Success Rates in a Diabetes Specialist Nurse-Led Education Programme: Re-setting the Glucostat

Abstract

Background

Analysis of National Diabetes Audit data from 2011–2012 of newly diagnosed people with type 1 diabetes mellitus (DM) found low initial success rates in much of the UK at 20% on initial training, while an unusually high success rate of 75% achieving target HbA1C<58 mmol/mol (< 7.5%) was found in Cheshire (England average=40.8%). We present a review of the approach taken by the Cheshire Diabetes team in the 12 months following diagnosis.

Methods

Between 2012 and 2013, 15 consecutive newly diagnosed people with type 1 DM were followed up for 18 months. All received support and advice by community Diabetes Specialist Nurses (DSNs) and Dieticians covering Central and Eastern Cheshire, UK.

Results

Mean±SD age at diagnosis was 23±3 years. The period of contact with the DSN service varied from 7–12 weeks. Baseline HbA1C of 99 mmol/mol [11.2%] (95% CI: 86–111 mmol/mol [10.0–12.3%]) declined by ~50% to 49 mmol/mol [6.6%] (41–57 mmol/mol [5.9–7.4%]; F=16.9, p<0.001) at 6 months and did not change between 6–12 months. Of those newly diagnosed with type 1 DM, 84.6% achieved a target HbA1C<58 mmol/mol (<7.5%) and 61.5% met a target<48 mmol/mol (<6.5%). There was no significant weight change during the study.

Conclusions

The key elements of this bio-psycho-social approach by the DSN team included providing psychological support, patient engagement, demonstrating positive regard, gaining trust, identifying health-seeking behaviour, providing key decision-making skills and developing a self-management plan. This resulted in improvements in overall glycaemic control well above the national average without untoward weight gain.

Summary

The UK National Diabetes Audit (2011–2012) in newly diagnosed type 1 diabetics in Cheshire, UK, showed a success rate at 6 months post-diagnosis of 75% achieving a target HbA1C<58 mmol/mol (<7.5%) compared with the national average of 40.8%. Initially thought to be erroneous, these excellent results were confirmed. The approach taken to achieve them is herein described.

Key words

type 1 diabetes - treatment - HbA1c - glycated haemoglobin A1c - education

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