Jenny Lind Diabetes Team
NNUH Diabetes Team Update - Sept 2010
We have listenedThanks to all parents, children and the young people who took part in the "satisfaction survey" conducted in 2008 (for under 14 years old) and again in 2009 (for 14 plus age group). We took your suggestions and criticisms on board and have made changes - you may already have felt the difference! We have started the twice a month late evening 4-7 PM clinic to offer appointments to those who did not want to miss schools or where parents found it hard to miss work. This change seems to have gone well and our clinics are fully booked. We have also changed the way we worked so that now there is only one consultant list on the day with the result that the processing time is short and your waiting time to see the team reduced. Many of you had found the waiting time excessive. Please tell us if your experience has been better! The young people have told us that the best age of transition to the adult service is 16 years. We are now actively trying to have a joint appointment after age 16 so that we can transfer the care to the adult colleagues. This is important as you need to know the adult team before you leave school and go to University. Late transfers can mean that you do not opportunity to know the adult teams locally. Most of you praised the support you get from the diabetes team but a significant number did not seem to get the diabetes information sheets. We have started to display the information sheets outside on the trolley for you to pick up as necessary. A small percentage of young people requested Saturday morning clinics!!!!! we were surprised. However at present we will not be able to do this. Sorry, there are not enough resources currently as you all are aware. Clinics• Under 6 Clinic We hope to start up our clinic for very young children, again. It will run on a Thursday evening in the Jenny Lind Children’s Department. The time won’t suit everyone, but it is when there is space available. In order to make it a bit easier, we will make sure snack boxes are available (including for brothers and sisters). We also hope to have a play therapist, to help the children understand their diabetes better. • 14+ Clinic A lot of you don’t like the name of our teenage diabetes clinic. Go to the NNUH website to have your say on the new name: http://www.nnuh.nhs.uk/ If you don’t like the names on offer, suggest an alternative – we will be glad to hear from you. Staff• Specialist Nurses We are delighted to welcome back Gill Ward after her stroke last autumn. She needs a stick, but she says that is for the consultants… • Psychology We were joined in June by a part-time Consultant Paediatric Clinical Psychologist, Dr Jo Derisley. Many of you will have met her at the Jenny Lind. Jo will help us to help you with the psychological burden of diabetes. She will be joined by Allison Coad in October 2010. • New Doctors We have been joined by a permanent member of staff, Dr Jo-Anne Veltman, and temporarily, by two new junior doctors, Cristina Matei and Clare Harrison. • Dietitian Our Dietitian Lucy Findlay is back from maternity leave, having added Daniel to her brood! Sadly, we must say farewell to Julia Eldridge, who stood in during Lucy’s absence. NNUH Staff AwardsTo our surprise and delight, the diabetes team has been nominated in the staff awards for this year. We were nominated by a parent – her kind words have made us blush! We will see if we win, on the 22nd October! How are we doing compared to other units across UK?We take part in the National Diabetes Audit every year. From this year it has become a requirement for all trusts. We sent data on 275 children under the age of 16 years. Our average HbA1c result is 8.3% compared to 8.7% nationally. So we are doing better than the national figures. The number of children achieving HbA1c below 7.5 % (the target) is 20% compared to the national average of 16%. So again we are doing better than the national average. Of the units who sent data to this audit, NNUH is amongst the 6 largest in numbers of children seen and only second to one other unit in the results. So well done every one for getting good diabetes control. What is HbA1c? Some of you might be wondering about it. It is a test we do on children every 3 months and it tells us about how the diabetes control has been over last 2-3 months. In people who do not have diabetes the number stays below 6 %. The national institute of clinical excellence (NICE) recommends the target of below 7.5%. It is believed that if the HbA1c is below 7.5% then there are minimum chances of any diabetes related problems later in life. However we realise that sometimes this is not possible to achieve. We will encourage you to try and bring your HbA1c as close to 7.5% as is possible so that your children have healthy and long life. Equipment• Freestyle Navigator • Insulin pens ResearchA number of important research studies are ongoing. Units that participate in research have significantly better results than those that don’t. We need your help if diabetes care is to continue to improve. These are the current studies we are involved with: • ADDIT - The Adolescent Type 1 Diabetes Intervention Trial. This study is trying to prevent the premature development of complications by using drugs to lower blood pressure and cholesterol. It is targeted at teenagers who already have some signs of excessive urine protein, but we are also recruiting those whos results indicate they are low risk for developing complications as controls. • ADDRESS - After diagnosis research support system. This is a database of type 1 patients from around the country. The idea is to collect information on newly diagnosed patients from baseline till 5 years after diagnosis. This database will be used to identify potentially eligible patients for other studies. • Artificial Pancreas Study - This is taking place in Cambridge. The aim of the study is to assess the safety and efficacy of the computer-based closed loop system to maintain glucose levels within the target glucose range (3.9 to 10.0 mmol/l) during a 36 hour period simulating normal daily activities in adolescents with T1D. Patients must be stable on an insulin pump to be eligible for this study. • Insulin Detemir vs Insulin Glargine - This study is comparing Detemir and Glargine in young women with diabetes to see if there are differences in weight gain, blood glucose control, total daily amount of insulin and hypoglycaemia. • The Genetics of Diabetic Nephropathy (NFS) - This is the feed in study for AdDIT. The study is looking at patients risk of developing diabetic complications from 3 early morning urine samples. • OCAPI - This study is being done to enhance knowledge on the safety profile of insulin APIDRA in real-life practice in children with type 1 diabetes aged 6 to 12 years, with a special focus on children aged 6 to 8 years. • Trialnet (natural history study) - This study screening relatives of people with Type 1 Diabetes to find out if those family members are "at risk" for developing Type 1 Diabetes. Screening involves a simple blood test to look for diabetes related autoantibodies that may appear years before the condition develops. PLANNED STUDIES • EPIC - This is a research study to develop and test an information pack for children/young people with type 1 diabetes. The aim of the age-appropriate information pack is to enable children and young people with the help of their parents and carers to manage their type 1 diabetes medication more effectively. • Trialnet (PRE-point) – This study is looking at children aged 2-7 years who either have a multiplex first degree family history of type 1 diabetes (both parents, parent and sibling or two siblings) Or have a sibling with type 1 who is identical. They are looking at oral insulin and its ability to delay or prevent the onset of type 1 diabetes in those who are at high genetic risk of developing it. • Trialnet (oral insulin study) – This study is looking at those who have shown to have certain markers when taking part in the Trialnet natural history study that put them at higher risk of developing type 1 diabetes. The study like PRE-point is looking at oral insulin and its ability to delay or stop the onset of type 1 diabetes. • DEFEND2 - This is similar to the Protégé study, looking at antibody treatment to delay the onset of new type 1 diabetes. As with all our research studies, if there is anything you would like to know more about, please ask or contact the Research Team: 01603 288530. Contacts: Jill Ward and Debbie Upton Research Team |
We have the use of a new continuous blood glucose monitor by Abbott, who make the blood glucose meters we use in hospital. It has been a big success, and we would like to buy some more, so that everyone who needs a glucose profile can have one. The glucose sensor is worn on the arm, and gives continuous glucose readings over 5 days. It alarms if you are too low or too high, and is a really good way of understanding what is going on - particularly if you are having unexplained hypos or high levels.