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The KICk-OFF study (Kids In Control Of Food) Progress towards a structured education programme Julie Knowles/Dr Kath

The KICk-OFF study (Kids In Control Of Food) Progress towards a structured education programme Julie Knowles/Dr Kath Price Sheffield Children’s NHS Trust. Diabetes UK and Department of Health 2005. Recommendations/guidelines Diabetes NSF 2001 NICE 2004 and 2004. Evidence based

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The KICk-OFF study (Kids In Control Of Food) Progress towards a structured education programme Julie Knowles/Dr Kath

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  1. The KICk-OFF study (Kids In Control Of Food) Progress towards a structured education programme Julie Knowles/Dr Kath PriceSheffield Children’s NHS Trust

  2. Diabetes UK and Department of Health 2005 Recommendations/guidelines Diabetes NSF 2001 NICE 2004 and 2004 • Evidence based • Clear aims and objectives • To meet personal learning needs • Trained educators • Structured • Quality assured and audited

  3. DAFNE – Dose Adjustment for Normal Eating for Adults • 5 daystructured 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

  4. Paediatric KICk-OFF courseresearch project Phase 1 – 2002 -Development of a curriculum Funded by Sheffield Children’s Appeal Phase 2 – 2004 - Pilot courses, refinement of curriculum Grant from DUK Phase 3 - Multicentre Randomised Control Trial To be funded by DUK awaiting confirmation of start date

  5. 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

  6. 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 learners needs?

  7. Working with school teachers • Style of teaching (observation) • Lesson planning • Specific teaching skills • Presentation • Setting boundaries/learning environment • Reading age

  8. Day 2, session 2. Counting grams of carbohydrate

  9. 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)

  10. EVALUATION Teaching, curriculum, course format : • independent peer review • interview • daily feedback questionnaire Effectiveness: • 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

  11. Table 1. Mean HbA1c Values Over Time More mild hypo’s No more moderate or severe hypo episodes No significant change BMI

  12. QOL: Generic Children F(3,81)=8.00,p=.0001*** Parents F(3,81)=6.14, p=.001** QOL: Diabetes Children F(3,81)=9.25, p=.0001*** Parents F(3,81)=4.56, p=.005**

  13. 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.

  14. 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

  15. Multi-centre cluster randomised controlled trial comparing intensive 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

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