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Type 1 education: SADIE, the Eastbourne experience

Janet Jackson
, Sally Faulkner

The National Service Framework (NSF) for diabetes recommends that people with diabetes should have access to advice and information through structured education (Department of Health, 2001). In addition, NICE (2003) considers structured education to be a fundamental part of diabetes care.

In 2005 the DH and Diabetes UK produced a report on structured education in diabetes. This recognised the DAFNE (Dose Adjustment for Normal Eating) programme as a structured education and treatment package for people with type 1 diabetes, recommended as best practice. Over recent years a number of diabetes centres across the UK have developed similar programmes. 

In 2004, following training received from the Bournemouth Diabetes Education Centre, staff at the Eastbourne Diabetes Centre developed a structured education programme – SADIE (Skills for Adjusting Diet and Insulin in East Sussex). SADIE is a structured education programme for adults with type 1 diabetes and is delivered over 5 days across 5 weeks.

In May 2009 a 5-year audit of the SADIE programme was conducted; the outcomes measured were glycaemic control (HbA1c), quality of life and body weight change. 

Results
Between October 2004 and May 2009, 64 people with type 1 diabetes completed the full SADIE programme. Of those 64, 12 were lost to follow-up, resulting in an audit group of 52 people.

Glycaemic control
A 0.5 percentage point reduction in HbA1c level was observed at 1 year post-SADIE (mean HbA1c level at pre-assessment, 8.4% [68 mmol/mol]; at 1-year follow-up, 7.9% [63 mmol/mol]; P<0.0001). While recognising that for some people a reduction in HbA1c may increase their risk of hypoglycaemia, many continue to strive for its reduction.

Quality of life
Using the Problems and Associated Issues with Diabetes (PAID) score, quality of life was compared over the audit period. A statistically significant reduction in score (P<0.0001), which is associated with an improvement in wellbeing, was observed. 

Body weight change
Part of the SADIE ethos is for people to experience food freedom with the confidence of appropriately matched insulin. It could be suggested, however, that this approach has a potential disadvantage of weight gain. The audit demonstrated no significant change in body weight at 1 year post-SADIE.

Conclusion
The knowledge and skills that participants gain through the SADIE approach of supporting people with type 1 diabetes gives confidence to people with the condition and has life-changing effects. 

Nationally recognised education programmes similar to SADIE are commended for their benefits of monitored outcomes. In this 5-year audit, SADIE has been shown to significantly reduce HbA1c levels while significantly improving quality of life and maintaining neutral body weight change. Reductions in HbA1c level have been proven to yield positive long-term vascular health outcomes in people with type 1 diabetes (Diabetes Control and Complications Trial Research Group, 1993).

The National Service Framework (NSF) for diabetes recommends that people with diabetes should have access to advice and information through structured education (Department of Health, 2001). In addition, NICE (2003) considers structured education to be a fundamental part of diabetes care.

In 2005 the DH and Diabetes UK produced a report on structured education in diabetes. This recognised the DAFNE (Dose Adjustment for Normal Eating) programme as a structured education and treatment package for people with type 1 diabetes, recommended as best practice. Over recent years a number of diabetes centres across the UK have developed similar programmes. 

In 2004, following training received from the Bournemouth Diabetes Education Centre, staff at the Eastbourne Diabetes Centre developed a structured education programme – SADIE (Skills for Adjusting Diet and Insulin in East Sussex). SADIE is a structured education programme for adults with type 1 diabetes and is delivered over 5 days across 5 weeks.

In May 2009 a 5-year audit of the SADIE programme was conducted; the outcomes measured were glycaemic control (HbA1c), quality of life and body weight change. 

Results
Between October 2004 and May 2009, 64 people with type 1 diabetes completed the full SADIE programme. Of those 64, 12 were lost to follow-up, resulting in an audit group of 52 people.

Glycaemic control
A 0.5 percentage point reduction in HbA1c level was observed at 1 year post-SADIE (mean HbA1c level at pre-assessment, 8.4% [68 mmol/mol]; at 1-year follow-up, 7.9% [63 mmol/mol]; P<0.0001). While recognising that for some people a reduction in HbA1c may increase their risk of hypoglycaemia, many continue to strive for its reduction.

Quality of life
Using the Problems and Associated Issues with Diabetes (PAID) score, quality of life was compared over the audit period. A statistically significant reduction in score (P<0.0001), which is associated with an improvement in wellbeing, was observed. 

Body weight change
Part of the SADIE ethos is for people to experience food freedom with the confidence of appropriately matched insulin. It could be suggested, however, that this approach has a potential disadvantage of weight gain. The audit demonstrated no significant change in body weight at 1 year post-SADIE.

Conclusion
The knowledge and skills that participants gain through the SADIE approach of supporting people with type 1 diabetes gives confidence to people with the condition and has life-changing effects. 

Nationally recognised education programmes similar to SADIE are commended for their benefits of monitored outcomes. In this 5-year audit, SADIE has been shown to significantly reduce HbA1c levels while significantly improving quality of life and maintaining neutral body weight change. Reductions in HbA1c level have been proven to yield positive long-term vascular health outcomes in people with type 1 diabetes (Diabetes Control and Complications Trial Research Group, 1993).

REFERENCES:

Department of Health (2001) National Service Framework for Diabetes: Standards. DH, London
Department of Health, Diabetes UK (2005) Structured Patient Education in Diabetes: Report from the Patient Education Working Group. DH, London
Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329: 977–86
NICE (2003) Guidance on the use of Patient-Education Models for Diabetes: Technology Appraisal 60. NICE, London

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