Diabetes in Wales – an education

In Wales there are 183 000 people, over 7% of the adult population, with diabetes (90% with type 2 diabetes and 10% with type 1 diabetes). No one would dispute the importance of diabetes education, and its provision formed a key part of the aims of the National Service Framework (NSF) for Diabetes (2003–2013), launched by the Welsh Government in 2003 to tackle the increasing prevalence of the condition. In 2009, it became apparent that, even with the NSF in place, diabetes education was only reaching between 1–2% of people with diabetes (personal communication with Julie Lewis). The Welsh Government’s Health and Social Care Committee (2013) held an inquiry into the short-comings of the NSF and recommended that “the Welsh Government should urgently address the variances in provision of structured education for people with diabetes”. As a result, the Welsh Government (2013) launched the Together for Health – A Diabetes Delivery Plan. A Delivery Plan up to 2016 for NHS Wales and its partners, which put providing patient education at the centre of the plan. The delivery plan has now been extended to 2020 and a refresh is to be published shortly.

Structured diabetes education (SDE) is the traditional format for diabetes education, but it can be resource intensive, requiring dietitian and diabetes specialist nurse (DSN) time, and requiring commitment from patients to attend several sessions of education and follow the advice given during the sessions. To encourage people to attend SDE, referral to an SDE programme was included in the Quality and Outcomes Framework. However, while referrals were high, the number attending the courses were low (in one Health Board there was a 90% referral rate, but only a 1% attendance at the courses). Clearly more incentive was needed to encourage individuals to attend SDE, or diabetes education itself needed to be delivered differently. In Wales, a suite of complementary resources has since been developed for healthcare professionals and people with diabetes to provide advice and deliver education in other formats.

Resources for clinicians and people with diabetes

• The Welsh Government has worked in collaboration with the PCDS to produce a suite of online e-learning modules, which are fully funded and supported by an educational grant from NHS Wales. The following modules for healthcare professionals are currently available.
• Diabetes and older people: Community care: A two-part module for healthcare assistants working in the community, care homes and GP practices, and for allied health professionals seeking a basic understanding of diabetes, its risks and management.
• Diabetes prevention: A module for healthcare professionals involved in identifying people at high risk of type 2 diabetes and in preventing or delaying its onset, including GPs, nurses and allied health professionals.
• Pre-conception and pregnancy management in women with diabetes: A module for all healthcare professionals involved in the care of women of childbearing age who have diabetes.

Future topics to be covered in the modules  series include making the right diagnosis in diabetes and the safe use  of oral therapy in the management of type 2 diabetes. Healthcare professionals in Wales can access the modules at www.learning.wales.nhs.uk/login/index.php, while clinicians in the rest of the UK can access them at www.diabetesonthenet.com/cpd.

• Diabetes UK’s information prescriptions are integrated into EMIS Web and Vision systems in every GP surgery in Wales and throughout the UK – they just need to be activated (see www.diabetes.org.uk/info-p-qa for details). Information prescriptions are designed for people with diabetes and provide information that is clinically accurate and easy to read, to improve their understanding and achievement of health targets. Currently information prescriptions cover HbA_1c, hypertension and blood lipids. There are two information prescriptions for pre-diabetes in development that are awaiting approval. The information prescriptions scan patients’ records, and, if a patient is above the NICE target levels for safe blood pressure, HbA_1c or cholesterol, the healthcare professional will be prompted to print out an information prescription for the patient. This will then be automatically recorded in the patient records.
• Dr Sam Rice, Clinical Champion for Diabetes UK and Diabetes Clinical Lead at Hywel Dda Health Board, the Welsh Assembly Government and Diabetes UK Cymru have partnered with Pocket Medic, a production company, to make videos about  chronic conditions, including various aspects of diabetes. These videos have been designed for GPs to prescribe to people with diabetes to help improve understanding and self-management of the condition. Each video is approximately 5 minutes in length and features advice from healthcare professionals and people with diabetes. The videos are engaging and can be viewed at any time on a phone, tablet or computer. A preliminary evaluation carried out by Dr Rice suggests that there have been improvements in markers of diabetes control among those who have watched and interacted with the videos and further analysis is ongoing.
• Diabetes UK Cymru and the Diabetes and Endocrinology National Service Advisory Group for Wales (2013) developed Advice for Newly Diagnosed People with Type 2 Diabetes, known locally as the “orange booklet”. It was developed by DSNs, dietitians and a behavioural psychologist and has proven  popular with people of all ages with diabetes, not just those who are newly diagnosed. An updated version is due to be published in the  very near future.
• Diabetes UK Cymru has begun to deliver peer support groups in partnership with Local Health Boards and GP surgeries. The “Living with Diabetes Days” have been well-attended in Wales; 250 people signed up to attend a day in the heart of rural Powys – the most attended day in the UK.
• Available to people with type 2 diabetes throughout the UK is Type 2 Diabetes & Me (www.type2diabetesandme.co.uk), a Diabetes UK online e-learning programme to help people understand and manage their diabetes successfully. Anecdotal reports suggest the programme is well-received by people with diabetes and healthcare professionals. The current module launched in 2013, is due to be updated shortly.

The next important step is ensuring that healthcare professionals and people with diabetes are aware that these resources are available and they know how they can be accessed.