Clinical care and other categories posters: Education and self‐management: Covid‐19

From the classroom to the living room: Delivering structured education to people living with type 2 diabetes during a pandemic

G. S. Alayyan; L. J. Beckwith; I. L. Kirby; K. A. Pomeroy; H. C. Price; S. A. Sims

West Hampshire Community Diabetes Team, Southern Health NHS FT, Lyndhurst, UK

Aim: To adapt and deliver type 2 diabetes structured education online during the covid‐19 pandemic.

Methods: The covid‐19 pandemic and resulting lockdown in March 2020 led to suspension of face‐to‐face diabetes education. In order to continue to deliver type 2 diabetes structured education we adapted our courses for both newly diagnosed and refresher education such that they could be delivered online. First, a series of videos covering key topics were recorded and posted online. These were advertised to patients and healthcare professionals. Online views showed strong initial interest, but we recognised that patients also needed interactive education. We piloted an approach combining ‘flipped classroom’ with blended learning. The videos became pre‐session ‘homework’ for a 90‐minute Zoom group session, where participants could apply their learning, ask questions, and gain peer support. Sessions were underpinned by behaviour change theory. DVDs were also produced for those without IT access.

Results: Feedback was overwhelmingly positive. Participants cited being able to access education from home and not having to use public transport as particular advantages. The length of the session was also popular. Staff reported a positive experience and benefitted from less travel time. The Quality Institute for Self‐Management Education & Training (QISMET) evaluation commended our strategy for meeting patient needs and enhancing patient empowerment.

Conclusion: We have adapted and delivered QISMET‐accredited online structured type 2 diabetes education during the covid‐19 pandemic. Uptake has been high and feedback good. We will continue to offer online education as part of our suite of educational options.

Acknowledgement: West Hampshire Community Diabetes Team

A longitudinal perspective on user uptake of an electronic personal health record for diabetes, with respect to patient demographics: 10 years of My Diabetes My Way (MDMW)

N. T. Conway^1,2; M. Bluett^2,3; C. Shields²; A. Taylor⁴; D. J. Wake^5,6; S. G. Cunningham²

¹ Tayside Children's Hospital, NHS Tayside, Dundee, UK; ² Division of Population Health and Genomics, University of Dundee, Dundee, UK; ³ NRS Diabetes Network, NHS Research Scotland, Dundee, UK; ⁴ SCI‐Diabetes, NHS Education for Scotland, Dundee, UK; ⁵Centre for Medical Informatics, Edinburgh University, Edinburgh, UK; ⁶ Diabetes Department, NHS Lothian, Edinburgh, UK

Introduction: The growing prevalence of diabetes has increased the need for scalable technologies to improve outcomes. My Diabetes My Way (MDMW) is an electronic personal health record (ePHR) available to all people with diabetes in Scotland since 2010, associated with improved clinical outcomes among users. MDMW pulls data from a national clinician‐facing informatics platform and provides self‐management and educational information. This study aims to describe MDMW user demographics through time with respect to the national diabetes population, with a view to addressing potential health inequalities.

Methods: Aggregate data were obtained retrospectively from the MDMW database and annual Scottish Diabetes Survey (SDS) from 2010 to 2020. Variables included diabetes type, sex, age, socio‐economic status, ethnicity and glycaemic control. Prevalence of MDMW uptake was calculated using corresponding SDS data as denominators. Comparisons between years and demographic sub‐groups were made using chi‐squared tests.

Results: Overall uptake of MDMW has steadily increased since implementation. By 2020, of all people with type 1 or type 2 diabetes in Scotland, 13% were fully enrolled to MDMW (39,881/312,326). There was proportionately greater numbers of users in younger, more affluent demographic groups (with a clear social gradient) with better glycaemic control. As uptake has increased through time, so too has the observed gaps between different demographic sub‐groups.

Conclusion: The large number of MDMW users is encouraging, but remains a minority of people with diabetes in Scotland. There is a risk that innovations like MDMW can widen health inequalities and it is incumbent upon healthcare providers to identify strategies to prevent this.

