Should all diabetics be offered the same courses when first diagnosed

[babsy2]

i joined this forum a few weeks ago and the first thing that stuck me is that their are different courses to the two I went on and some people haven't been on any course I think this is wrong their should be uniformity so that we are all treated the same I had fantastic advice when first diagnosed (2009 for me) I think through the Nhs & this form there should be contact between them and the govenment to try to arrange a course for beginners so they stand a better chance of understanding this awful disease I be very interested in people's views

 

[ladybird64]

Thi9s is a difficult one to answer to be honest. I can see your point, but for many of us, the advice we are given by either/or the GP/diabetic nurse is not helpful. The NHS dietary advice tends to be to that one must eat so called healthy carbohydrates such as brown bread, rice etc but these usually raise blood sugars, there is also the tendency to advice against self monitoring for Type 2's who aren't on certain meds or insulin.
If there was more flexibility in the NHS approach I would say yes but I don't have much faith in it I'm afraid. I was never offered a course, and I'm actually quite glad I wasn't!

Just my own opinion of course

 

[babsy2]

I fully understand what you have said the NHS course I went on ( 1 full day and 1 half day) were interesting but the most valuable info I was given was in the first three weeks or so and that was the first visit with my DN & dietician & the first retinopathy & the first hour of the first day on the all day course but I had a little experience as I worked with people with learning difficulties and challenging behaviour as several were T1 & T2 but having read a lot of threads I believe there is plenty of room for improvement the newly diagnosed have their work cut out to understand diabetes

 

[Prem51]

I agree with you @babsy2. Although the DEMOND course I went on did advise that eating a moderate amount of carbs was necessary, the course was helpful in reassuring me that diabetes can be controlled and isn't a one way street to the complications that could come if I didn't take action.
I think diabetes courses should be offered to everyone who is in the pre-diabetic range too. If I had known more about diabetes when I was pre-diabetic a year ago I think I would have done something to avoid it then.
The Government does seem to have realised that diabetes is going to cost the NHS a lot more in the future if nothing is done, but I don't think they are prepared to put in the funding to educate people.

 

[Chook]

I was offered a course but chose not to go on it because a friend who had been diagnosed a short while before me had followed the advice given on the course and her BG had gone up in to the 20s.

My own research and this forum have been far more helpful.

 

[Daibell]

Hi. First the range of diabetes types and states varies a lot so a course aimed at 'everyone' would not work. Like Ladybird64, I've never been offered a course and glad that I haven't as I've heard on this forum that they can vary from good to dire. To spend a week on a DAPHNE course would make my brain go soft; it's ridiculous. There are far too few diabetes experts and even fewer diet experts around to provide good training so the NHS must waste a lot of money with time-consuming and wasteful training. A lot of training could be provided by a mix of good brochures/books by real experts together with 1-day seminars where questions could be answered. The NICE Guidelines could form the basis for some of this information as overall the guidelines including this year's updates are good. The problem with the 'Government' which often means a weak mix of the NHS, DUK, Dieticians and other bodies is that it can be non-expert, politically correct and influenced by industry lobby groups.

 

[tim2000s]

Hi. First the range of diabetes types and states varies a lot so a course aimed at 'everyone' would not work. Like Ladybird64, I've never been offered a course and glad that I haven't as I've heard on this forum that they can vary from good to dire. To spend a week on a DAPHNE course would make my brain go soft; it's ridiculous. There are far too few diabetes experts and even fewer diet experts around to provide good training so the NHS must waste a lot of money with time-consuming and wasteful training. A lot of training could be provided by a mix of good brochures/books by real experts together with 1-day seminars where questions could be answered. The NICE Guidelines could form the basis for some of this information as overall the guidelines including this year's updates are good. The problem with the 'Government' which often means a weak mix of the NHS, DUK, Dieticians and other bodies is that it can be non-expert, politically correct and influenced by industry lobby groups.

What we tend to forget is that courses have to cater for the lowest common denominator.

Speaking purely for Type 1s here, when you consider that 56% of patients in the last National Diabetes Audit had an Hba1C between 7.5% and 10%, 27.3% were below 7.5%, only 7.5% were below 6.5% and 17% were more than 10%, then there is a greater requirement for courses to address the 73% rather than the 27.3%, given the DCCT complications indicators.

