Conference programme book

Conference programme book
fend
Foundation of European Nurses in Diabetes
17th Annual Conference
28-29 September 2012
Berlin
unite for diabetes
Programme design and layout M J Felton
Contents
The Foundation of European Nurses in Diabetes acknowledges and thanks the following sponsors
for their continuing support and commitment to FEND:
Abbott Diabetes Care
AstraZeneca & Bristol Myers Squibb
Bayer Diabetes Care
LifeScan
Lilly
Novartis
Novo Nordisk
Roche
Sanofi
FEND Executive Committee
FEND Distinguished Service Award
Kristin de Backer
Belgium
(Membership & Conference Registrar)
Nadine van Campenhout Belgium
(Exhibition Co-ordinator)
Rosana Cisic
Croatia
Tineke Dijkstra
Netherlands
Anne-Marie Felton
UK
(President & co-founder)
Selda Gedik
Turkey
Sijda Groen
Netherlands
Deirdre Kyne-Grzebalski UK
(Chairman)
Jacqueline Herbst
Switzerland
Unn-Britt Johansson
Sweden
Marianne Lundberg
Sweden
Chantal Montreuil
Switzerland
Johanna Rosenberg
Finland
Lurdes Serabulho
Portugal
Mrs Stina Wallenkrans (co-founder)
Local volunteer helpers (VBDB)
Michaela Berger
Angela Ehlich
Barbara Knothe
Kathrin Perschke
Pharmaceutical Exhibitors
Abbott
Artsana
Bayer
Becton Dickinson
Lilly
Medtronic
Menarini
Mendor
Novo Nordisk
Roche
Sanofi
Ypsomed
Non-Governmental Organisations
Abstract Selection Committee
Prof Angus Forbes
Magdalena Annersten Gershater (Chair)
Claudia Huber
Chantal Montreuil
Seyda Ozcan
Prof Regina Wredling (co-founder)
Jane Robinson (Admin asst.)
PCDE (Primary Care Diabetes Europe)
IDF Europe (International Diabetes Federation)
EURADIA (European Research Area in Diabetes)
IMAGE
DIAMAP
FEND Special Advisors
ADDITIONAL CONFERENCE SUPPORT
We thank the pharmaceutical industries for their participation in the exhibition during the conference and European Diabetes Nursing (the official journal of FEND) and Practical Diabetes International for their reporting of this conference.
• Post-conference online webcasts courtesy of Bayer Diabetes Care
• DESG Award courtesy of Diabetes Education Study Group
• Delegate name badges courtesy of Menarini Belgium
• Delegate bags courtesy of Novo Nordisk
Els Denis, Netherlands
Prof Sally Marshall, UK
Dr Colin McIntosh, UK
Dr Seyda Ozcan, Turkey
Prof Regina Wredling, Sweden (co-founder)
Ms Deirdre Cregan, Ireland (co-founder)
FEND Accountants
Kinnair & Company
FEND Honorary Members
Mrs Stina Wallenkrans (co-founder)
Ms Deirdre Cregan (co-founder)
Mrs Sue Hamilton (co-founder)
Dr Michael Hall
CONTENTS
Sponsors ..................................................IFC
Mission Statement ......................................2
Welcome ......................................................3
PROGRAMME .........................................4-5
Plenary Abstracts ..................................6-14
Speaker Biographies ..........................15-17
Poster Abstracts .................................18-49
FEND & DESG Awards...........................50
Connecting Nurses..................................50
Next Conference .....................................51
Conference Dinner ..................................52
Location Plan ..........................................IBC
1
Mission Statement
Welcome
FEND Mission Statement
The objects for which FEND is established are:
• To promote for the public benefit improvements in the health
and treatment of sufferers from diabetes by the development and
promotion of the role of the diabetes nurse sepecialist throughout Europe.
• To promote for the public benefit the education and training of
nurses working in diabetes care throughout Europe, by the development and support of training programmes, including the organisation of conferences and symposia, to further such programmes and the dissemination of information relating to the
proceedings at such conferences or symposia.
Welcome
Dear Participants
On behalf of the Executive committee of FEND it is our pleasure to welcome you
to the FEND 17th Annual Conference and the city of Berlin.
The conference this year is multi-faceted reflecting the complexities and challenges
of the diabetes epidemic in Europe.
The significant political recognition by the European Union of the impact of the
diabetes pandemic is evident by the EU Parliamentary Resolution of March 2012.
Such a significant resolution must ensure that this political commitment is realised in
national health policies and all sectors of society.
FEND has played and will continue to play an active role in advocacy, policy
development and implementation.
A key contribution by FEND is the FEND ENDCUP academic training programme
led by Prof Angus Forbes. This programme is available to all members of FEND and
it is noteworthy that the cost of this unique programme is funded by FEND.
FEND continues to work with key pan-European organisations within the European
Coalition on Diabetes (ECD) comprising EURADIA, FEND, IDF Europe and PCDE.
We thank our distinguished international speakers for their commitment and
generosity of time. We thank Prof Andrew Boulton, President EASD for his courtesy
and support in permitting this conference to be included in the programme of
meetings on the occasion of 48th Annual Meeting of EASD.
We acknowledge with deep appreciation the support of our sponsors for all of
FEND’s activities and special thanks also to our FEND volunteers from VBDB, the
German Association of Diabetes Nurses.
Your attendance at this conference represents diabetes nursing from Europe and
beyond – a truly international gathering and evidence of the commitment of the
nursing profession to people with diabetes.
We thank you for your presence and active participation – the conference is now in
your hands.