Evaluation of an online social learning environment in type 1 diabetes self‐management education

S. C. MacKenzie¹; K. M. Cumming¹; D. Garrell¹; D. Brodie¹; L. Wilson²; S. Mehar^1,3; S. G. Cunningham⁴; A. Bickerton⁵; D. J. Wake^6,7

¹ MyWay Digital Health Ltd, Dundee, UK; ² NHS Lanarkshire, Bothwell, UK; ³ NHS North West London Collaboration of Clinical Commissioning Groups, London, UK; ⁴ Department of Population Health & Genomics, University of Dundee, Dundee, UK; ⁵ Department of Diabetes & Endocrinology, Yeovil District Hospital NHS FT, Yeovil, UK; ⁶ Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK, ⁷ Edinburgh Centre for Endocrinology and Diabetes, NHS Lothian, Edinburgh, UK

Aims: Self‐management education is an essential component of type 1 diabetes care which improves health outcomes. Online mediums of education delivery are growing in popularity, offering a flexible alternative to traditional group education. Interest in online education has increased as healthcare restructuring secondary to covid‐19 has restricted face‐to‐face offerings. We delivered and evaluated a free open online course in type 1 diabetes self‐management education.

Methods: Understanding type 1 diabetes was a free open online course accessible via registration on an online platform. The course was delivered over a 2‐day period in December 2020 and focused on key self‐management concepts featuring videos, quizzes and moderated comment sections accompanied by a daily live Q&A session. The course was evaluated via a post‐course questionnaire to establish user feedback and experience.

Results: 216 users started the course, with 106 users completing >75% of the course steps (completion rate 49.1%). Among the 103 users who completed the optional post‐course questionnaire, 69 had type 1 diabetes and 21 were healthcare professionals. Most users agreed that the course was easy to follow (95.1%), improved their knowledge of diabetes (76.2%), motivated them to manage their diabetes (79.7%) and improved their self‐management confidence (79.4%). Thematic analysis of free‐text responses identified appreciation of the peer‐learning environment provided with minimal technical difficulties experienced.

Conclusions: Open online courses offer a remotely accessible, engaging and scalable method of self‐management education delivery that motivated and improved the self‐management confidence of their user base.

Virtually delivering a diabetes prevention programme (Healthier You) increases accessibility and equity

V. Johnson¹; S. Harrison¹; J. Lewin²; J. Troughton¹; B. Stribling¹

¹ Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; ² Operations and Supply Chain, Ingeus, London, UK

Aim: Healthier You (HY) is an NHS England commissioned diabetes prevention programme meeting criteria for structured education programmes (SEPs). It is evidence‐based, informed by theory, underpinned with a philosophy and usually delivered as sixteen 90 minute face‐to‐face group sessions for participants at risk of type 2 diabetes. We decided to adapt HY for virtual delivery to enable this SEP to continue during covid‐19. We aimed to examine the uptake and impact of this new delivery mode.

Method: A multidisciplinary group of stakeholders reviewed and modified the programme to support virtual delivery, while retaining credibility as SEP. HY facilitators were trained in the new mode of delivery. Delivery of virtual HY began April 2020. Data was collated over 2 time periods; face‐to‐face delivery (2019) and virtual delivery (1/4/2020–1/12/2020) and compared for acceptability and accessibility.

Results: Uptake to face‐to‐face HY was 66%, increasing to 69.5% for virtual delivery during covid‐19. An increase in attendance of people <35 years of age (12% vs. 5%), from non‐White groups (30% vs. 23%) and from the most deprived quintile of deprivation (28% vs. 17%) was seen for virtual HY compared to face‐to‐face. Average weight loss improved with virtual delivery compared to face‐to‐face (3.6 kg vs. 2.4 kg).

Conclusions: Since covid‐19, there has been increased uptake to virtual HY by those who are younger, employed, from BAME background and/or socially deprived areas. Fewer older, retired people attended. Post‐covid‐19, a hybrid approach to HY delivery may support accessibility and equity while improving weight loss.

Impact of virtual care during covid‐19 on glycaemic control and weight among DAFNE Kuwait graduates

A. El Samad; E. Taghadom; S. Murad; R. Al Awadhi; M. Azizieh; M. Irshad; J. Al Kandari; E. Al Ozairi

DAFNE Kuwait, Dasman Diabetes Institute, Kuwait City, Kuwait

Aims: Severe acute respiratory syndrome coronavirus (covid‐19), changed diabetes care delivery globally. The impact of virtual care is unknown. Our study aims to evaluate the effectiveness of virtual clinics on glycaemia in DAFNE Kuwait graduates.

Methods: A total number of 221 DAFNE graduates were invited to join virtual care. 184 DAFNE graduates accepted to follow‐up virtually and were recruited to the cohort group. A matched number of 184 DAFNE graduates did not follow‐up virtually and served as controls. Three structured virtual care were developed by the multidisciplinary team at DAFNE Kuwait. The primary outcome measures were HbA1c and weight which were monitored at baseline and after three months for both groups. A cross‐sectional analysis was conducted in this study.

