Better Regulation Using Better Regulation Using Carbohydrate and Insulin Carbohydrate and Insulin

Education: B.R.U.C.I.EEducation: B.R.U.C.I.E

Susan Diamond, Diabetes Specialist DietitianSusan Diamond, Diabetes Specialist DietitianAnne Reid, Diabetes Specialist NurseAnne Reid, Diabetes Specialist Nurse

ObjectivesObjectives

Primary ObjectiveTo assess if regulation using carbohydrate and insulin education will improve treatment satisfaction and quality of life for individuals with type 1 diabetes.

Secondary ObjectivesTo assess if regulation using carbohydrate and insulin education will improve biochemical parameters for individuals with type 1 diabetes including HbA1c, BMI and Waist:Hip.

Study DesignStudy Design

This will be a randomised control study of 52 weeks

A total of 36 participants will be recruited for the treatment arm of the study and 36 participants will be recruited as a control group.

Descriptive statistics will be calculated for all key variables within the study.

A statistical package will be used to analyse the data.

Study PopulationStudy Population

Approximately 72 participants with type 1 diabetes using an analogue insulin basal bolus regime will be recruited. 36 patients will be randomly recruited to the treatment group and 36 to the control group.

AssessmentsAssessments

The key measures are change in treatment satisfaction and quality of life from baseline, 12 weeks and 52 weeks.

Biochemical parameters will be measured. HbA1c will be analysed using DCCT aligned analysis.

Waist:hip ratio and Body Mass Index will be recorded.

MethodologyMethodology

Treatment Group Visit 1 – one day CHO training baseline

assessments for QoL/Treatment Satisfaction and clinical parameters

Visit 2 – group discussion Visit 3 – group discussion, QoL/Treatment

Satisfaction and clinical parameters Visit 4 – group discussion, QoL/Treatment

Satisfaction and clinical parameters

MethodologyMethodology

Control Group Visit 1 – regular clinic visit Dietetic/DSN

consultation QoL Satisfaction and clinical parameters

Visit 2 – regular clinic visit (optional) Visit 3 – regular clinic visit, QoL/Treatment

Satisfaction and clinical parameters Visit 4 – regular clinic visit, QoL/Treatment

Satisfaction and clinical parameters

Study MaterialsStudy Materials

Photographic Atlas of Food Portion Sizes B.R.U.C.I.E Carbohydrate Counting and Insulin Adjustment

Workbook Stanford D. ed. (1999). The Fat, Fibre and Carbohydrate

Counter: the essential guide to healthy eating. London: Murdoch Publishing.

ROCHE Diagnostics Ltd Blood Glucose Diary Insulin Treatment Satisfaction (ITSQ) Questionnaire Copyright

2001 Novo Nordisk (A/S) Audit of Diabetes Dependant Quality of Life (ADDQoL)

Questionnaire Prof C Bradley Patient Information and Informed Consent GP/Consultant Letter B.R.U.C.I.E Poster Patient Invitation Letter

Feedback So FarFeedback So Far

Verbal feed back from participants has been positive so far:

“Completely changed my life”“Feel liberated”“My expectations have been

exceeded”

BRUCIE CurriculumBRUCIE Curriculum

Philosophy Learning Style – Social Learning Theory(1)

Lesson Plans

1. Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice Hall.

BRUCIE PhilosophyBRUCIE Philosophy

To empower people living with diabetes through training and development

To provide information that will allow individuals to make lifestyle choices that will have a positive impact on blood glucose

To provide support and enable people to manage their lifestyles and achieve quality of life

Sample Lesson Plan (brief overview) – Sample Lesson Plan (brief overview) – Insulin and CarbohydrateInsulin and Carbohydrate

Process Learning Theory – Social Learning Theory Learning Objectives:1. To understand the relationship between

insulin and carbohydrate2. To be able to identify why carbohydrate is

counted3. To be able to identify different types of

carbohydrate and their effect on blood glucose

Brief Lesson Plan Insulin and Brief Lesson Plan Insulin and CarbohydrateCarbohydrate

Theory Educator Activity Participant Activity Resources Verbal Persuasion: identifying knowledge base on insulin and carbohydrate Emotion Management: identifying past thoughts/experiences/myths Content

1. Current insulin regimens

2. Relationship between carbohydrate and insulin

3. Why we count carbohydrate – advantages and disadvantages

4. Different types of carbohydrate

Educator will:

1. Provide brief presentation on basic facts about insulin and carbohydrate

2. Elicit knowledge

base from participants

3. Ask questions on

insulin and carbohydrate to increase understanding

4. Encourage

participants to share experiences of insulin and carbohydrate

Participant will:

1. Use own experiences and reactions to insulin and carbohydrate

2. Describe current

relationships with carbohydrate

3. Use own experiences

to answer questions on insulin and carbohydrates

4. Share information

with fellow participants to increase personal knowledge

1. BRUCIE Workbook

2. Food Atlas

3. Carb Counting Book

4. Presentation

Audit and QualityAudit and Quality

Self ReflectionPeer ReflectionResearch ProjectFuture Plans - ?? external assessment

Questions ?

AcknowledgementAcknowledgement

RECLAIM Clinic Edinburgh Royal Infirmary

DAFNE

Diabetes Education Network