No. of Children No. of HCPs Trained No. of Children Campsnnef.in/nnefadmin/uploads/medianewsletters/cdic-Dec 2015.pdf · 21st Nov 2015 22nd Nov 2015 28th Nov 2015 6th Dec 2015 Other

Issue: 12 / December / 2015

Editorial Committee: Prof. P. Raghupathy, P. Dinakaran, Dr. Shuchy Chugh, Anupama Rau Attawar, Dr. Neera Gupta

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Editorial Desk

Changing Diabetes® in Children (CDiC) - Quarterly Update

World Diabetes Day 2015

Capacity Building Initiative-HCP training

"PMEA 2015" win for Novo's Changing Diabetes in Children. Unique Initiative in CDiC

FAQ

Diabetes Educator column (Different needs of children in different age groups)

No. of Children

No. of HCPs Trained

No. of Children Camps

Reaching Out DashBoard

Editorial Desk

Dear Friends

Thank you for your continued support & commitment to the CDIC program. With your support & concerted efforts, awareness creation on type 1 diabetes reached newer heights during the WDD programs across India in November 2015. Thank you for helping us implement the CDiC educational scholarship program. It is great that 353 young and promising children with type1 diabetes from poor families across India, could be supported through this initiative and we are hoping that this can be a small beginning to help them becoming self-reliant. We should now focus on working together to influence society , policy makers and government so that comprehensive care becomes the right of every child with type 1 diabetes.

I take this opportunity to wishing you and your family a prosperous Happy New Year.

Thank you Melvin D’Souza Managing Trustee NNEF VP & GM Novo Nordisk India Pvt. Ltd.

Dear Colleagues

Working for Changing diabetes in children is always satisfying for me in many ways and I appreciate your dedication and commitment towards this program. I always feel that this is just the beginning of journey and we need to reach many more children suffering from type 1 diabetes. This can only happen when there are many more dedicated health care professionals like you, taking care of children with diabetes all over India. In this direction , I will like your support for the HCP and Diabetes Educator training modules and programmes. Diabetes educator training module is ready for use. Let’s work together with best of our ability to support and help every child with type 1 diabetes.

Let this new year bring new hope, joy and health in life of everyone. Wishing you and your family a very happy and prosperous New Year 2016.

With Best Wishes

Prof. Ashok Kumar Das

Dear Friends / Colleagues,

I would like to thank each one of you for creating mass awareness about type 1 diabetes in the month of November during WDD and taking this program to a new height. It was great that in most of the centres , children participated in oath program and pledged for self-care. We also need to re-pledge our commitment towards children with type 1 diabetes. It is essential to fulfil our dream of seeing all these children with diabetes growing into healthy and self-dependant adults.

Let us make best use of this opportunity and increase our efforts. It is heartening to note that we are all capturing data in the CDiC registry on type 1 diabetes. I request you to keep on doing this on a continuous basis and also take the necessary approval of “Ethics committee”. As you know this essential step will help in getting out publications and sharing knowledge for better care to these children with type1 diabetes. We hope to bring more scientific literature and further increase our understanding on type 1 diabetes through this initiative in the coming years.

Wishing you and your family a very happy new year 2016.

With Regards, Prof. P. Raghupathy Chairperson, CDiC.


Changing Diabetes®

in Children (CDiC)Years ofCommitment & Care4

Infrastructure

• 21 Centers/27 Satellite centers

• 4063 BPL children

Training & Education

• 2486 Drs and 1370 Paramedics

• > 2000 books and 2000 CD’s of ISPAD book on type1 management given

• DKA posters made

• Handbook for Diabetes Educators and Nurse Educators with support of all CDiC center heads made and distributed

Free Insulin & Supplies

• Free consultations, insulin , syringes, glucometer, strips and lancets

• Free diagnostic tests which include HbA1c, TSH, CBC & Eye fundus examination

Learning & Outcome

• Two national level advocacy programs and participation in five State Round Table Meetings

Diabetes registry& equipment

• Data collection and update under process

• Scientific committee working on publication

Patient Education

• 389 camps reaching to around 16000 children

• Innovative education material like NOTTI, Mishti, Snake & Ladder, Make your own plate, HbA1c Calculator

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2

3

4

5

6

Worlds largest project onT1 diabetes

Changing Diabetes® in Children (CDiC)-on-going journey of care & commitment for children with type 1 diabetes


Infrastructure & Equipment

• Comprehensive care for more than 4000 children continues.

• Around 400 children, who are lost to follow up or grown beyond 21 years are being replaced centre wise by children registered under Novo Aid in respective centres.