Results: At three months’ follow‐up, there was a significant reduction in HbA1c for subjects who attended all virtual appointments (n = 122, pre 72.75 vs. post 63.81 mmol/mol, p < 0.001) in the cohort group. Whereas, HbA1c increased significantly for subjects in the control group (n = 134, pre 56.82 vs. post 63.05, p < 0.001). On average, the mean of virtual visits per subject was 18 visits for completers. The frequency of daily hypoglycaemic episodes decreased significantly among the hypoglycaemia unawareness group (n = 6, pre 2.8 vs. post 1.7 events per day, p = 0.002). Interestingly, the difference between HbA1c and weight in covid‐19 infected (n = 6) and non‐infected cases (n = 178) were almost equal. Lastly, a significant weight reduction was observed among overweight DAFNE graduates followed up virtually (n = 85, pre 80.9 vs. post 77.8 kg, p < 0.001).

Conclusions: DAFNE Kuwait virtual care had significantly reduced HbA1c and weight.

Building educator confidence, through training workshops, to deliver structured self‐management education for type 2 diabetes and pre‐diabetes virtually during the covid‐19 pandemic

S. Harrison; F. Brant; T. Douglas; J. Farmer; V. Johnson; A. Northern; A. Rodgers; J. Troughton

Leicester Diabetes Centre, University Hospitals Leicester NHS Trust, Leicester, UK

Objective: To provide training and support to build confidence of educators delivering an adapted portfolio of diabetes education and self‐management for ongoing and newly diagnosed (DESMOND) structured education programmes (i.e. newly diagnosed and foundation programme, let’s prevent diabetes, and walking away from diabetes) during the covid‐19 pandemic.

Methods: The DESMOND curriculums and resources were adapted from face to face delivery to support virtual delivery, but remain congruent to the theoretical and philosophical underpinning of the interventions and content. A virtual DESMOND academy was established offering a portfolio of 2 hour workshops (delivered through MS TEAMS) to support existing DESMOND educators with confidence to set up and deliver bespoke DESMOND programmes. Workshops included a demonstration of visual resources available to support virtual delivery and discussions about how to use behaviour change techniques based on the DESMOND philosophy and learning theories virtually. Attendees provided feedback via an online survey.

Results: To date (18.01.2021) 47 workshops have been delivered to 329 attendees. Post‐training surveys show: 95% of attendees rated the workshop as useful/very useful and 84% felt more confident to deliver virtually afterwards. Aspects of training reported as most useful were; an overview of the visual aids, facilitation skills for virtual delivery and sharing good practice. The main concern was the use of, and access to, reliable technology by educators and participants.

Conclusions: Workshops designed to build confidence of educators to deliver self‐management education virtually are effective in increasing educator confidence. Technology skills and access are concerns that need to be further addressed.

Launching virtual type 2 diabetes education across Northamptonshire

A. Northern¹; A. Mandalia²; S. Boardman²; S. Stanton²; M. Jeffrey²; L. Spence²; J. Hall²; L. MacDonald²; L. Burgess²

¹ Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; ² Northants Diabetes MDT, Northamptonshire Healthcare NHS FT, Northampton, UK

Aim: To launch virtual means of delivering DESMOND (Diabetes Self‐Management for Ongoing and Newly Diagnosed) groups across Northamptonshire.

Method: In March 2020 all face‐to‐face groups were cancelled and as a result a virtual programme was developed by DESMOND National Office. In Northants, a small working group of DESMOND Educators and administrators reviewed this and attended virtual workshops to support rollout, subsequently delivery pathways were revised. Lay volunteers assisted with testing Microsoft Teams, new processes and the co‐production of promotional materials. Mock sessions were delivered between Educators to build confidence and the first virtual DESMOND was delivered at the end of September, delivering the six‐hour curriculum over three 2‐hour sessions.

Results: Since September Northants Diabetes MDT have delivered 14 virtual groups with 46 participants attending all three sessions. The importance of administrative support was deemed paramount to securing attendance, reducing anxiety relating to remote attendance and troubleshooting technical queries. Evaluation data showed self‐management confidence scores increased from 5.93/10 pre‐group to 8.41/10 post‐group (n = 28), with 100% of respondents stating their expectations had been met. Qualitative data highlights the usefulness of attending in helping people to better understand their type 2 diabetes, as well as a wealth of positive feedback about the use of virtual delivery and the Educators delivery skills.

