Quality Standards for Diabetes Care Toolkit

The Manawatu, Horowhenua, Tararua Diabetes Trust offers consumer education courses for people diagnosed with diabetes and their family members. Education sessions are provided in group sessions across the MidCentral Health District and in general practices on request about:

diabetes ‘Healthy Living’, including a free supermarket tour

carbohydrate awareness courses

diabetes ‘healthy food choices and label reading’

type 1 support persons course

prediabetes education.

For more information go to: www.diabetestrust.org.nz/.

In Waitemata District Health Board (DHB) the Dose Adjustment for Normal Eating (DAFNE) programme for people with type 1 diabetes was implemented and assessed for clinical and cost effectiveness.

Synopsis: DAFNE is recommended by NICE in the UK as best clinical management for patients with type 1 diabetes. The DAFNE team currently comprises six DAFNE educators, a part-time administrator and two physicians. DAFNE graduates are invited to a rolling program of follow-up, which is currently being piloted. Clinical contact is recorded on the patient information management system (PIMS) and the concerto, cardiovascular and diabetes information system (CVDIS). The authors report that they have delivered 18 courses (152 patients) with 100% attendance. Principal DAFNE goals to improve quality of life and reduce severe hypoglycaemia have been achieved (PAID [diabetes distress] score reduced 50%, hypos reduced by 70%). Lipids, creatinine and HbA1c all improved. Mean improvement in HbA1c at one year was 0.1% but this included patients who have improved from overly tight control. Course costs per patient include a salary for educator time allocated to a precourse assessment, a five-day course, a follow-up rolling programme, preparation and stats collection and email support, a one-year follow-up clinic and 30% overhead. This calculates to $466 per patient. Compared to a clinic setting, if a patient sees a nurse twice per year, a dietitian and consultant once a year, this calculates to $236 per patient. The authors concluded that initial outlay costs for the course are feasible. When the amount of time the patient has alongside a clinician, 50 hours for the DAFNE programme (including FU,) is compared with 3.67 hours of standard care, the cost benefit is $9/hour of clinician time for DAFNE and $64/hour for standard care. They go on to say that increased patient autonomy, which is another key goal of the DAFNE programme, will reduce patient dependency on one-to-one clinic visits.

www.hiirc.org.nz/page/20562/how-to-incorporate-dafne-into-routine-clinical/?q=McNamara%20&highlight=mcnamara§ion=10538