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Diabetes Nursing


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Taking communication in diabetes into the 21st century

Heather Reed
, Mhairi Meldrum

As diabetes nurses, we need to provide consistent, current and accessible information to both people with diabetes and other healthcare professionals. Because the internet is now such an integral part of everyday life, two DSNs thought it would be a good idea to develop a diabetes website designed solely to provide this information. This article outlines the development of the website, and describes how the site has progressed since its launch in May 2001 and how it has changed in response to feedback.

Two DSNs based at York District Hospital conceived and developed the idea of producing a diabetes website to provide information to both people with diabetes and healthcare professionals. As far as they were aware, there was no other website of this nature in the UK at that time, so this was a ground-breaking project.

The nurses were keen to use an alternative medium to printed leaflets for the dissemination of information, and the internet was an obvious option. For those people who do not have access to the internet, there is no shortage of printed written information (i.e. leaflets) on all aspects of diabetes care. However, a growing number of people are now using the net to access information.

It is to be hoped that patients are now challenging decisions made by healthcare professionals, and questioning traditional practices. Some patients, however, might be reluctant to confront professionals with questions face-to-face; the internet gives these patients the opportunity to become more informed and hence more confident in their approach.

Development of the website
The website was developed over 12 months, during which time discussion took place about what should be included in the site and who should be involved in its development and maintenance. Presentations about the proposed website were made to healthcare professionals in the Yorkshire region. This helped to gauge support and gain ideas about how the website would evolve. Planning of the site was also discussed with some local patients and carers. 

The basic philosophy behind the site is to dismantle the boundaries of primary and secondary care, and to help people with diabetes take control of their condition. The site can be accessed by anyone, and favours regional coordination of information and sharing of best practice by involving practitioners from all parts of the region in the editorial board and encouraging local healthcare practitioners to advertise innovative practice.

Local representatives of drug companies involved in diabetes care were approached to secure funding for the site. GlaxoSmithKline (GSK) funded the initial costs of £2500. This covered the regional launch meetings and the work done by the site design company. GSK also provided advice on how to launch and advertise the site, and continue to fund meetings of the site’s editorial board. It costs approximately £350 to update the site, which equates to £1400 per year because the site is updated every 3 months. Site updates have so far been paid for by donations from the York Diabetes Centre’s funds and some pharmaceutical companies. The editors are currently approaching other companies involved in diabetes care for donations.

Editorial board
The nurses and GSK agreed that an editorial board should be brought together to manage the content and maintenance of the site. They initially approached DSNs who had attended the preliminary presentations, and then expanded this group to include one person with diabetes, one representative from Diabetes UK and one from Rossman Haigh, the site-designing company. The board meetsa every 3 months to consider any suggestions for updating current pages and developing new ideas. A GSK representative continues to meet with the editorial board.

Content of the website

The following sections describe each page of the website. In order to whet appetites and encourage people to explore the website these have been kept deliberately brief.

Local profiles
A map of Yorkshire highlights the main centres of diabetes care in the region. About half the towns and cities named have links that open up to reveal details about local diabetes services, from staff names and clinic times to Diabetes UK groups. The profiles are gradually developing as members of the editorial board add information about their own area. The design company charges £100 for each area’s initial entry on the website.

Detailed information about the current range of meters, insulin pens and other devices is updated every 3 months to provide a reference guide for the public and professionals alike.

A grid shows the range of insulins and oral hypoglycaemic agents available, including details such as cartridge sizes and maximum tablet doses.

GP prescribing codes
This page has recently been added to assist surgery and pharmacy staff in ordering from the rapidly increasing range of diabetes products. It is gradually developing to include insulins, pen needles, lancets and test strips.

Children and teenagers
This page was developed by paediatric DSNs and has already been adapted and changed in response to feedback from children using the site. The quiz has proved popular with children and teenagers, particularly as a small prize, e.g. a teddy bear, is offered.

‘Top tips’
This page offers general information about diabetes management, such as advice about coping with going back to school.

‘Myths and legends’
This section contains statements that could be true or false, e.g. ‘If you have diabetes you must always eat your meals at exactly the same time every day’. The correct advice is then given.

This section has changed significantly since the launch of the website. For the first few months, abstracts and summaries of a range of articles from medical and nursing journals were included. These were chosen by one editorial team member, but proved very time-consuming, as that person had to read through many articles; it was also too selective, reflecting only one person’s choice. Now, the contents pages of the main diabetes journals are displayed, allowing people to choose the articles they wish to read.

Patient support
This section of the site comprises Diabetes UK pages, with details of local support groups, contact names and telephone numbers. All Diabetes UK events, both local and national are also highlighted.

Diabetes teams in various parts of the region have produced information leaflets on topics such as insulin stabilisation, erectile dysfunction, hypoglycaemic episodes and retinal eye disease. These can provide ideas for people creating their own leaflets, or can be printed off for use by patients and carers.

Local, national and international conferences and events related to diabetes are listed, along with application addresses.

Guidelines such as the Desktop Guides to Type 1 and Type 2 Diabetes, the ISPAD 2000 Consensus Guidelines, and Classification of Diabetes and its Complications are available to read and can be printed off if required.

Useful links
Links to other websites related to diabetes care are located on this page, including those of the Royal College of Nursing, the UK Association of Diabetes Specialist Nurses, the Diabetes Nurses Forum, various pharmaceutical companies and Diabetes UK.

Future developments
These are early days in the development of and the editorial board are debating how to carry things forward. We have discussed various options: should we remain independent; should we link to other regional sites that might develop; should we be bringing other members of the diabetes team on board; and how do we continue funding the site?

Although the costs of implementing and maintaining the website are significant, responses and feedback lead us to recommend that making information accessible by this means is a useful way of providing health education.

The website went live in May 2001 and was widely advertised at the Diabetes UK 2002 Conference in Birmingham. In the 12 months from September 2001 to September 2002 we have had 112287 hits, an average of 9357 per month. This would appear to be proof that people are keen to access the internet for information.

With thanks to Moira Digby and Paul Dromgoole at York District Hospital.

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