2
Deirdre Kyne-Grzebalski
FEND Chairman
Anne-Marie Felton
FEND President
3
Programme
Programme
Saturday 29 September 2012
Friday 28 September 2012
0730
Registration and Coffee
0845
Welcome and Opening Remarks
Session Chairs
FEND Chairman Deirdre Kyne-Grzebalski
EASD President Prof Andrew Boulton
FEND President Anne-Marie Felton
Session Chairs Prof Regina Wredling
Chantal Montreuil
UK
Sweden
Switzerland
Diabetes Nursing in Germany
Elisabeth Schnellbächer
Chair VDBD
Germany
0930
A Theory of Care in Chronic Diseases
Prof Gerard Reach
France
1115
Therese Anderbro
Åsa Ernersson
Maja Mlakar
Dulce Nascimento do Ó
The Policy Puzzle: Next Steps
Anne-Marie Felton
UK
0930
Focusing on Personal Understandings of
Diabetes in Group Support
Dr Åsa Hörnsten
Sweden
1000
Masterclasses: (parallel)
1. Prevention of Diabetes Foot Ulcers and
Outcome
Dr Magdalena Annersten
Sweden
Dr Maggie Shepherd
UK
2. Hypoglycaemia Awareness Toolkit
Sweden
Sweden
Croatia
Portugal
1115
Refreshments & Exhibition
1145
Masterclasses (Repeated):
1. (as above)
(parallel)
Chantal Montreuil
Dr Seyda Ozcan
Dr Magdalena Annersten
Sweden
Dr Maggie Shepherd
UK
Refreshments & Exhibition
Session Chairs Rosana Cisic
Sijda Groen
SWEET - Securing Appropriate Services
and Infrastructure for Paediatric and Adolescent Diabetes in Europe
Prof Thomas Danne
1215
Optimum Care Pathways for End-Stage
Kidney Disease in Type 1 & 2 Diabetes
Prof Liam Plant
1255
Lunch & Exhibition
1145
0900
Guided Poster Tour 1 Oral Presentations 1-4:
1. (see page 18)
2. (see page 19)
3. (see page 20)
4. (see page 21)
Belgium
UK
UK
0900
1015
Nadine Van Campenhout
Anne-Marie Felton
2. (as above)
Croatia
Netherlands
Guided Poster Tour 2 Germany
1300
Session Chairs Marianne Lundberg
Johanna Rosenberg
(parallel)
Lunch & Exhibition
Session Chairs
Ireland
Sweden
Finland
1400
Redesigning the Intensive Clinic Model
for Type 1 Diabetes
Prof Angus Forbes &
Assoc Prof Seyda Ozcan
UK
Turkey
1430
Type 2 Diabetes: Treatment with Incretin
Therapy
Prof Bo Ahren
Sweden
1500
Refreshments & Exhibition
Chantal Montreuil
Dr Seyda Ozcan
1415
Use of a Web Portal to Support
Young Diabetes Patients and Families
1445
Oral Presentations 5-8:
5. (see page 22)
6. (see page 23)
7. (see page 24)
8. (see page 25)
1545
Refreshments & Exhibition
Session Chairs
Session Chairs Jacqueline Herbst
Lurdes Serrabulho
Unn-Britt Johansson
Kristin de Backer
Sweden
Belgium
Dr Lena Hanberger
Sweden
Alison Jeffery
Margarida Jansà
Stella Freund
Marie Olsen
UK
Spain
Croatia
Sweden
Selda Gedik
Tineke Dijkstra
Turkey
Netherlands
Switzerland
Portugal
1615
The Genetics of Type 2 Diabetes:
Nature or Nurture?
Prof Graham Hitman
UK
1530
Eating Through the Myths:
Food, Health and Happiness
Prof Roy Taylor
UK
1645
Guidelines in Diabetes Management: the
Missing Link of Personalised Targets and Care
Prof Stephen Colagiuri
Australia
1600
Primary Prevention of Diabetes the IMAGE Effect
Prof Peter Schwarz
Germany
1715
Awards Ceremony:
FEND and DESG
Deirdre Kyne-Grzebalski
Anne-Marie Felton
UK
UK
1930
2000
Pre Dinner Cocktails
Conference Dinner
Palais am Funkturm
Masurenallee
1720
Closing remarks
Deirdre Kyne-Grzebalski
UK
4
5
Plenary Abstracts
DIABETES NURSING IN GERMANY
Elisabeth Schnellbächer
Chair VDBD, Germany
The Diabetes Nurse is not considered to be a fundamental profession like the nurse, but
is the product of further qualification and training on top of the basic one. Due to this
ambiguity the origins of the Diabetes Nurse in Germany may vary. Several professions
may educate their members to be a Diabetes nurse. An official recognition of their
status has been found in 2011 by the DDG (German Diabetes Association) and partially
by public institutions. The contents of the training are organized in modules, which encompass i.e. medical and pedagogic basics and statistics. Our members work in both stationary and ambulant facilities. Continuing training can be achieved through the acquirement of certificates provided by the VDBD (German Association of Diabetes Nurses).
A THEORY OF CARE IN CHRONIC DISEASES
Prof Gérard Reach
Head of the Endocrine, Diabetes, and Metabolic Diseases Department of Hospital
Avicenne in Bobigny, France
Between the person who becomes ill and the health care provider (HCP) who takes
care of her, an unusual relationship takes shape. The purpose of this talk is to analyze the
double meaning of the concept of care in chronic diseases: care of oneself by the patient
(self-care), patient’s care by the HCP (care). I will try to show bridges between self-care
and care.
First, self-care by patients: the patient takes care of herself if she is concerned for her
future. The highest form of self-care is self-love. However, in some people, the onset of
the disease leads to an ambivalence of the mind that prevents them to love themselves,
and this is a source of anxiety. Second, the HCP takes care of her patient: I will suggest
that the HCP not only provides a treatment, but in addition helps the patient to put an
end to this ambivalence. Indeed, the HCP, by expressing her concern of the patient’s future, shows her the road to self-love. I will defend the quite provocative idea that the
HCP does it if she loves the patient and her art, expressing a form of love compatible
with the respect of patient’s autonomy.
Plenary Abstracts
SWEET - SECURING APPROPRIATE SERVICES AND
INFRASTRUCTURE FOR PAEDIATRIC AND ADOLESCENT
DIABETES IN EUROPE
Prof Thomas Danne
Thomas Danne, Diabetes Centre for Children and Adolescents “AUF DER BULT”, Hannover, Germany, [email protected]
In light of the technological advances in diabetes therapy becoming more widely available
and with health care costs rising generally, economic data regarding health care are desperately needed to allocate resources appropriately. "SWEET" is an acronym derived
from “Better control in Pediatric and Adolescent diabeteS : Working to CrEat CEnTers of
Reference” and is based on a partnership of established national and European diabetes
organizations (www.sweet-project.eu) led by the International Society for Pediatric and
Adolescent Diabetes (ISPAD) with valaubele contributions of IDF Europe, FEND, and
PCDE. Initial participating paediatric centres are from the Czech Republic, France, Germany, Greece, Hungary, Italy, Luxembourg, the Netherlands, Poland, Portugal, Romania,
Sweden, and the UK. Co-funding for the initial project was granted by the European Public Health Executive Agency with additional funds from corporate partners and foundations. Recommendations for Diabetes Care and Treatment, as well as age-appropriate
Education for children and adolescents with diabetes and Paediatric Training Programs
for Health Care Professionals have been developed by SWEET. The proposed Criteria
for an European Paediatric Diabetes Reference Centre (“COR”) include a multidisciplinary approach, an ongoing electronic documentation of at least 150 paediatric diabetes
patients < 18 years (i.e. at least age, diabetes duration, gender, HbA1c, type of diabetes),
and the readiness to participate in external peer-reviewed auditing process and quality
control circles. An initial 12 COR´s were approved jointly by the ISPAD Executive
Committee and IDF Europe. The SWEET project hopes to extend from the initial group
of centres within countries and throughout Europe and beyond.