Conclusions: For this group of virtual DESMOND attendees the experience was positive, and led to a noticeable increase in confidence to self‐manage their condition. Northants Diabetes MDT have 13 virtual groups per month planned for 2021.

How do patient attendees rate virtual group education: Our initial findings?

A. Northern¹, F. Brant¹; T. Douglas¹; J. Farmer¹; S. Harrison¹; V. Johnson¹; A. Rodgers¹; J. Troughton¹; M. J. Davies²

¹ Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; ² Diabetes Research Centre, University of Leicester, Leicester, UK

Aim: To understand how patients find the experience of attending virtual group education during the covid‐19 pandemic.

Method: Diabetes Education and Self‐Management for Ongoing and Newly Diagnosed (DESMOND) programmes for people with or at risk of type 2 diabetes were adapted for virtual delivery in late May 2020, so UK and Ireland DESMOND providers could implement virtual groups during covid‐19. 14 DESMOND providers distributed online surveys at the end of each group; either via chat functions or follow‐up emails. A range of questions were included rating how participants had found the experience before and during attendance. The responses were all entered anonymously and automatically analysed by the online survey software.

Results: To date 147 responses have been received with an average overall experience rating of 4.7 out of five was given. 97% reported finding it easy to log into their virtual group. 92% were happy to attend virtually rather than waiting to attend in‐person. 93% felt able to express how they were feeling about their type 2 diabetes. 93% were able to keep up with the information provided. 90% reported feeling part of a group. 94% reported making a plan to make a lifestyle change with 68% focusing on weight loss/maintenance and 19% on HbA1c. 97% would recommend attending.

Conclusion: Although implementation is in early stages these initial findings suggest those who attend a virtual DESMOND group find the overall experience positive. It is envisaged that virtual means of group delivery will now become part of diabetes education provision permanently.

Acknowledgement: on behalf of DESMOND licenced providers and educators

Virtual type 1 diabetes structured education delivery during the covid‐19 pandemic

M. J. McDonald; G. S. Alayyan; C. Atkinson; K. Fayers; I. R. Hibberd; H. S. Houghton; I. R. Kirby; E. L. Perry; H. C. Price; L. Ward

West Hampshire Community Diabetes Service, Southern Health NHS Trust, West Hampshire, UK

Aim: To adapt and deliver our QISMET accredited type 1 diabetes structured education programme online during the covid‐19 pandemic.

Method: The covid‐19 pandemic and resulting lockdown in March 2020 led to suspension of face to face diabetes education. In order to continue to deliver type 1 diabetes structured education we adapted our course such that it could be delivered online. The online programme utilised live group webinars, bespoke videos and online resources and maintained QISMET accreditation. The Zoom breakout room feature was used to allow small group sessions. Videos were uploaded to YouTube and participants sent the links via email in advance of each session. The course continues to run as weekly sessions over four weeks.

Results: Uptake of the course was good particularly from people who were unable to access face to face learning due to work or other commitments and from all age groups. Seven courses have been held during 2020, 79 people attended at least one session with 67 completing the entire course. Feedback collected via survey monkey was positive with the breakout rooms particularly well received.

Conclusion: We have adapted and delivered QISMET‐accredited online structured type 1 diabetes education during the covid‐19 pandemic. Uptake has been high and feedback good. We will continue to offer online education as part of our suite of educational options.

Healthy Eating and Active Lifestyles for Diabetes (HEAL‐D) programme for African and Caribbean communities: Feasibility and acceptability of a remote education programme and lessons learnt

L. Goff¹; A. White²; R. White³; A. Newman³; J. Sampford⁴; E. Pirie²

¹ Faculty of Life Sciences & Medicine, King's College London, London, UK; ² Health Innovation Network, Health Innovation Network, London, UK; ³ Dietetic Department, Guy’s & St Thomas' NHS Trust, London, UK; ⁴ Physiotherapy Department, Guy’s & St Thomas' NHS Trust, London, UK

Aim: To assess the feasibility and acceptability of remote videoconferencing delivery of the Healthy Eating and Active Lifestyles for Diabetes (HEAL‐D) programme during the covid‐19 pandemic.

Method: Stage one: a patient telephone survey, assessed likely engagement with remote delivery, alongside provider and commissioner discussions to establish affordability. Stage two: development of a specification and delivery model for HEAL‐D remote delivery, considering referral pathways and platform functionality e.g. delivery of participatory activities (e.g. exercise classes), and fostering of peer support. Stage three: pilot delivery of four courses to 23 patients across three boroughs and evaluation, comprising a pre/post‐course questionnaire.