Insulin & Supplies

• Access to insulin continues with same dedication and momentum .

• Support for monitoring continues with new glucometers, strips and lancets being supplied to all the centres for children

• Twice a year HbA1c tests undertaken along with other key diagnostic tests.

Capacity Building and Raising Awareness

• Two diabetes educators training workshops conducted at Bangalore and Puducherry respectively reaching to 278 nurses.

• One accredited HCP workshop conducted at Samatvam Bangalore reaching to 52 Doctors and 24 diabetes educators.

Quarterly Update Patient Education

• Keeping the theme of “ Healthy eating and Diabetes” of WDD in focus, 28 activities conducted all over India reaching around 2300 children and >6500 people.

• A “Snack Box”, with an important message on healthy eating given as a gift to all children during WDD programs.

• “Know your Carbs”, leaflet distributed, keeping in mind the need for the understanding among children on carbohydrate intake

Learning

• 8th Advisory board meeting was conducted on 23rd Aug 2015 & way forward plans reviewed for implementation.

• Strategies for improving follow-up among the registered children discussed

Going forward the key objective of the program is to ensure good outcomes for children with type1 diabetes. Along with this, focus would be on creating better understanding of type 1 diabetes among HCP’s and improved awareness in general public.

Keeping the theme in mind , Diabetes education classes, Diet quiz programs, Diabetes walk and cultural programs were conducted to mark World Diabetes Day all over the country in various CDiC centres and satellite centres. More than 28 such programs happened all over the country involving more than 2300 children and 6500 people in total.

Activity brief- Main centers


Activity

Diabetes Education, Diet Exhibition, Motivational Program

Painting Competition, Oath , Games, Giving a tree

Painting Competition, Oath

Diet Demonstration, Cultural Program, Drawing Competition

Walk, Dance competition, Diet quiz, Rangoli competition

Painting Competition, Oath taking , Diet Education

Walk, Education program, Cultural Program

Walk, Painting competition, Diabetes Education

Magic show, Dance performance, Diet Education

Walk, Talk on living with diabetes

Walk, Diabetes Education Program

Diet Education, Cultural Program, Painting Competitions

Education, Painting Competition, Motivation Program

Diabetes Education, Cultural Program, Painting Competition

Diabetes Education , Painting Competition

Diabetes Education , Painting competition

Date

24th Oct 2015

1st Nov 2015

4th Nov 2015

8th Nov 2015

8th Nov 2015

8th Nov 2015

8th Nov 2015

14th Nov 2015

14th Nov 2015

14th Nov 2015

14th Nov 2015

19th Nov 2015

21st Nov 2015

22nd Nov 2015

28th Nov 2015

6th Dec 2015

Other camps

Total

Place

AIIMS, New Delhi

Samatvum, Bangalore

Tapadia, Hyderabad

IGICH, Bangalore

BDH Bangalore

SPAD Kanpur

Sarda center, Aurangabad

TOTALL Indore

DRS, Hyderabad

PMC, Patna

SSKM, Kolkatta

KEM , Mumbai

IID, Trivandrum

Diacare , Ahmedabad

Jehangir Hospital, pune

Wadia

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28

No ofchildren

295

132

46

108

275

37

300

30

110

20

50

40

53

275

45

71

420

2308

Total Noof people

700

320

100

250

550

80

800

200

300

150

120

100

125

700

100

150

1830

6575

World Diabetes Day 2015 campaign focused on “healthy diet and diabetes”


Healthy diet and diabetesKeeping theme of “ Healthy eating and Diabetes” of WDD in focus, diet education programs were conducted in all centres. Every centre had many activities focused on diet, which included diet classes, diet quiz and diet exhibition. Snack box containing message on healthy eating were distributed among children. It aimed at inculcating habit of having healthy food and also preventing hypoglycaemia . Leaflets on Knowing carbs were designed according to age. Pictorial and easy representation for children less than 10 years of age and more detailed explanation for older children and parents. These were also distributed among children.

WalksTo create awareness about diabetes in children , highlight the need to understand diabetes in order to control it, and communicate that diabetes can affect anyone, at anytime, walkathons were held at many centres. Around 3000 people participated in walkathons.


Painting CompetitionsThis year the theme of painting competition was – Understanding Diet – Red, Yellow and Green way. The aim of this painting competition was to create awareness and highlight the need to understand the relationship of diet in managing diabetes among children with diabetes. Competition was conducted in most of the centres and satellite centres. More than 2000 children participated in the competition.