I will even go further. By accomplishing this most gratifying task, the HCP too arrives to
self-love. According to Spinoza’s Ethics, self-love, or being satisfied with ourselves, what
we may today call self-esteem, “is really the highest thing we can hope for”. This applies to
patients and to HCPs as well.
Care is a difficult task, both for the patient and for the health care provider. Again, according to Spinoza’s Ethics’ last words, “but all noble things are as difficult as they are rare.”
6
7
Plenary Abstracts
Plenary Abstracts
OPTIMUM CARE PATHWAYS FOR END-STAGE
KIDNEY DISEASE IN TYPE 1 & 2 DIABETES
REDESIGNING THE INTENSIVE CLINIC MODEL FOR
TYPE 1 DIABETES
Prof Liam Plant
Department of Renal Medicine, Cork University Hospital & University College Cork
Prof Angus Forbes & Assoc Prof Seyda Ozcan
King’s College Hospital, London & Florence Nightingale Nursing Faculty of Istanbul
University, Turkey
Diabetic nephropathy in patients with Type 1 or Type 2 Diabetes leads to a substantial
increase in morbidity and mortality. The majority will not progress/not survive to require
renal replacement therapy (RRT) for End-Stage Kidney Disease (ESKD), but many will,
and these form a substantial proportion of incident (15% in SW Ireland) and prevalent
(14% in SW Ireland) ESKD patients treated by dialysis or renal/renal-pancreas transplantation.
The potential to progress/survive to ESKD differs considerably between Type 1 and Type
2 Diabetes. Furthermore, the timeline over which this occurs, the nature and extent of
other co-morbidities, and the optimum timing and type of RRT differs.
This is reported in many studies, and is the ongoing experience of Renal Units around
the world.
In South West Ireland over the last 10 years, prevalence of ESKD patients with diabetic
nephropathy has trebled, from 33pmp to 110pmp. As a proportion of total ESKD patients there has been a doubling, from 7% to 14%. 15% of all incident patients had diabetic nephropathy (71% of these had Type 2 Diabetes).
In this presentation we will present an integrated analysis of patient expectations and
clinical care needs in patients with Type 1 diabetes. The analysis was conducted to inform
service development in a large diabetes treatment centre. The centre provides a wide
range of services to support patients with Type 1 diabetes to help them manage their
diabetes and in intensifying insulin therapy . The analysis applied the Chronic Care
Model to conceptualise the current care system and identify areas for development.
These areas included: enhanced systems for sharing clinical information; more flexible
and easy to access sel-management resources; support with diabetes technology; psycohosocial support; and the need for greater integration and care continuity. In addition
we will present clinical data defining the characteristics of the current patient population
and their current self-manage practices. We have explored risk factors such as hypoglycaemia unawareness and level of glycaemic control. Finally, we provide data on patient
general quality of life; depression and satisfaction with their current insulin treatment.
The presentation concludes be identifying key areas in which patient care for people
with Type 1 diabetes might be enhanced both in the studied centre and beyond.
Only 23% of transplants were performed in Type 2 patients. Incidence of ESKD due to
Type 1 diabetes was fairly constant around 5pmp p.a. – 75% of these patients received a
kidney/kidney-pancreas transplant.
We are very grateful to the Beta Cell Trust and FEND for supporting this project.
This presentation will reflect on the experience of our centre and on reports from the
world literature to advance suggestions as to how differential Care Pathways can be optimised.
TYPE 2 DIABETES: TREATMENT WITH INCRETIN THERAPY
Prof Bo Ahrén
Lund University, Lund, Sweden
Glucose-lowering therapy in type 2 diabetes is important for reducing the risk for complications. The therapy aims at improve insulin resistance, impaired insulin secretion and
augmented glucagon secretion in order to reduce hepatic glucose production and increase peripheral glucose uptake.
Medication is added if life style modifications are insufficient. The most widely used
medication is metformin, which improves insulin sensitivity and reduces hepatic glucose
production. It is weight-neutral with no increased risk for hypoglycemia. It may cause
gastrointestinal side effects, and in rare cases, lactic acidosis.
When life style modifications plus metformin is insufficient, several options exist for additional drugs. During recent years, incretin therapy has been developed as a promising
option. It is based on the effect of the gut hormone glucagon-like peptide-1 (GLP-1) to
increase insulin secretion and inhibit glucagon secretion. Incretin therapy consists of injectable GLP-1 receptor agonists which activate the GLP-1 receptor, and oral dipeptidyl
peptidase 4 (DPP-4) inhibitors, which prevent the inactivation of GLP-1 theraby increasing the endogenous GLP-1 concentration. Incretin therapy improve both fasting and
8
9
Plenary Abstracts
postprandial glycemia without increased risk for hypoglycemia. GLP-1 receptor agonists
result also in weight loss, whereas DPP-4 inhibitors are weight neutral. Apart from nausea with GLP-1 receptor agonists, incretin therapy is rarely associated with any adverse
events.
Incretin based therapy may be used as add-on to metformin and in combination with sulfonylureas, thiazolidinediones and insulin. DPP-4 inhibitors can also be used in monotherapy in patients for whom metformin in unsuitable.
EATING THROUGH THE MYTHS:
FOOD, HEALTH AND HAPPINESS
Prof Roy Taylor
Newcastle University, UK
What kind of disease is type 2 diabetes? What really causes it? The best available information suggests that onset of type 2 diabetes is determined by relatively sudden failure
of the beta cell to respond normally to a rise in blood glucose. Once established, the
disease seems to behave as inevitably progressive with an irreversible beta cell defect. All
the large studies of type 2 diabetes show a dismally progressive pattern such that around
50% of people require insulin therapy within 10 years.Various ideas on what is happening
in the pancreatic islets have been proposed, including amyloid deposition, oxidative stress
and cytokine action. Where does insulin resistance fit in? To date it has seemed to be
rather complicated.
