Pioneers in patient care: consultants leading change
North East
Innovation: A training programme, known as the DAFNE project (Dose Adjustment for Normal Eating) which equips Diabetes type 1 sufferers with the skills to manage their condition themselves
Dr Simon Heller
Northern General Hospital, Sheffield
Job title: Senior lecturer in medicine, Sheffield University and honorary consultant physician
Specialty: Diabetes
A chronic condition like diabetes affects every aspect of a person’s life. People with type 1 diabetes often put their long-term health at risk because they want to limit either the restrictions conventional diabetes management can impose or the number of daily injections they have to endure. Their blood glucose levels then remain above normal. “This puts them at greater risk of severe microvascular complications leading to kidney failure, deteriorating vision, recurrent foot ulceration and premature death from heart failure,” says Dr Simon Heller.
A training programme introduced by diabetes teams in three different centres (Consultant physicians, Simon Heller in Sheffield, Sue Roberts in North Tyneside and Stephanie Amiel, Kings College Hospital, London) indicates that people with diabetes can increase their own management of their condition.
Dr Heller explains: ‘We have introduced a skills training programme for patients with Type 1 diabetes, delivered by diabetes nurses and dieticians, which allows them to eat whatever they want. By teaching patients to match their their insulin dose to food intake on a meal by meal basis, they keep their blood glucose level controlled.”
The three centres explored this new approach because they realised that conventional diabetes care was failing many of their patients. Thirty per cent of patients with type 1 diabetes develop severe complications and it has been estimated that although only two to three per cent of the population suffer from the condition, their care consumes 10 per cent of the NHS budget. A multidisciplinary team visited the WHO Collaborating Centre for Diabetes in Dusseldorf, Germany, where the educational programme was pioneered. A feasibility study was conducted between January 2000 and June 2001.
With financial backing from the charity Diabetes UK, 150 adults with type 1 diabetes were recruited in the three centres. Preliminary results from the trial indicate that six months after patients have received intensive skills training, there are significant improvements in their glycaemic control and their quality of life (measured by Prof Clare Bradley, Royal Holloway, London). Although the teams will need to assess whether this improvement is sustained, evidence from Germany, Russia and Romania, where the approach has been used for many years, is highly encouraging.
Dr Heller says that patients who have participated in the trial are now keen that the approach should be spread throughout the country. “We are now struggling to make this mainstream practice. I estimate that perhaps half of the patients with Type 1 diabetes could benefit from and sustain this approach to managing their own condition. “That is 75,000 people whose lives could be transformed, and over time the saving to the NHS could be enormous by reducing life threatening complications of diabetes and freeing up staff time to focus on other areas of care.”
The three centres are hoping to encourage the development of similar courses for patients with Type 2 diabetes as well as spreading its use with Type 1 diabetes sufferers. Although they believe that the UK lags behind other countries in the management of diabetes, this is an area where health care professionals would be keen to make radical changes to their practice. They just need the resources to do so.