The KICk-OFF study The KICk-OFF study (Kids In Control Of Food) (Kids In Control Of Food)

Progress towards a structured Progress towards a structured education programme education programme

Julie Knowles/Dr Kath PriceJulie Knowles/Dr Kath Price

Sheffield Children’s NHS TrustSheffield Children’s NHS Trust

The KICk-OFF study The KICk-OFF study (Kids In Control Of Food) (Kids In Control Of Food)

Progress towards a structured Progress towards a structured education programme education programme

Julie Knowles/Dr Kath PriceJulie Knowles/Dr Kath Price

Sheffield Children’s NHS TrustSheffield Children’s NHS Trust

Diabetes UK and Department of Health 2005

• Evidence based• Clear aims and

objectives• To meet personal

learning needs • Trained educators • Structured• Quality assured and

audited

Recommendations/guidelines

Diabetes NSF 2001

NICE 2004 and 2004

DAFNE – Dose Adjustment for Normal Eating for

Adults 5 day structured

training programme 4-5 injections a day 4-5 blood tests a day Free diet Insulin dose to match

carbohydrate intake Reduce HbA1c Improved QOL

Paediatric KICk-OFF courseresearch project

Phase 1 – 2002 -Development of a curriculumFunded by Sheffield Children’s Appeal

Phase 2 – 2004 - Pilot courses, refinement of curriculum Grant from DUK

Phase 3 - Multicentre Randomised Control TrialTo be funded by DUK awaiting confirmation of start date

Development of the KICk-OFF curriculum

• PDNS survey (Autumn 2002)

• Focus groups (Jan. 2003 Comparing current

education programmes with DAFNE )

• Lubeck, Germany (Jan. 2004)

• School teachers

Working with school teachers

• DAFNE to KICk-OFF• National schools curriculum

“Intellectual development” - growth in pupils knowledge understanding and skill “ Social development” - growth in self esteem, self confidence, greater maturity

• Office For Standards in Education (OFSTED) Is it clear what the purpose of the lesson is?Has the lesson taken into account the learnersneeds?

Working with school teachers

• Style of teaching (observation)

• Lesson planning

• Specific teaching skills

• Presentation

• Setting boundaries/learning environment

• Reading age

Monday Tuesday Wednesday Thursday Friday

Introduction to the course

What is diabetes?

Group discussesblood sugar levels

Hypoglycaemia

Discuss overnightblood sugar levels.

How to adjust insulin

Discuss blood sugarlevels Healthy eating/weightcontrolSweets, treats andsnacks

[Friends invited]Discuss overnight blood sugarlevels. Friends recap what is diabetesEveryone discusses using Kick-Off in school

Break Break Break Break Break

Signs and symptoms,InsulinTypes of food and

CP’sCP booklet and diary Insulin/CHO

relationship

Hypoglycaemia andKick-off treatment

CP/insulin ratio

Work out CP’s forpacked lunch

How to manageillness usingKICkOFF guidelines

Alcohol and socialissuesPoster displayExercise [theory]

Managing hypos in and out ofschool Puberty awareness and controlWhat happens next?Follow-up after the courseDiscuss school packs Recap weeks learning objectives Evaluation

Lunch Packed lunch Lunch Lunch Lunch - buffet

Insulin/CHOcontinuedCorrection dose Monitoring

Practicing countinggrams of CHO +practical

Diabetes and longterm healthdiscussionHealthy lifestyle vsunhealthy

ExercisePractical session.

Parents will discuss follow-upcare, discussion about the weekand continued supportChildren do fun activity

Break Break Break Break

Millionaire game Recapping the daysobjectives

Plan evening insulin dose.

Personal interviews

Practical session continued

Quiz Prepare food forparents Recap objectives ofthe dayPlan evening insulin

dose

Quiz Students to planevening insulin dose

Quiz Free session for guestspeaker or otheractivity

Continued Presentation of quiz winners Finish

Day 2, session 2. Counting grams of carbohydrate

TUESDAY

Session 2:-

Counting grams of carbohydrate

Practical session

Learning Objectives

Continue with carbohydrate and insulin ratios

Continuing with learning the skills for counting grams of carbohydrate

Materials

Scales Food ingredientsRecipesFlip chartPens Diaries Work sheets Calculators PlatesKitchen equipmentDigital scalesPots and pansBaking tinsWashing up materials(tea towels, cloths, washing up liquid)

Educator Dietitian and nurse

Preparation Transport children to school cookery room. Set up the work stations with foods needed for recipes.

TIME

EDUCATORACTIVITY

STUDENTACTIVITY

MATERIALS

11am Explain:-This session is a practical session to learn how to work out how much CHO is in the food you prepare.

Group to split into pairs and they are each given a recipe

Response:Split into pairs but not the same pairs as the morning

Follow recipes

Tidy up after the food is prepared

Complete work sheet

4 recipes for fruit muffinsfruit scones jam and butterscalesPaper platesingredientsutensilsCalculatorsPensFlip chartsWorksheet for estimating CP’s in rice, pasta, potato, cereals.

Pilot Study 2004

• 8 per course, 11-13 and 14-16 yr

• 2 research educators and 1 local educator

• 3 Paediatric centres Sheffield, Manchester and Derby

• Training the trainers course Sheffield Hallam University 3 days (2 theory, 1 practical)

• independent peer review• interview• daily feedback questionnaire

EVALUATION

Effectiveness:

Teaching, curriculum, course format :

• HbA1c pre course , 3 and 6 months• hypoglycaemia rates• BMI

Psychological outcome at 0, 2 weeks, 3 and 6 months• QoL• Satisfaction with treatment• family conflict• self management responsibility• self efficacy

Table 1. Mean HbA1c Values Over Time

Baseline 3-months 6-months

Mean (sd) 8.58 (1.80) 8.72 (1.98) 8.69 (1.98)

More mild hypo’s

No more moderate or severe hypo episodes

No significant change BMI

QOL: Generic

70

75

80

85

90

pre Post 3m 6m

children

parents

ChildrenF(3,81)=8.00,p=.0001***ParentsF(3,81)=6.14, p=.001**

60

65

70

75

80

85

90

pre Post 3m 6m

children

parents

QOL: Diabetes

ChildrenF(3,81)=9.25,

p=.0001***ParentsF(3,81)=4.56,

p=.005**

Psychosocial Outcomes for child and parent

Satisfaction with Treatment: Greater satisfaction with diabetes treatment after the course.

Self-Efficacy: Children more confident managing their diabetes after the course.

Family Conflict: no significant change (minimal before and after course).

Parent-child Responsibility: more responsibility for managing diabetes after the course.

Coping with Diabetes: more able to cope after the course.

Changes to the course:

• Venue• Timings of difficult sessions- in the first 2

sessions• More practical sessions• Specific parent teaching – 1 day teaching

course• Improved school support• Follow-up• Interactive booklet• More CHO/Ratio practice • 5 day skills training programme for educators

Multi-centre cluster randomised controlled trial comparingintensive education with standard education in 11-16 year olds on

intensive insulin therapy. Sponsored by DUK

36 UK paediatric diabetes clinics (576 total participants)

18 intervention/18 control – both using MDI

2 year follow-up

Control group receives skills training course and KICk-OFF curriculum

Outcomes measured at 0, 6, 12, 24 months:-

HbA1c

Psychological outcomes

Hypoglycaemia episodes

DKA

BMI

Diet related behaviours