The Need for a New Approach
Adolescence is often a time in which young people with type-1 diabetes struggle to control their blood glucose levels. This may be a result of lack of skills in self-care, a lack of agreement between the young person and the parent who should be responsible for their care, or difficulty in including the activities of care in normal everyday life.
Whatever the reason, poor control can lead to severe complications in later life such as blindness and renal failure. Therefore, ensuring good control is of paramount importance. The current diabetes transition clinics for young people with type-1 diabetes jointly run by Sheffield Teaching Hospitals and Sheffield Children’s Hospitals are associated with poor attendance and poor diabetic control. This suggests the traditional clinics do not meet the needs of young people. A more radical approach involving a team of professionals dedicated to supporting adolescents with Type-1 diabetes may be more successful in supporting self-care in adolescence.What is the theme doing?
Using funding from the NIHR, the theme plan to develop and assess a new model of care for young people with Type-1 diabetes living in Sheffield. The model of care will be tailored to the needs of each individual and their families and may include structured education, targeted skills training, psychosocial support, and peer support. The model of care will be delivered by Diabetes Specialist Nurses and Diabetes Specialist Dietitians with input for Clinical Psychology. The work to develop the model will take part in defined phases:
The views of Young People, Families and Staff on Current Services
Professor Christine Eiser is leading a project aimed at understanding the views of staff, young people aged 11-21 years with type-1 diabetes, and members of their family. Through individual interviews, it aims to explore barriers to good self-management and views about possible interventions. Individuals will be recruited from Sheffield Teaching Hospitals, Sheffield Children’s Hospital, Barnsley Hospital, and Rotherham Hospital. Interviews are currently been undertaken and results are expected in 2011.
Prevalence of depressive symptoms, diabetes distress and eating disorder in young people with type - 1 diabetes
This questionnaire study aims to find out how common depressive symptoms and eating disorders are among young people aged 16 -25 years with type-1 diabetes in Sheffield and other areas of South Yorkshire. Data collected in this study will be linked to clinical data, such as blood sugar, collected from the service evaluation (see below). This study will be one of the first of its kind in the UK; most work looking at depression and eating disorders in diabetes has been conducted in the US. We will look for links between depression and eating disorders with poor control of diabetes. It will help us to understand if there is a need to develop specific interventions to target these problems to improve care of young people with Type-1 diabetes. For further information please contact Professor Christine Eiser (link to information with contact details).
Dr Adrian Scott is the lead for a Service Evaluation which will assess the current provision of service for young people aged 16 -25 years with type-1 diabetes and the outcomes of care. Data collection for the Service Evaluation will commence shortly with data being collected across Sheffield Teaching Hospitals and Sheffield Primary Care Trust. It is expected that the results of this evaluation will be available later in 2010 and will provide an indication of keys areas in which change is needed. The results will act as a baseline in which to measure the impact of any future changes in service.
Dr Neil Wright is leading the development of a telemedicine intervention which will allow the remote monitoring of blood glucose by the clinical care through real-time automated transmission of results from the patients monitor. It is hoped that this may allow more timely support to young people to assist them in managing their diabetes.
Results from phase 1 will be used to inform phase 2 of the project
Phase 2 will involve a multi-disciplinary team of dietitians, Diabetes Specialist Nurses, psychologists and clinicians developing a new model of care. Action research will be used to further develop and evaluate the model. By the end of CLAHRC, we hope to plan a formal trial to evaluate the new model in more detail.
Diabetes Public Patient Involvement
Jenna Allot, film student York University and Sheffield Teaching Hospitals patient, was inspired by her experience of the pilot WICKED education programme (Working with Insulin, Carbs, Ketones and Exercise to manage Diabetes) to write and produce a short film publicising the course for other young people who may wish to attend.
With all long-term health conditions the voices of those actually living with the day-to-day problems can be lost in the planning and delivery of health care - diabetes is no exception to this. Jenna’s film, featuring the acting talents of WICKED graduates, Diabetes Service patients and staff, gives a voice to young people with type-1 diabetes, helping shape the Adolescent Diabetes service of the future.
Jenna’s WICKED film can be seen below.
For more information about WICKED please click here
Click here to view the Adolesent Programme Team