DESMOND….Diabetes Education and Self Management for Ongoing and Newly   Diagnosed

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Between 1999 and 2004 Portsmouth City ran a programme called ‘Starting out with Type 2 Diabetes’. However it was felt that as there were many varied education programmes around the county we wanted to ensure that education for patients newly diagnosed was consistent and Portsmouth helped to pioneer DESMOND which has now become a national programme.

DESMOND is funded by local PCTs and is a whole day’s education for patients who have been newly diagnosed with type 2 diabetes within the past year.

Two DESMOND trained educators run the day on a Friday. We invite 10 patients along with a partner or friend. The day is informative and also fun,  We start the day with the patient story, finding out a little about them, how they found out they had diabetes, what it means to them and what they understand about it, as the day unfurls we pull out and expand on the relevant information and dispel any myths. Portsmouth diabetes team believes that patients work well within a group setting by sharing knowledge and drawing experiences from each other.

We then proceed to the professional story, What is diabetes? What are the long term effects? and How can we manage the disease? The day is made real for patients by using their own blood test results, so prior to the day they will have a blood test to check their HbA1c and lipid profile. We measure blood pressure on the day and ask participants to complete a well being questionnaire. We also discuss blood glucose monitoring to ensure that is used accurately and appropriately if the patient chooses to do so.

The day concludes with goal setting.The patients choose one aspect of care that they wish to work at and are encouraged to link with their practice nurse for on going support.

We also see DESMOND as an educational day for other health care professionals who are welcome to observe us on the day as we work with the patients who are embarking on a long journey ahead with type 2 diabetes.

If you wish to join us on the day or have patient who has recently be diagnosed with Type 2 diabetes please contact the Diabetes Centre 023 9228 6000 ext 6260 to book a place for Portsmouth City. The day is held at Buckland Community Centre, Portsmouth.

For Hampshire PCT patients the day is held at Gosport War Memorial or Petersfield hospitals or Havant health Centre

DESMOND trainers:

Portsmouth City

Sarah Moutter  Kate Marsden  Sharon Allard  Lisa Skinner

Hamsphire PCT 

Jane Egerton  Debbie Fishwick

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BASAL BOLUS CONVERSION GROUPS

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The BBC programme aims to assist adults with diabetes in the transition to a basal bolus insulin regimen. It consists of four 2-hour sessions over a period of six months. A diabetes specialist nurse (DSN), a diabetes specialist dietitian, or both, facilitates each group and up to six people with type 1 or type 2 diabetes (and their partners) are able to attend.

At the start of the programme, participants share their frustrations with their current insulin regimen, and identify what they hope to achieve by changing to a basal bolus regimen. The insulin change is made during group 2 and is then reviewed at subsequent sessions. Throughout the programme there is a focus on carbohydrates, matching insulin doses to food and insulin dose titration.

In order to attend the programme patients must already be treated with insulin. They must be willing to monitor their blood glucose levels intensively, especially before and in the first few weeks after their insulin has been changed. They must also be able to attend all four group sessions.

Participants are referred into the BBC group programme by doctors, DSNs and specialist dietitians within the Diabetes Centre. Referrals from general practitioners and practice nurses are also welcome, although the initial appointment would be on a 1:1 basis with a DSN prior to entering the groups.

PAINFUL PERIPHERAL NEUROPATHY STRUCTURED EDUCATION GROUPS

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These groups aim to enable people with painful peripheral neuropathy to gain a better understanding of their condition.

During the groups we explore:

• What is Painful Peripheral Diabetic Neuropathy?
• Causes of Painful Peripheral Diabetic Neuropathy
• Symptoms of Painful Peripheral Diabetic Neuropathy
• Diagnosis of Painful Peripheral Diabetic Neuropathy
• Treatment of Painful Peripheral Diabetic Neuropathy
• Associated health risks and how to prevent them
• Support for sufferers of Painful Peripheral Diabetic Neuropathy

Attendees also have the opportunity to ask questions and share their experiences and concerns with other people in the group.

The groups are usually a ‘one off’ session although if further support is required it can be arranged.

Between six and eight people are able to attend each group. Patients who are under the care of the Diabetes Centre are able to refer themselves into the groups. Referrals from GPs, Practice Nurses and Podiatrists are also welcome and should be directed to Kate Marsden at the Diabetes Centre, Queen Alexandra Hospital.

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STARTING INSULIN GROUPS:

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These groups are for people with Type 2 Diabetes on maximum oral hypoglycemic agents, who, due to poor glycaemic control, now require conversion to insulin therapy.

Introduction to insulin.

Once a decision regarding Insulin start is made, a Diabetes Nurse will assess the patient on a 1:1 basis in order to proceed into a Starting Insulin Group, taking into account any special needs.

At this appointment, insulin regimens will be discussed, together with the action profile of the insulin available, although a decision on the choice of regimen may not be made at this stage.

A practical demonstration of the insulin delivery pen device is given and the patient will experience a dry injection in order to dispel any fears or anxieties regards injections. Patients will be given a pen device pack to take home to allow them to make a choice of device to suit their needs and or dexterity. Also provided is a Starting With Insulin Manual, which will provide written information to support verbal information given. Three appointments will be mutually agreed in order to initiate insulin therapy.