Hub-and-spoke model for a 5-day structured patient education programme for people with Type 1 diabetes.
OBJECTIVE
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.
Rogers
H
H
Diabetes Centre, King's College Hospital, London, UK. helenrogers@nhs.net
Turner
E
E
Thompson
G
G
Hopkins
D
D
Amiel
S A
SA
D001786:Blood Glucose / Q000187:drug effects*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000523:psychology; D055317:Evidence-Based Practice / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D011788:Quality of Life / Q000523:psychology
D001786:Blood Glucose