in established diabetes. This risk can be further increased when there is a family history of diabetes or previously diagnosed gestational diabetes. Steroid Induced Diabetes is caused by stimulation of gluconeogenesis and glycogen synthesis resulting in increased hepatic glucose production and insulin resistance. In clinical practice, it has been observed that no readily available written information exists for patients who may develop this condition. Anecdotally, patients have a poor understanding about the hyperglycaemic effect of steroid treatment. An extensive literature search for patient information regarding this issue identified that no such information existed. This prompted the production of a printed booklet written specifically for patients to provide them with an explanation of the link between steroids and diabetes and the treatment for diabetes. This information was to be straightforward, clear and easy to understand. When written and illustrated, the booklet ‘Understanding Steroids and Diabetes’ was sent for peer and patient review and then amended appropriately. It is now published and available to secondary and primary care in Lothian. Ultimately, it will be available nationally, in printed and downloadable formats, for patients and health professionals.

P-7DEVELOPMENT OF INFORMATION FOR PEOPLE WITH DIABETES PREPARING FORCOLONOSCOPY

Delaney S, Douglas S, Strachan M

LothianUniversityHospital Division, Edinburgh

Development Of Information For People With Diabetes Preparing For Colonoscopy
Background:
A Colonoscopy allows direct inspection of the entire colon, anal canal and terminal ileum. Patients undergoing colonoscopy need a bowel purge to cleanse the colon of its contents. The patient is advised to eat a low-residue diet for 24 hours and this may present problems for people with diabetes in blood glucose management, particularly in those patients on sulphonylurea medication or insulin.
Aim:
Development, implementation and evaluation of a patient information leaflet for patients with diabetes preparing for a colonoscopy procedure in an acute teaching hospital.
Method:
In conjunction with the consultant diabetologist and senior diabetes dietician, three information leaflets were produced:

1. Information for People with Diet-Treated Diabetes who are preparing for Colonoscopy.
2. Information for People with Tablet-Treated Diabetes who are preparing for Colonoscopy.
3. Information for People with Insulin-Treated Diabetes who are preparing for Colonoscopy.

They were sent out to 28 healthcare professionals for review including, gastroenterologists, surgeons, diabetologists, dieticians, endoscopy unit charge nurses, diabetes specialist nurses and diabetes patients for peer review. Following favourable comments from the peer review group, some adjustments to the leaflets were made. They were introduced into the endoscopy units to be sent out to patients with diabetes attending for colonoscopy, with their appointment information.
Results:
A questionnaire was developed to evaluate the effectiveness of the information leaflet and the information from this is currently being gathered.
Discussion:
The aim of the information leaflets for patients with diabetes preparing for colonoscopy is to avoid problems with their blood glucose management and facilitate self-management

P-8MODY LINK NURSE PROJECT FOR SCOTLAND

Little J, Robertson L, Strachan M

Western GeneralHospital, Edinburgh

Mody link nurse for Scotland project
Maturity onset diabetes of the young ( MODY) is a monogenic form of diabetes estimated to account for at least 1% of UK diabetes (20,000) cases ( Stride, 2002 ).
The importance of molecular genetic testing in diagnosing subtypes of diabetes is well recognised as it can inform treatment decisions, predict likely clinicalcourse, help genetic counselling and explain the co-inheritance of apparently unrelated features ( Owen 2001 )
The aim was to increase awareness and recognition of monogenic diabetes leading to an increase in the patients receiving an accurate diagnosis and appropriate treatment.
The nurses all underwent thorough extensive genetic training and still attend for quarterly educational meetings where they are updated on current practices and knowledge is reviewed.
The post in Scotland has evolved. Each area of Scotland has been targeted and all have been asked if they would like to have an informal visit including presentation and a review of case notes.
A review of Scotland’s performance is 8.2 cases of MODY per million in the population have been found in Scotland, compared with 1.1 in Ireland, 1.3 in Wales, and 4.7 in England. Scotland have also referred more patients for testing than England, Ireland and Wales, 27 referrals per million compared with 4.7 for Ireland, 5.5 for Wales, 20.2 for England. Prior to the GDN post Feb 2003 there were 47 referrals, 21 positive. Thereafter there have been to date 112 referrals and 37 of those were positive.
There has been much effort to highlight MODY diabetes within the diabetic community. It would seem that this has been viewed very positively and has stimulated thought and improved clinical acumen.

P-9TYPE 1 DIABETES:AN ESSENTIAL GUIDE AT DIAGNOSIS

Charlton J, MacKay L

LothianUniversityHospital Division, Edinburgh

Type 1 Diabetes: An Essential Guide At Diagnosis
The delivery of initial education at the time of diagnosis of Type 1 diabetes may have a significant impact on the persons’ psychological well being and coping mechanisms, for their future management. Healthcare professionals have a responsibility to give core information to ensure safety of self-management in the initial period. The emotional impact of the diagnosis of Type 1 diabetes is well documented. The necessity to teach the person essential practical skills such as insulin injections, blood glucose testing and treating hypoglycaemia, often overrides the attention needed for psychological aspects of care. The focus is often based on checklist completion and not the persons’ individual needs. Often external influences such as time constraints and caseload determine this.
There is a wealth of information leaflets available for people with Type 1 diabetes. Patients are bombarded with oral and written information that may not be appropriate for their needs at diagnosis. After 20 minutes of teaching, the retention of information is compromised. Patients are preoccupied with their own personal concerns regarding their lives.
We have observed a lack of concise, essential information necessary for the immediate period post-diagnosis. A leaflet was developed considering patients priorities, identified from a questionnaire, given to current patients with Type 1 diabetes. Multi-disciplinary input was sought together with peer and patient review. This contains easy to follow instructions covering all practical issues. Advice regarding day to day lifestyle issues such as alcohol, exercise, driving and sex. The aim is to reduce the compulsion by the healthcare professional to overload the patient with inappropriate literature at the time of diagnosis.

P-10TAYSIDE DIABETES EDUCATION PROGRAMME – GROUP EDUCATION FOR PATIENTS WITHNEWLY DIAGNOSED TYPE 2 DIABETES

Wilson E, Black A, Cameron J, Emslie-Smith A, Grant L, Hill K, Matheson L, Peters R,Walters E

NHS Tayside, Dundee

Tayside Diabetes Education Programme – Group Education for Patients with Newly Diagnosed Type 2 Diabetes
Collaboration between clinical and IT colleagues in Tayside has led to an exciting and innovative development benefiting people newly diagnosed with Type 2 diabetes and their carers. The Tayside Diabetes Education Programme (TDEP) provides structured, professionally led, group education sessions for patients with newly diagnosed Type 2 Diabetes.
Groups operate in Angus, Dundee and Perth on a regular basis, led by specially trained nurses and dieticians. They allow patients and their carers to meet soon after diagnosis to receive high quality information and advice about their condition and how this will affect them. The programme is delivered in two 2-hour sessions with around 8 people who can bring along a friend/relative/carer. A variety of techniques are used to promote adult learning and patients are providing with materials to take away with them. The programme covers: what diabetes is, managing diabetes, diet and lifestyle issues, driving, prescription exemption, foot care, screening/annual clinics, monitoring and taking action, Risks and long term complications.
A web based system, utilising the NHS intranet was developed to allow “on-line” booking by the GP or practice nurse whilst the patient is with them in the consulting room. This enables the patient to choose to attend an education session on a day and time which suits them.

P-11PATIENT EDUCATION – TAYSIDE INSULIN MANAGEMENT PROGRAMME

Wilson E,Anderson C, Grant L, McAlpine R, Robertson M