The whole point of the courses is to improve life for the far less engaged than those who are actively participating on the internet/in local groups. There are some 150,000 members of this forum, of which 15,000 should be T1 if the demographics of the forum match the population. The majority of those are reading rather than engaging. Based on the NDA data, there is no way that all of these watchers have an Hba1C in target. That's why the courses exist.

It's a much cheaper way to at least attempt to get everybody on track with better management of their diabetes. It's got an evidence base that demonstrates that it works (and one that shows better results than the evidence base for either pumps or CGM systems, which is admittedly a little sparse).

For those of us who have worked out how to manage our diabetes using principles that are essentially the same as DAFNE teaches, and have been doing it for years, then yes, they aren't a great deal of benefit. For those who struggle or are new to the condition, they can be life changing. The key addition they need is to introduce experienced practitioners of the principles they espouse and get those on the courses involved in the network of community support.

Whilst I've spoken mainly about T1s there, the reality is that the same applies for T2s.

 

[Enclave]

On a very personal note .. And as a T2 person .. I am very happy to not be sent on any government run courses .. It would have been helpful if the information I had been given via a leaflet had the correct advice on. I am also really miffed at the total doom and gloom advice given to me when I was first diagnosed. I have heart failure and the diabetic nurse is trying to tell me that my T2 is far worst than having another heart attack and dying ... Bu**s*** ...
However if I was T1 ..then I would be very happy to go on courses to learn how to manage this.

 

[britishpub]

Didn't go, won't go.

 

[Brunneria]

I would politely decline the course the nurse mentioned to me, after she said

'it is a great course for newly diagnosed type 2s, it tells you all sorts of things you can eat, and stops you worrying about having diabetes'.

I interpreted that as 'it tells you to stuff carbs at every meal and pretends that you shouldn't worry about complications'

I don't want to do that! - the only thing that stops me worrying about complications is testing, controlling carbs and keeping my bg to normal levels..

 

[Daibell]

What we tend to forget is that courses have to cater for the lowest common denominator.

Speaking purely for Type 1s here, when you consider that 56% of patients in the last National Diabetes Audit had an Hba1C between 7.5% and 10%, 27.3% were below 7.5%, only 7.5% were below 6.5% and 17% were more than 10%, then there is a greater requirement for courses to address the 73% rather than the 27.3%, given the DCCT complications indicators.

The whole point of the courses is to improve life for the far less engaged than those who are actively participating on the internet/in local groups. There are some 150,000 members of this forum, of which 15,000 should be T1 if the demographics of the forum match the population. The majority of those are reading rather than engaging. Based on the NDA data, there is no way that all of these watchers have an Hba1C in target. That's why the courses exist.

It's a much cheaper way to at least attempt to get everybody on track with better management of their diabetes. It's got an evidence base that demonstrates that it works (and one that shows better results than the evidence base for either pumps or CGM systems, which is admittedly a little sparse).

For those of us who have worked out how to manage our diabetes using principles that are essentially the same as DAFNE teaches, and have been doing it for years, then yes, they aren't a great deal of benefit. For those who struggle or are new to the condition, they can be life changing. The key addition they need is to introduce experienced practitioners of the principles they espouse and get those on the courses involved in the network of community support.

Whilst I've spoken mainly about T1s there, the reality is that the same applies for T2s.

I think we can both agree that any courses or information needs to be targeted at those who don't participate in forums or the Internet etc. However I still feel there aren't enough up to date experts around to adequately do that training. We've all seen posts on these forums where the 'loads of carbs mantra' has been preached so it's no surprise that the ill-informed have high HBa1Cs?

 

[tim2000s]

I think we can both agree that any courses or information needs to be targeted at those who don't participate in forums or the Internet etc. However I still feel there aren't enough up to date experts around to adequately do that training. We've all seen posts on these forums where the 'loads of carbs mantra' has been preached so it's no surprise that the ill-informed have high HBa1Cs?

The issue comes back to the question of the evidence base, and no-one has, as yet, produced enough of one to get the NHS and health bodies to change their recommendations. As long as that doesn't change, those who are employed by the authorities that have this mantra will continue to regurgitate it. Their livelihoods depend on it!