Several recent pieces of information appeared not to fit with this complex analysis. Also,
when people lose weight due to any cause, blood glucose levels return towards normal
even when insulin or oral agents are stopped. Could it be that type 2 diabetes is a simple
direct consequence of too much fat in the pancreas? And that insulin resistance is simply
a direct consequence of too much fat in the liver?
By developing new methodology to measure fat content in specific organs it has been
possible to answer these questions, and to demonstrate the basic simplicity of type 2
diabetes. Complete normality of beta cell function can be restored by dietary means
alone. The myths about type 2 diabetes can be discarded, and for many people reversal
of type 2 diabetes can increase both health and happiness.
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Plenary Abstracts
PRIMARY PREVENTION OF DIABETES THE IMAGE EFFECT
Prof Peter E. H. Schwarz
Department for Prevention and Care of Diabetes, Medical Clinic III, University Clinic
Carl Gustav Carus at the Technical University Dresden, Germany
Type 2 diabetes can be delayed or prevented among people who have IGT with lifestyle
interventions or medication as shown by major clinical trials of diabetes prevention, but
it is a completely different challenge to translate this message derived from the lifestyle
trials to clinical practice. The European funded Project IMAGE have been addressing the
implementation process to take a step ahead and to collate available information in a
systematic manner and developed practical relevant standards for diabetes prevention. A
group of about 100 European experts in this field has worked for 2.5 years, to prepare
the main deliverables of the projects, which are the Evidence-based guideline on T2D
prevention, a Toolkit for diabetes prevention and a guideline for evaluation and quality
indicators and management in T2D prevention. Furthermore a European training curriculum for prevention managers to perform diabetes prevention intervention programmes was developed.The implementation of the IMAGE recommendations might
facilitate the controlling of the T2D epidemic and eventually diminish the burden of diabetes. There will be a lot of work in implementing these recommendations in the future.
Also, there is a need to continue systematic research into the aetiology, prevention and
care management of T2D. In particular, translational research regarding the implementation of existing knowledge into public health and clinical practice must be carried out –
the time to act is now.
THE POLICY PUZZLE - NEXT STEPS
Anne-Marie Felton
President FEND
This presentation will reflect on:
•
the potential impact and opportunity arising from the European Parliament Resolution on Diabetes of March 2012
•
the findings of the 3rd edition of the Policy Puzzle “Is Europe Making Progress?”
Nov 2011.
•
“The Diabetes Atlas of Variation Europe” (DAVE) – the next steps in the evolution of the survey.
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Plenary Abstracts
FOCUSING ON PERSONAL UNDERSTANDINGS OF
DIABETES IN GROUP SUPPORT
Dr Åsa Hörnsten
Senior lecturer at the Department of nursing, Umeå University, Sweden
In Sweden as well as other European countries, group support of people with type 2diabetes mellitus (T2DM) is recommended. Group support facilitates for people to discuss disease management and more life oriented issues that may complicate coping with
a chronic disease and may lead to integration of illness and effective self-management.
Group support may also contribute to the ongoing paradigm shift towards person centred care where patients have a higher degree of power. Group support focusing on personal understandings (PUs) of illness highlights more than a need for new routines in
daily life. Personal understandings of type 2 diabetes include a person’s view of the nature, severity and burden of disease, which might differ from a biomedical view. PUs also
include personal meanings of being diagnosed with a life-long illness. The successive integration of illness and its self-management in daily life as well as the responsibility and
space for it is included in PUs of T2DM. Lastly, viewing the disease in a life perspective
including thoughts about when and why it came and how it will influence the future is
included in people’s personal understandings of illness.
A five year follow-up of an intervention (Hörnsten et al., 2008) where people newly diagnosed with T2DM were randomized to either a 10 sessions group support based upon
PUs and led by the first author, or traditional care delivered at local health care centres,
revealed that group support was more effective. A difference in HbA1c of 1.37 percent
units was demonstrated. An ongoing intervention study where people with T2DM are
randomized to either a 6 session group support or individual support led by local diabetes specialist nurses or traditional care has not demonstrated effects at the same level.
Reasons may relate to dose-response effects and that diabetes specialist nurses need to
get acclimatised and also more training in person centred care. Concluded, group support and a focus on PUs seem to be more effective than traditional care but nurses need
training to deliver it.
USE OF A WEB PORTAL TO SUPPORT YOUNG DIABETES
PATIENTS AND FAMILIES
Dr Lena Hanberger
Childrens Hospital, UniversityHospital, Linköping, Sweden
Information technology is developing rapidly and the Internet has become increasingly
popular. The use of Internet in health care is called eHealth. “Web 2.0” is a term for the
second generation of the Internet, referring to improved communication and collaboration between people via social networking. The World Health Assembly emphasizes the
importance of eHealth and asks member states to draw up strategic plans for the development and implementation of eHealth services in the health sector.
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Plenary Abstracts
Internet interventions need further development. Patients have welcomed the potential
of Internet interventions but have felt that many websites do not achieving their full potential.
Access to relevant information is the first step to patient empowerment, and it Health
2.0 / Medicine 2.0 will likely lead to empowerment of the patient as the Internet can deliver information in vast quantities.
Different cathegories of web sites for patients can be found: A) information about facts,
B) other patients´ experiences and C) health care on the Internet. The number of Apps
(application software) offered for smart phones has expanded exponentially.
An intervention with web portal, Diabit.se, with diabetes related information and the
possibility to communicate with others with diabetes and health care professionals was
performed. The study supports the fact that a Web 2.0 portal can be successfully used as
a complement to traditional patient education and support. The implementation might
be further enhanced by easy access, by highlighting new information, by promotion from
active diabetes team members and through other reminders in the structure of care.
THE GENETICS OF TYPE 2 DIABETES:
NATURE OR NURTURE?
Prof Graham Hitman
Professor of Molecular Medicine and Diabetes, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, UK
Type 2 Diabetes (T2D) is a multifactorial disease with significant genetic and environmental components. In recent years T2D has reached epidemic proportions. Fortunately,
recent studies have shown that diabetes can be prevented by changing lifestyle and to a
lesser extent with the use of some medications. In the last 5 years there has been an exponential increase in the number of genes associated with disease. Many of newly identified genes associated with diabetes are involved in pancreatic beta cell function underlying the importance of defects of insulin secretion as a prime cause of T2D.
