Online structured education for people with type 1 diabetes

Structured education for people with type 1 diabetes has shown improved outcomes and is now an integral part of clinical care (Department of Health, 2001; 2003; NICE, 2004). However, there are major time and resource implications for hospital and community trusts.

The course available at the Imperial College Healthcare NHS Trust is based on Broomfield’s Education Resources for Training in Insulin and Eating (BERTIE; Everett et al, 2003). In 2007, the BERTIE syllabus was provided free online (BDEC, 2007), endorsed and supported by Diabetes UK. The aim of this study was to evaluate the clinical effectiveness of a new shorter model of type 1 diabetes education, using group tutorials and an online carbohydrate-counting programme.

Method
In all 304 people with type 1 diabetes using multiple daily injections were invited to attend the course. The course was delivered over 2 weeks and supported by a dietitian and DSN, using two group tutorials, individual e-mails and telephone contact. It was run alongside the syllabus provided by BDEC online, which covers flexible intensive insulin therapy, carbohydrate counting and insulin adjustment. Primary outcomes were HbA_1c and quality of life, measured by the Problem Areas in Diabetes (PAID) questionnaire, at 3 and 6 months. Secondary outcomes were weight, BMI, severe hypoglycaemia, minimum and maximum insulin bolus, and frequency of blood glucose monitoring.

Results
A total of 48 individuals responded and 40 attended the course (see Table 1 for overview of results). HbA_1c levels fell significantly to a mean of 8.0% at 3 months (P=0.001). The PAID score significantly reduced at 6 months (P=0.01) but was not changed at 3 months. In the year prior to the course, 11 out of 48 participants reported 17 episodes of severe hypoglycaemia. At 3 months after the course, two participants out of 27 had five episodes of severe hypoglycaemia, and at 6 months, two out of 23 had three episodes of hypoglycaemia.

The maximal prandial insulin bolus dose fell significantly at 3 and 6 months (P=0.018; P=0.021) compared with baseline. Both weight and BMI significantly increased at 3 months (P=0.044; P=0.037) but returned to baseline at 6 months.

The course was met with positive feedback, including one comment on:
“… the personal ‘hands-on’ approach – time to discover or learn more about controlling blood glucose levels, and sharing ideas.”

Conclusion
Structured education on type 1 diabetes delivered online with supplemental tutorial time increases the accessibility for young people and has a significant positive impact on HbA_1c at 3 months, as well as quality of life and prandial insulin bolus dose at both 3 and 6 months.

The authors would like to acknowledge the Imperial College Healthcare Charity, which provided funding for the project.