Cultural ActivitiesCultural programs were conducted in most of the centres to motivate children. Children presented their talents to the audience. They presented dance programs which included excellent classical dance performances like Bharatanatyam and kathak. There were skit, rangoli making activities, hoola hoops, aerobic and yoga performances at various centres.


Diabetes Education classesPeer group support and diabetes education classes for child and parents are very important in management of diabetes. For Empowering children and families and providing them essential support from peers in same situation, diabetes education classes were conducted. Along with diet, many other topics of importance like insulin taking technique, hypo and hyper and sick day rules were among main topics which were discussed

OATH Taking and Motivational Programs


Children at most centers also took part in oath campaign. Oath Campaign created a moment to involve every child with type 1 diabetes in self-Management. To keep this oath every child was needed to make few promises . To make these promises, 4 Pillars leaflet was given . Along with that, children had a chance to meet adults living healthy and normal life with type 1 diabetes which motivated them and reemphasized the importance of diabetes self-management.

First Step - Child needs to take oath about following diabetes management and studying well. Then he she needs to write his / her wish for life.

Parents , doctor , diabetes educator gets involved at this point to provide support system for the child. They help the child ideate the essential steps to fulfill their wish in life.

Second step - Child thinks and set few tasks for themselves through which his / her wish can be achieved . Individual goals need to be made.

They should be simple and achievable e,g – I will eat bottle gourd by a 10 year old boy

I will not cry when mom gives insulin by a six year old.

Third step - These need to discussed with parents , doctors and educators . This activity needs to be kept alive on every follow up visit of the child. These goals and outcomes can change after some time. Eg every 3 months. It would be nice if we all keep the momentum and help children with diabetes grow into healthy and self-dependent adults.

OATH CAMPAIgn

HCP Training


Section 1 : Overview of Diabetes

• What is Diabetes?

• Diabetes in Children - Types of diabetes and their unique features

• Clinical features and investigations of Type 1 diabetes

• Four Pillars and soul of Type 1 diabetes Management & Importance of Insulin.

Section 2 : Lifestyle Management of Type 1 diabetes

• Diet – An important pillar of diabetes management

• Balanced Diet and normal growth

• Adjusting Carbohydrates through exchange and counting

• Exercise and its impact on child with Type 1 diabetes &

• Precautions for a safe exercise regimen

Section 3 : All about Insulin

• Insulin injection site and technique

• Storing Insulin and disposal of waste

• Premixed Insulin Regimens

• Intensive Insulin Regimen

• Blood glucose Monitoring - essential for dose correction and Type 1 diabetes management

Section 4 : Coping Skills for managing Type 1 diabetes

• Parents counselling- an important aspect of managing Type 1 diabetes

• Hypo and Hyperglycaemias

• Sick Day Management

• Medical, physical, psychological and social – environment.

• Positive reinforcement- a powerful tool for counselling

Section 5 : needs for Specific age group

• Infant and Toddlers

• School going children

• Adolescents

• Transition to adulthood

Section 6 : Specific Situations

• Traveling

• Party and Festivals

• Fasting

• Surgery

In the last quarter of 2015 , we had 3 HCP training training programs.

2 nurses education programs. One such program was conducted

at Fortis Hospital, Cunningham Road Bangalore on 19th Oct. The

programme was attended by 78 nurses. The other program was

conducted on 15 Dec 2015 at Pondicherry Institute of Medical Sciences

by Prof A K Das. Around 200 nurses participated in this program. We

also had a 1 day program in Practical Diabetology for Health Care

professionals on 22nd December at Samatvum CDiC centre. It was

attended by 52 doctors and 24 diabetes educators. Dr S S Srikanta,

Dr A Sharda, Dr Tejeswini Deepak, Dr Vasanthi Nath and Dr T Kamala

were among the key speakers.

Diabetes is unlike other diseases, where taking medication alone can solve the issue. There are a multiple components of care in diabetes

management , such as: the diabetes disease process, nutritional management, physical activity, medications – time and adjustment, Insulin

taking technique , glucose monitoring, and psychosocial adjustment. This is the reason why diabetes education is considered soul of diabetes

management. Training module for diabetes educators is now ready for use. It has been divided into 6 parts and is focused completely on

management of type 1 diabetes. Please find the brief of the module.


CDiC programme wins the EY award for Socially Responsible initiatives at the PMEA awardsNovo Nordisk's Changing Diabetes in Children (CDiC) programme

aimed to improve the availability, accessibility, affordability and quality

of care for children with type 1 diabetes won the EY award for Socially

Responsible Initiatives at the PMEA Awards.