Despite the rapid progress, the genes identified do not explain the majority of the genetic component of T2D indicating that there is likely to be another incremental step
required to understand the genomics of diabetes. Amongst the many approaches being
taken, we are studying how the triggering environment can directly affect gene regulation
(so called epigenetics). For many years it has been realised that in utero nutritional factors can prime the foetus towards insulin resistance and diabetes. Genome-wide epigenetic reprogramming occurs during gametogenesis, implicating early foetal development
as a period susceptible to environmental influence. There is also evidence of transgenerational effects of environmental factors associated with diabetes that can be reversed by correcting the nutritional deficiency. It is hoped that these advances will provide some of the missing clues in T2D, but more importantly lead to novel strategies to
prevent and treat the disease.
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Plenary Abstracts
GUIDELINES IN DIABETES MANAGEMENT - THE MISSING
LINK OF PERSONALISED TARGETS AND CARE
Prof Stephen Colagiuri
Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders,
University of Sydney, Australia
Guidelines have become an essential component of clinical care and are designed to
educate clinicians and improve patient care and outcomes. Guidelines have a number of
limitations including the lengthy and costly preparation process and the frequent lack of
solid evidence to address and make recommendations about difficult and controversial
issues.
While much focus has been on guideline preparation methodology, the key issue with
which we continue to struggle is guideline implementation. Key barriers include limited
clinician knowledge and time, and health system deficiencies.
An emerging issue is how to adapt general guideline recommendations to make them
relevant to an individual. For example a general glycaemic HbA1c target of 7.0% / 53
mmol/l is recommended in many guidelines, but clearly this target needs to be personalized to take into account individual circumstances. This target may be too high in a
younger person with type 2 diabetes without co-morbidities and in the early stages of
their diabetes, while it is likely to be too low in an older person with co-morbidities and
limited life expectancy.
The attention of many guideline developers is now focused on methods for taking general guideline recommendations and providing guidance on how to personalized targets
and treatments to make them more relevant and practical for an individual.
Speakers
Prof Bo Ahrén
Bo Ahrén received his MD at Lund University.
Since 1999 he holds the position of professor
in Clinical Metabolic Research at Lund University and consultant at the Department of Endocrinology at Skane University Hospital. He
was 2006-2011 the Dean of the Faculty of
Medicine, Lund University..
Dr Ahrén has published several original articles and review articles within the area of islet
function and the treatment of type 2 diabetes.
He has combined basic science with clinically
oriented research, and has during many years
concentrated on developing the new incretin
therapy.
Prof Stephen Colagiuri
Stephen Colagiuri is the Professor of Metabolic Health at the Boden Institute of Obesity,
Nutrition, Exercise and Eating Disorders at
the University of Sydney.
His research interests focus on development
and implementation of evidence-based guidelines, cardiometabolic risk assessment, diabetes screening and prevention, the glycemic index, and economic aspects of diabetes and
obesity. Professor Colagiuri is Chair of the
International Diabetes Federation (IDF) Clinical Guidelines Task Force, and an advisor on
diabetes to the World Health Organization.
He is the Editor-in-Chief of the journal Diabetes Research and Clinical Practice and a past
President of the Australian Diabetes Society.
Prof Thomas Danne
Professor Thomas Danne is the Director of
the Department of General Pediatrics and
Endocrinology/Diabetology at the Kinderkrankenhaus “AUF DER BULT” in Hannover,
and heading the largest pediatric diabetes center in Germany. He is Chair of the German
IDF member organization Deutsche DiabetesHilfe (diabetesDE) and Past President of ISPAD and the German Diabetes Society
(DDG). His research interests include multiple
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aspects of pediatric diabetology with special
emphasis on novel insulins, insulin pump therapy, and, ultimately, closed-loop systems. He
has been the Principal Investigator of several
international multi-centric clinical trials and is
the chairman of SWEET e.V.
Anne-Marie Felton
Anne-Marie Felton was a diabetes specialist
nurse for over 20 years. She is currently working within the voluntary sector pro bono, nationally and internationally. She is President
and co-founder of FEND and a Vice President
of IDF.
In 1999 she was appointed as a Vice President
of Diabetes UK and has been a member of the
Diabetes UK Advisory Council since 2002. In
addition, Anne-Marie is an Honorary consultant at Queen Mary's Hospital, Roehampton,
London, UK,Vice President IDF and Chair of
the IDF Global Advocacy Task Force, a member of the Alliance for European Diabetes Research (EURADIA), Executive committee
member of PCDE and chair of European Coalition for Diabetes 2012 (ECD). Anne-Marie
has been appointed Chair of the Organising
Committee for IDF Congress 2013 Melbourne
Prof Angus Forbes
Professor Forbes holds the FEND Chair of
Diabetes Nursing. He is based at King’s college
London and has held an honorary post as a
specialist diabetes nurse at King’s College
Hospital since 2003. Prof Forbes is an active
researcher in diabetes, recent studies include:
a national scoping project on diabetes care
and organisation; an assessment of the nursing
contribution to chronic disease management
(diabetes); the relationship between cognitive
impairment and diabetic retinopathy; supporting patients in insulin intensification; evaluating a telecare intervention to support weight
loss in type 2 diabetes; and diabetes prevention in women with GDM. Angus also runs a
wide range of different courses for health pro15
Speakers
fessionals in diabetes, including the FEND
ENDCUP programme. He has an interest in Ehealth and psychological interventions in diabetes. Angus was previously: a senior lecturer
in diabetes at King’s College London; a lecturer in health services research at University
College London Medical School; and a health
visitor and district nurse in East London.
Dr Lena Hanberger
Lena Hanberger is a Diabetes Nurse at the
Childrens Hospital, UniversityHospital,
Linköping, Sweden and PhD at Linköping University. The research focus is on quality of care
from the patients´ perspective as well as the
health care professionals´perspective, and also
patients use of Internet in pediatric diabetes
care
Prof Graham Hitman
Graham Hitman is Professor of Molecular
Medicine and Diabetes at Barts and The London School of Medicine and Dentistry and
Consultant Diabetologist at Barts Health NHS
Trust. He is Editor-in-Chief of Diabetic Medicine.
His main research interests are the genomics
of type 2 diabetes and prevention strategies,
especially in people from South Asia. He is also
one of the principal investigators of the
CARDS (Collaborative Atorvastatin Diabetes
Study) trial that has influenced the development of current lipid lowering guidelines in
diabetes. He has over 240 peer reviewed publications.
