HNY Policy and Pathway Repository - Humber

The NICE technical appraisal on patient education models published in 2003 stated the importance of education in improving glycaemic control, quality of life and reducing the risk of diabetes associated complications. They recommend that education be provided as a group.

The technical appraisal was superseded in March 2011 when NICE published a quality standard for adults with diabetes (QS 6) in which the quality statement 1 states:

"People with diabetes and/or their carers receive a structured educational programme that fulfils the nationally agreed criteria from the time of diagnosis, with annual review and access to ongoing education.

Structured patient education has had a strong presence in Hull and East Riding for over a decade as the DAFNE programme has been delivered since 2002 and for those with type 2 diabetes we have developed a local programme, Living with Diabetes, which has been running since 2009.

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DAFNE Type 1 Diabetes Structured Education

DAFNE stands for Dose Adjustment for Normal Eating. Essentially it is a comprehensive structured group education programme specifically for people with type 1 diabetes who use multiple dose insulin therapy. The DAFNE programme is nationally recognised as the gold standard for those with type 1 diabetes.

DAFNE has a solid evidence base. The programme has been developed over more than 25 years of rigorous research. The UK trial was published in 2002 showing sustained improvements of HbA1c, quality of life measures, and reduced incidence of hypoglycaemia. Locally we have also shown a reduced admission rate for those in diabetic ketoacidosis (DKA) post DAFNE.

Living with Diabetes - Type 2 Diabetes Structured Education

Living with Diabetes is a structured education programme for individuals with Type 2 Diabetes which meets the national criteria. The programme consists of two half-day sessions provided at various locations and times to suit, is delivered by trained educators who are either dietitians or diabetes specialist nurses and has a strong focus on self-management, healthy lifestyle and diet.

CHCP and Hull and East Yorkshire Hospitals Trust are working in partnership to deliver the Living with Diabetes (LWD) courses for residents of Hull and the East Riding of Yorkshire.

In order to optimise patient choice and ensure patients are offered a place on a course as soon as possible and at a location of their choice, HEY will now offer a single point of contact for all referrals. 

Therefore please advise patients that referrals will go to HEY and that CHCP and HEY will collectively facilitate courses.

The new address for referrals as provided by HEY is:

Patient Education Team

The Diabetes Centre
Allam centre
Anlaby Road
Hull

Referral Criteria - DAFNE Type 1 Diabetes Structured Education

• Type 1 Diabetes Mellitus post 1 year after diagnosis
• Over 17 years old
• HbA1c <108mmol/l
• Able to speak and understand/read English
• Frequent hypos
• Frequent admissions with DKA
• Motivated to improve diabetes control
• Need for flexibility of eating/insulin regime
• Willing to inject and test at least 5 times a day (for those on other insulin regimes a discussion with the diabetes specialist team would be arranged as to whether they would wish to change to an MDI regime)
• Absence of "end-stage" diabetes complications
• Those who have already completed the course are keen to promote the course should be offered to anyone with type 1 diabetes regardless of whether they are though as being in control or not of their condition
• Able to attend a full 5 days course

The Diabetes specialist team would be happy to discuss anyone who doesn't fit the criteria if you (or the patient) have concerns about their diabetes management.

Referral Criteria - Living with Diabetes - Type 2 Diabetes Structured Education

• Newly established type 2 diabetes
• Established type 2 diabetes but never received structured education previously
• Those with type 2 diabetes with poor/deteriorating control, on maximum oral therapy and likely to progress to injectable treatment and no structured education in last 5 years
• Able to speak and understand/read English
• Be able to participate in a group*
• Able to attend both half-day sessions

*Please contact the education team to discuss anyone who may not benefit from group education due to their other medical conditions (such as dementia, active mental health problems, severe frailty or moderate to severe visual or hearing impairment.

The diabetes specialist team would be happy to discuss anyone who doesn't fit these criteria if you (or the patient) have concerns about their diabetes management.