The PMEA judges said: “This entry is a great example of partnership

working and a project which has been sustained over several years. It

had a huge impact over the long term and had great uptake with the

number of new children enrolled and new healthcare professionals

trained. We were all hugely impressed; congratulations to all

involved.”

To overcome financial hurdles, it offers free provision of insulin and

blood glucose monitoring equipment for the children.In India, the

programme has been a huge success with the establishment of 21

centres and 27 satellite centres. The programme has a registry of

more than 4,063 children with type 1 diabetes and has imparted

training to over 2,302 doctors and 1,068 paramedical staff through

workshops.

In winning the EY Award for Socially Responsible Initiatives Novo

saw off competition from Astellas Pharma EMEA and the Astellas

Innovation Challenge, J&J's wide-reaching CSR strategy and Reckitt

Benckiser - with support from Tonic Life Communications - and the

GiveA campaign.

The PMEA programme, run by PMLiVE publisher the PMGroup, is

specifically designed to recognise and commend excellence, best

practice and innovation in local, European and international markets.

We thank each one of you for your support and efforts towards

changing diabetes in children.

Diacare CDiC centre organizes

"Mother education program"."When you educate a Man, you educate a person, when you educate

a woman, you educate a Family" So goes an old proverb. Educating

and empowering a mother goes a long way in achieving exponential

results whether it is in academics, sports or good control of diabetes

as in our cases. Keeping this thought in mind , an education session

was organized only for mothers by Diacare on SMBG, carbohydrates

counting and insulin correction factor. On this occasions., mothers

also presented their recipes to the Nutrition expert Mrs.Smita Shah

and then choosen recipes were circulated among the group.

CDiC programme wins the PMEA - 2105

FAQQ1 - How is basal bolus insulin regimen better than premixed insulin regimen?

In a body with normally functioning insulin production, the levels of insulin change all the time. An automatic feedback mechanism follows the amount of carbohydrate taken in the food and then regulates the level of glucose in the blood by appropriate insulin secretion. When a child is diagnosed with type 1 diabetes , he/ she needs to take insulin from outside on regular basis.

There are two general types of intensive insulin treatment plans:

1. Basal Bolus Regimen is best for keeping blood sugar in tight control especially for children with type 1 diabetes. In this regimen, child needs to take three or more insulin shots of short acting insulin along with main meals per day and most of the time one dose of long acting insulin for maintaining minimal requirement of insulin throughout the day. The long-acting insulin is called the basal insulin. Long-acting insulin generally provides for the body’s basic insulin needs for 20-24 hours. Short-acting, or bolus insulin, covers the body’s insulin needs for a meal. Doses of short acting insulin can be adjusted according to the food eaten. This regimen attempts to mimic body’s natural process and thus helps to maintain blood glucose levels as near normal as possible while providing flexibility of meal time and quantity and also less chances of hypoglycaemia.

2. Pre Mixed Insulin Regimen – In this regimen 2 doses of premixed insulin (short and long acting e.g. 30/70 or 50/50) before breakfast and dinner are given. Children on this regimen need to have a fixed diet at the particular time, with least variations in activities to achieve the optimal glucose control.

The goal of treatment is to maintain not only best possible level of glucose control but also optimal quality of life. Basal bolus insulin regimen tends to provide both for children with diabetes.

Q2 - If insulin dose of a child is increasing, is diabetes getting worse?

The most important goal for people with diabetes is keeping near-normal blood sugar levels in order to feel well and avoid long-term diabetes complications. Right dose of insulin along with right nutrition and exercise are essential for management of type 1 diabetes in children. It may take some time to find the right dose for any individual as insulin requirement is dependent on many factors like height , weight and daily routine of a child. Insulin doses need to be continuously adjusted to help keep blood sugar levels in a healthy range. Many factors affect blood sugar levels, including diet, exercise, time of day , illness or any stress. In addition, insulin doses may need to be changed over time. Insulin needs often increase for these children (not so much in adults) especially during their growing years. Changes in weight, height, other hormones, diet, activity level and any stress (mental or physical) can affect the amount of insulin

needed to control blood sugar. Mostly total daily dose of insulin do increase as the child grows into adulthood and then usually it becomes stable to some extent.

Q - 3 Are bitter gourd and fenugreek (methi) seeds, jamun useful for children with diabetes?