Dr Åsa Hörnsten
Postgraduate educations: Anesthesia and intensive care nursing 1988, District / Primary
health care nursing 1991, Diabetes specialist
nursing 2000, Master (one year) exam 2000,
PhD exam 2004, Associate professor 2012.
I have worked full or part time at in-patient
clinics until 1990, at out-patient clinics until
2011. Currently Senior lecturer at the De-
16
Speakers
partment of nursing, Umeå University.
Research interests are patients’ perspectives
on illness; Self-management support; Patient
education; Type 2-diabetes
Dr Seyda Ozcan
Dr Ozcan has intense experience in
academical/clinical area and international / national settings of diabetes nursing over twenty
years. Seyda worked as a registered nurse,
then as a research assistant and now as an associate professor at the Florence Nightingale
School of Nursing in Istanbul University. She
has been teaching in undergraduate, graduate
and postgraduate programmes.
Dr.Ozcan was an Executive Committee Member of FEND(2001-2007), now a member of
its Advisory Board. She has been a member of
Diabetes Education Consultative Section of
International Diabetes Federation since 2008;
executive committee member of Turkish Diabetes Nursing Association since 1998; and
member of Turkish Diabetes Foundation.
Dr.Ozcan has scientific awards, some research
fundings, published articles, books and chapters in books. Seyda was a visiting professor/
research scholar at the New York University
(Nov 2004-Dec 2005); guest researcher in
Uppsala University/Sweden (Oct 2006); FEND
Clinical Research Fellow funded by Beta Cell
Trust in King’s College London&Hospital (Feb
2011-2012) to conduct a service development
project in intensive insulin clinic.
Prof Liam Plant
Graduate of University College Cork, Ireland.
Trained in Renal Medicine in Ireland and Scotland.
Previously Consultant Renal Physician, Royal
Infirmary of Edinburgh & Senior Lecturer in
Medicine, Edinburgh University. Currently
Consultant Renal Physician, Cork University
Hospital & Clinical Senior Lecturer in Nephrology, University College Cork.
National Clinical Director, HSE National Renal
Office, Ireland.
Prof Gerard Reach
Professor Gérard Reach is a diabetologist and
head of the Endocrine, Diabetes, and Metabolic Diseases Department of Hospital
Avicenne in Bobigny, France. He is Professor
of Endocrinology and Metabolic Diseases at
University Paris 13. He published two books
on patients’ adherence to long term therapies
(one of them is being translated into English),
and a book, to be published in September,
2012 (in French) by Springer on doctors’ clinical inertia.
Elisabeth Schnellbächer
Finished training as a nurse in 1975, absolved
university in 1980 as a teacher, achieved title
as Diabetes Nurse in 2000.
Since 2008 Member of the Executive Committee of the VDBD. In this period I was the initiator for our campaign on the occasion of the
World Diabetes Day. It was about creating
motivation for a healthy diet and exercise in
children. Following the principle: Healthy is
tasty and exercise is fun! The movement was
supported by several secretaries of education
of the various states. During the first year ca.
10.000 children have been reached. Due to
the great success, the campaign was repeated
the following year in a modified form. The following evaluation showed a learning success
and changes in behavior.
Since 2011 Chairwoman of the VDBD (Verband der Diabetesberatungs und –schulungsberufe, German Association of Diabetes
Nurses)
Prof Peter Schwarz
Prof. Schwarz was born 1971 in Eisenberg,
Germany. He studied medicine at "Medizinische Fakultät Carl Gustav Carus" in Dresden and completed his dissertation in 2001.
From 1999 - 2000 he worked as postdoc at
University of Chicago in a Howard Hughes
Institute. 2000 - 2007 he worked as resident
for the Department of Endocrinology and
Metabolic diseases at "Technische Universität".
In 2007 he obtained his qualification as a spe-
cialist for Internal Medicine. Since 2008, Prof.
Schwarz is head of the Division of Prevention
and Care of Diabetes at "Universitätsklinikum
Carl Gustav Carus" in Dresden. In 2008 he
obtained his postdoctoral lecture qualification
and was appointed as Professor of Prevention
and Care of Diabetes. The aims of his work
are the development and monitoring of the
implementation of methods for primary prevention of type 2 diabetes and its implementation in in-patient and out-patient care. Prof.
Schwarz is coordinating the German work
group called Diabetes Prevention and is a
member of the scientific advisory board of the
"Diabetes-Präventions-Forum (DPF)" of the
International Diabetes Association in the
European Union (IDF-EUROPE). He has published a large number of national and international publications.
Prof Roy Taylor
Roy Taylor qualified in medicine at the University of Edinburgh, and is now Professor of
Medicine and Metabolism at Newcastle University and Newcastle Hospitals NHS Trust.
He has been conducting research on type 2
diabetes since 1981, and has used a wide
range of methods to understand the condition. Most importantly, Prof. Taylor founded
the Newcastle Magnetic Resonance Centre in
2006. This new facility furthers medical and
scientific knowledge by direct study of how
the body works, bringing together cutting
edge physics and physiology. This has led to an
understanding of how food is handled by the
body in health and disease.
He also directs the Newcastle diabetes eye
screening programme which has abolished
blindness due to diabetes in young people in
Newcastle. This work led to the establishment
of the current English National Screening Programme for Diabetic Retinopathy.
Prof. Taylor has authored over 200 scientific
papers and has given over 70 invited lectures
internationally including a lecture to FEND in
2009. He has delivered several named lectures
including the 2012 Banting Memorial Lecture
of Diabetes UK.
17
Poster Abstracts
1
PSYCHOSOCIAL ASPECTS OF FEAR OF HYPOGLYCEMIA
Anderbro T. lic psychologist, PhD student1,2, Bolinder J. MD prof3, Lins P-E. MD
prof1, Wredling R. prof1, Moberg E. MD assoc prof3, Lisspers J. lic psychologist
prof4, Johansson U-B. assoc prof1,2
1 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of
Medicine, Stockholm, Sweden
2 Sophiahemmet University College, Stockholm, Sweden
3 Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Huddinge, Sweden
4 Department of Social Sciences, Mid Sweden University Campus Östersund, Sweden
Poster Abstracts
2
LOWER FEAR OF HYPOGLYCAEMIA IN PATIENTS WITH
TYPE 1 DIABETES OF SHORT DURATION
Ernersson Å. PhD1,2, Berggren B. MD1, Hollman-Frisman G. PhD2, Lindström T. MD
PhD1,3
1 Department of Endocrinology, University Hospital, County Council of Östergötland, SE
58185 Linköping Sweden,
2 Division of Nursing Sciences, Department of Medicine and Health Sciences, Faculty
of Health Sciences, Linköping University, SE 58185 Linköping Sweden,
3 Division of Cardiovascular Medicine, Department of Medicine and Health Sciences,
Faculty of Health Sciences, Linköping University, SE 58185 Linköping Sweden.