Results: Eleven of 16 patients said they would attend a remote programme, one needed support and five had no internet/equipment. Of 80 funded places, only 27 referrals were received; 85% (n = 23) accepted a place and four courses were delivered. 70% (n = 16) completed the course (attended ≥six of seven sessions). Service provider barriers to referring included the referral process not embedding within standard referral pathways and pressures associated with covid‐19 and flu vaccinations. Patients evaluated the course highly; all agreed/strongly agreed that, as a result of the course, they learned practical skills and feel more motivated and supported to manage their diabetes.

Conclusions: Remote delivery of culturally tailored diabetes education is acceptable to patients, however; a better understanding of digital exclusion is needed and ease of referral pathways is pivotal for service providers. More work is required to establish if the on‐line programme elements can replicate the engagement and clinical improvements of face‐to‐face delivery

Accessibility and adherence to clinical guidelines on diabetic emergencies during the covid‐19 pandemic: A survey to connect with healthcare professionals via digital platforms

S. Azam^1,2; F. Neale²; H. Furness²; E. Hui^1,2

¹ Department of Diabetes and Endocrinology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK; ² Department of Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK

Aims: The covid‐19 pandemic has brought many challenges to medical training and education. Clinical guidelines are an important resource especially for redeployed healthcare professionals (HCPs) to manage diabetes emergencies. Our aim is to understand how non‐specialist HCPs prefer the diabetic ketoacidosis (DKA) and hyperosmolar hyper‐glycaemic state (HHS) guidelines to be presented to improve accessibility and adherence.

Methods: An online survey was conducted in January 2021, using a QR code to access the survey via digital platforms including email, posters and MS teams.

Results: Among the 101 responders, 42% were core‐medical or trust‐grade doctors, 22% foundation year 1 doctors, 17% higher specialty trainees and the remainder nurses, healthcare assistants, pharmacists and consultants. Despite online access to national‐based trust diabetes guidelines, only 17% of surveyed HCPs were confident in prescribing and administering treatment for DKA or HHS. 92% responders had managed DKA or HHS more than once in the last 6 months. Despite the majority (88%) knowing where to access the current guidelines, only 13% of prescribing responders followed the guideline in prescribing regular basal insulin with fixed‐rate intravenous insulin infusion. 88% preferred a pre‐printed proforma of the guideline with examples of model prescriptions. Most useful features rated were flowcharts (76%), checklists (72%), criteria for escalation (62%) and model prescriptions (58%). Guidance on fluid management, especially in renal and heart failure, was most frequently requested.

Conclusions: An online survey with QR code access has facilitated a good response and has allowed diabetes emergency guidelines to be tailored to the needs of non‐specialists during the covid‐19 pandemic.

Can a face‐to‐face training programme be converted to a remote format at pace in challenging times? An evaluation of the remote DAFNE educator programme

S. Woolgar¹; L. Richardson¹; B. Hedgcock¹; G. Thompson¹; J. Elliott^1,2,3

¹ DAFNE Central Office, North Tyneside Hospital, North Shields, UK; ² Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; ³ Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals, Sheffield, UK

Background: The DAFNE Educator Programme (DEP) is a training programme for diabetes specialist nurses and diabetes specialist dietitians, training them to deliver structured education to people living with type 1 diabetes and includes face‐face training elements. The restrictions imposed by the covid‐19 pandemic have impacted on face‐to‐face training programmes, so a Remote DEP has been developed.

Aims: To provide a Remote DEP that is accessible to both existing educators and new trainees within the pandemic restrictions, maintain confidence in the quality of the programme and enable diabetes specialist teams to continue to provide DAFNE structured education to people living with type 1 diabetes.

Methods: Existing educators took part in a half‐day virtual workshop. For new educators a Remote DEP was developed in partnership with The Open University. Remote educator training programmes were piloted and evaluated between June and December 2020 and rolled out post‐pilot.

Results: Most DAFNE centres in the UK, 82 out of 92 (89%) now have educators trained in the delivery of Remote DAFNE. Two thirds, 215 of 323 (66.6%), were previously trained in face‐to‐face DAFNE courses. One third, 108 of 323 (33.3%) were new educators who learnt via a blended approach of online and remote workshops, and were assessed in a virtual environment, 81% said the training programme was excellent, 19% rated it as good, and 86% rated the assessment feedback as excellent.

Conclusions: The Remote DAFNE Educator Programme is an effective way of training diabetes specialist team members to deliver Remote DAFNE courses within the restrictions imposed by the covid‐19 pandemic.