There is as yet no strong scientific evidence to prove that bitter gourd, jamun or fenugreek seeds play a major role in bringing down blood sugar levels to any significant level. At the most they work just the same way as many other dietary fibres. It is also important to mention that there is no data to prove that they are harmful. While, these are good for every one including people with diabetes. Food rich in soluble fibers however cannot be a substitute for insulin. One more thing , which is also essential to consider the choice of the child for whom the food is made. So have them if you want to but do not skip or discontinue the medications advised by your doctor.

Q4 - Can a child with diabetes re use the syringes?

Mostly all needles and syringes are recommended for single use. However many people reuse syringes and needles to help cut costs. Reusing is not a bad idea but it is essential to keep in mind few things to have safe injection. It is essential to talk with your doctor or nurse before you begin reusing.

Do not reuse* if-

• You are ill,

• You have open wounds on your hands, or

• You have poor resistance to infection.

Here are some tips to keep in mind when reusing syringes:

• Keep the needle clean by keeping it capped when you are not using it.

•Never let the needle touch anything but clean skin and the top of the insulin bottle.

•Never let anyone use a syringe you've already used, and don't use anyone else's syringe.

Things not to do

• Cleaning needles with alcohol swab. This removes the coating that helps the needle slide into the skin easily and can make taking the injection painful.

*http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-storage-and-syringe-safety.html


Stage Issues to be dealt Diabetes Self Management* Education to be taught

1.Infant and Toddlers –are dependent on parentsfor every thing

• Brain is very sensitive to hypoglycaemia• Sensitive to Regular/rapid insulin• Picky eater• Unpredictable activity

Infancy (birth–18 months)• Providing warmth and comfort measures after invasive procedures is important• Feeding and sleeping or nap routines• Vigilance for hypoglycemia May need to give insulin after mealsPlay age (3–5 years)• Begin process for teaching child awareness of hypoglycemia. Identification of hypoglycemic signs and symptoms (temper tantrums and nightmares are common)• Include child in choosing injection and finger-prick sites• Positive reinforcement for cooperation

2. Child -A young human being belowthe age of puberty- physicallyindependent but not otherwise

• Education• School entry, New class, beginning high school• School Meals• Sports, annual day, day trips, educational tours• Psychological issues• Lying to parents

• Integrate child into educational experience - step by step• Determine skill level• Identify self-care skills – self monitoring of blood glucose levels, insulin dosing and correct injection technique• Determine roles and responsibilities• Food Choices• Communication with peers and school staff - who and when to tell about diabetes

3. Teenager -A person from thirteen tonineteen years of age-physical independencealong with mental andsocial independence too

• Insulin resistance• Non compliance• Fabrication• Denial• Eating out and snacking• Family conflicts• Alcohol• Eating disorders• Carrier options

• Begin transition care planning• Personal meaning of diabetes• Determine roles and responsibilities in care• Being Independant• Eating out• Social situations and dating• Who or when to tell about diabetes• Driving• Sex and preconception counseling• Alcohol and drugs• College and career planning

4. Adults – Adults usual start workingfor livelihood.

• Education/ vocational training• Independent living• Employment• Marriage• Pre- conception counselling

• Personal meaning of diabetes• Roles and responsibilities in care• Social situations and dating• Who or when to tell about diabetes• Genetic risks, conception, and preconception• Travel• Choosing or pursuing a career• Workplace rights• Health or life insurance• Involving friends and significant others in diabetes care• Safety• Creating a support network• Establishing or maintaining independence

Diabetes Educator Column

As we all understand that education and counselling for children is always depend on the child’s age. Play and art may be used to involve and encourage young children, while stories and talking about feelings may help children in their early teens to express themselves.

Although different methods may be used for diabetes education and counselling children, the aim remains the same; to help the child cope better and understand diabetes self-management education. In this article we will learn age specific issues and focuses in management of type 1 diabetes and the important things to be taught to child and the parents.

Every individual is still different. It is always good that while dealing with every child, four specific steps are taken- Assess – What is the need of child ?/ not diabetes , Plan- How can you fulfill the need /while managing diabetes, Action – Putting the plan into reality, Review – Review periodically for better results

(Age specific issues and the corresponding Diabetes Education)


"We thank everyone for their kind efforts in implementation of the changing diabetes in children program. Please write to us about your views, stories and ideas which can add value to this program and to the newsletter at [email protected]."

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* http://care.diabetesjournals.org/content/37/7/2034/T6.expansion.html accessed on 16th Oct 2015

Documents

No. of Children No. of HCPs Trained No. of Children Campsnnef.in/nnefadmin/uploads/medianewsletters/cdic-Dec 2015.pdf · 21st Nov 2015 22nd Nov 2015 28th Nov 2015 6th Dec 2015 Other