Background
Fear of hypoglycaemia (FH) is common among patients with type 1 diabetes and it is
well known that it has a negative effect on quality of life as well as on self-management
and health outcomes. So far a strong association has been found between previous episodes of severe hypoglycaemia and FH but there is a lack of knowledge about the role of
psychosocial factors in the development and maintenance of this fear.
Background: Fear of hypoglycaemia is common in patients with type 1 diabetes and
many patients deliberately aim at higher blood glucose than recommended to avoid hypoglycaemia. Patient empowerment is a process whereby patients have the skills, attitudes, and self-awareness necessary to influence the quality of their lives. An empowered
patient has sufficient knowledge to take relevant decisions about their illness, medical
treatment and their own health.
Aim
The aim of this study was to investigate FH in adults with type 1 diabetes and its association with psychological, demographic and disease specific factors with the aim of identifying targets for intervention. Furthermore this study aimed at investigating possible differences regarding these factors in sub-groups of patients with high or low FH with or
without experience of severe episode(s) of hypoglycaemia in the past year or with poor
or satisfactory HbA1c.
Aim: The aim was to study empowerment, fear of hypoglycaemia and problem areas
among patients with type1 diabetes.
Method
Questionnaires were sent by mail to 764 patients with type 1 diabetes. FH was measured using the Hypoglycemia Fear Survey (HFS). Psychological measures included Perceived Stress Scale, Hospital Anxiety and Depression Scale, Anxiety Sensitivity Index, Social Phobia Scale and Fear of Complications Scale, Alcohol habits and Exercise habits.
Univariate analysis, multiple stepwise linear regression analysis, chi-square test, unpaired
t-test and ANOVA were used in the statistical analysis.
Results
A total of 469 (61%) patients responded. The HFS was significantly associated with The
Anxiety Sensitivity Index, the Anxiety subscale of Hospital Anxiety and Depression Scale
and Social Phobia Scale. Together with the disease-specific factors the regression model
explained 39% of the variance.
Conclusion
This study showed that HFS is positively associated with the psychological factors anxiety, anxiety symptoms and social phobia. The study confirms previously found gender differences. It also showed differences in factors associated with FH between the different
subgroups that may have implications in developing interventions.
18
Method: Four hundred fifty-seven patients, mean age 48.5 (±15.4) years, completed an
questionnaire including questions on the duration of diabetes, episodes of severe hypoglycaemias and metabolic control, the Swedish Diabetes Empowerment Scale – 23 (SweDES-23), Fear of Hypoglycaemia Survey (HFS) and the Problem Areas in Diabetes scale
(SWE-PAID-20) .
Results: The level of HbA1c was not associated with fear of hypoglycaemia while patients with newly diagnosed (0-5 years) diabetes had significantly lower (p=0.001) fear of
hypoglycaemia than those with longer duration. Episodes of severe hypoglycaemia during
the last year also influenced the rating on HFS. HFS was 24.7(11.6) in those with no episodes, 30.5(13.9) 1 episode, 33.0(15.4) 2-4 episodes (all p<0.01). Patients with HbA1c
≥8.0 % rated lower empowerment (SWE-DES-23) compared to those who had an
HbA1c between 6.1-7.9% (p=0.02) and compared to those with HbA1c lower or equal
to 6.0 % (p<0.001).
On the SWE-PAID-20 patients with HbA1c ≥8 % scored in average 32.2(20.5) while
those with HbA1c ≤6.0% scored 20.0(17.6) (p<0.001) (higher value indicates more emotional distress related to diabetes).
Conclusion: Patients with poor metabolic control, HbA1c ≥8 % are less empowered
and also experiences more emotional distress related to their diabetes. Fear of hypoglycaemia was lowest in patient with up to 5 years duration of type 1 diabetes. HbA1c was
not associated with fear of hypoglycaemia while repeated episodes of severe hypoglycaemia during the last year increased this fear.
19
Poster Abstracts
Poster Abstracts
3
FEAR OF HYPOGLYCEMIA IN TYPE 2 PATIENTS ON INSULIN
THERAPY
4
PROMOTION OF HEALTHY FOOD CHOICES FOR CHILDREN
IN FIRST GRADE
Jonke T. RN, Mlakar M. RN, Kolarić V. RN, Ajduković D. MA
Vuk Vrhovac University Clinic, Zagreb, Croatia
Nascimento do Ó D. RN MPH MSN, Varandas L. RN PhD*, Serrabulho L. RN MED,
Raposo J. MD PhD
APDP – Diabetes Portugal, Lisbon, Portugal
* Lisbon Nurse School, Lisbon, Portugal
Background
Patients perceive hypoglycaemia to be one of the most unpleasant acute complications.
Fear of hypoglycaemia entails both behavioural and emotional responses directed toward avoiding hypoglycaemia, some of which can be non-adaptive and worsen medical
outcomes.
Aim
The aim of this paper was to examine the sources of worry and the strategies that patients use to avoid hypoglycaemia in order to assess the hypoglycaemia-related educational and emotional needs of the patients.
Method
Type 2 diabetes patients on insulin therapy (N=69) filled out the Fear of hypoglycaemia
scale (Irvine et al., 1994) during their annual diabetologist check-up. Mean subscale (behaviour and worry) scores were compared to T2DM norms using t-tests. Subscale items
were grouped based on content, and frequencies of responses were calculated.
Results
The mean subscale scores were lower than norms (behaviour: M=16.8, worry: M=14.5,
p’s<.0001). The most frequent behavioural responses to risk of hypoglycaemia were
aimed at increasing BG levels (eating something: 72%, having food on hand: 71%), but
about one-third usually kept their BG high “just to be safe” (35%) and before going to
sleep (34%). Less than one-half of patients adjusted their insulin dose (47%) and avoided
exercise (42%) when their blood sugars were too low. A significant proportion (40%)
avoid being alone when their blood sugar may be low.
