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Hub‐and‐spoke model for a 5‐day structured patient education programme for people with Type 1 diabetes
Author(s) -
Rogers H.,
Turner E.,
Thompson G.,
Hopkins D.,
Amiel S. A.
Publication year - 2009
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2009.02796.x
Subject(s) - medicine , type 2 diabetes , diabetes mellitus , quality of life (healthcare) , glycated haemoglobin , glycated hemoglobin , type 1 diabetes , diabetes management , pediatrics , emergency medicine , nursing , endocrinology
Aims Structured education programmes for people with Type 1 diabetes can deliver improved diabetes control (including reduced severe hypoglycaemia) and quality of life. They can be cost‐effective but are resource intensive. We tested the ability to deliver an evidence‐based 5‐day programme in diabetes centres too small to deliver the courses. Methods Specialist medical and nursing staff from three district general hospital diabetes services (the ‘spokes’) were trained in all aspects of the education programme, except those directly related to course delivery, by a larger centre (the ‘hub’). The hub staff delivered the 5‐day patient education courses, but all other patient education and management was managed locally. Diabetes control and quality of life were assessed at 1 year post‐course. Results In 63 patients with follow‐up data, glycated haemoglobin (HbA 1c ) fell by 0.42 ± 1.0% ( P = 0.001), with a greater fall in those with high HbA 1c at baseline, and no mean weight gain. Emergency call‐out for severe hypoglycaemia fell from 10 episodes in seven patients the year before to one episode in one patient ( P = 0.03). Quality‐of‐life measures improved, with reduced negative impact of diabetes on diabetes‐related quality of life ( P < 0.00004) and ‘present quality of life’ improving ( P < 0.001). Conclusions The benefits of a 5‐day structured education programme can be provided to patients with Type 1 diabetes attending centres without the resources to provide the teaching course itself, by a ‘hub‐and‐spoke’ methodology.