The most common sources of worry were not being able to recognize hypoglycaemia in
time and not having won’t have food at hand (23% and 30%, respectively). About one-fifth
(19%) reported fear of being alone when hypoglycaemic. About 16% reported fears concerning endangering self or others, with one-fifth worrying about hypoglycaemia when
driving. Fear of public embarrassment affected a minority of patients (9%).
Conclusion
Fear of hypoglycaemia is low in the studied sample. Hypoglycaemia avoidance strategies
are largely based on additional food intake, rather than insulin dose adjustment. A significant proportion of patients keep their BG high and avoid being alone out of fear of hypoglycaemia. Diabetes education should focus on improving patients’ self-efficacy in
managing hypoglycaemias by more adaptive strategies.
20
Background: The increasing prevalence and incidence of overweight and obesity in
childhood is a serious public health problem. Thus health nutrition habits and physical
activities are fundamental to deal with this trend.
Aim: Development of a communitarian intervention project in a first-grade school to
promote healthy eating habits and physical activity in 1st grade children.
Method: This project was based in Betty Neuman’s Systems Model and in health planning methodology. 46 third-grade-students filled in a nutrition and physical activity questionnaire for the assessment and diagnosis of the situation. The results showed a high
consumption of non-healthy food, especially in the snacks and moderate physical activity
for most children. Subsequently, semi-structured interviews were made to experts, who
validated the results obtained in the questionnaires. The experts considered important
an intervention on healthy eating, with priority incidence on the snacks. The promotion
of physical activity was not considered a priority area for community intervention. Then,
we defined priorities, objectives and intervention strategies. The interventions involved
teachers, students and parents. We developed activities with interactive group methodologies, using facilitating, empathetic and positive reinforcement attitudes. Considering
the relationship between the students and parents/legal guardians, during the implementation of the several interventions, there were proposed some activities to be jointly developed.
Result: The intervention results were analyzed according to indicators such as productivity, adherence, quality, direct effect and efficiency. This analysis showed that the initial
objectives were achieved. The participation of parents was higher in activities to be undertaken with students at home.
After 8 weeks of intervention, the students’ nutrition choices during the snacks improved – there was a decrease of sugar intake (48,5% to 16,7%) and an increase of fruit
intake (3,2% to 19,1%), cereals and vegetables (21,2% to 28,2%) and milk products
(20,4% to 30,2%).
Conclusion: The results are according with the consulted bibliography, underlining the
importance of intervention in schools for the promotion of healthy food choices, with
the parents’ involvement, using flexible educational tools enabling the participation in
students’ homes.
21
Poster Abstracts
5
INSULIN RESISTANCE AND IMPAIRED FASTING GLUCOSE
DURING PUBERTY
Jeffery AN, PhD, RGN, Wilkin TJ, MD, Professor of Medicine,
Peninsula Medical School, Plymouth, UK
Background
Childhood and adolescent prevalence of both types of diabetes is increasing. Type 2 is
characterised by insulin resistance (IR). Impaired fasting glucose (IFG) is a recognised
risk factor for diabetes, but prevalence among ‘healthy’ children is unclear.
Aim
To use annual measures taken over a 10-year period in healthy children to characterise
those who develop high IR or IFG during puberty.
Methods
EarlyBird: a longitudinal study of 300 healthy children recruited from randomly selected
schools at 5y and followed to 15y. Birth-weight (sds) was available from the Child Health
Register.
Annual measures: Body mass index (BMI;sds), sum of 5 skinfolds (SSF), waist circumference (WC), total physical activity (TPA, accelerometer), fasting glucose, insulin, insulin
resistance (HOMA-IR), beta-cell function (HOMA-%B). Puberty was adjusted for by age
at peak height velocity (APHV).
High IR was identified by HOMA-IR ≥90th centile (gender specific) at the pubertal peak,
IFG by ADA criteria of fasting glucose ≥5.6 mmol/l.
Results
34 children had high IR (12 boys), 55 had IFG (39 boys), 6 had both (1 boy).
High-IR group: IR was significantly higher from 9y (0.81 v 0.59 units, p=0.003). The highIR children were fatter from 5y (BMI 0.86 v 0.29sd, SSF 5.01 v 3.89cm, WC 53.26 v
50.8cm; all p<0.01), and continued to be fatter during puberty (all p<0.001). In longitudinal analyses adjusting for BMI and APHV, the IR group had lower TPA (4.51 v 4.78 E-6),
lower birth-weight (-0.10 v 0.20 sd, p<0.001) and greater weight gain 0-5y (0.51 v
0.25sd; all p<0.01).
IFG group: Glucose was higher throughout in those who developed IFG (p< 0.001).
There were no differences in adiposity between those who showed IFG and those who
did not (p≥0.35), and no difference in IR (p≥0.12), but HOMA-%B, was lower from the
5y in IFG children (p=0.005).
Conclusions
Two groups of at risk children were identifiable from early childhood. Action to moderate early weight gain and increase activity may reduce high IR during puberty. IFG is
common in contemporary children, and lower beta-cell function was identifiable in these
individuals from 5y.
22
Poster Abstracts
6
ADHERENCE TO SELF-CARE ONE YEAR AFTER ONSET OF
TYPE 1 DIABETES. ITS IMPACT ON METABOLIC AND QUALITY OF LIFE OUTCOMES
Jansà M., Vidal M., De Hollanda A. MD, Conget I. PhD, Giménez M. MD, Ara P.,
Yago G., Roca D., Llorens E., Esmatjes E. PhD.
Diabetes Unit. Endocrinology and Nutrition Department. IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer). ICMDM, Hospital Clínic Universitari. Barcelona, Spain.
Background
Metabolic control from the onset of Type 1 Diabetes (T1D) is an essential factor for the
future outcomes of the disease. Patient self-management is a relevant part of this process.
Aim
We investigated the impact of adherence to self-care in metabolic control and quality of
life after the first year of T1D onset.
Patients and Methods
We performed a longitudinal, prospective, unicentre study including all patients with
newly diagnosed T1D during the period 2009-2011. All patients followed the specific and
structured Therapeutic Education Programme mixing individual and group interventions
(survival, basic and advanced level) and were treated with multiple doses of insulin analogues. We evaluated socio-demographic characteristics, metabolic control (A1c and frequency of hypoglycaemia), awareness of hypoglycaemia (Clarke test), knowledge of diabetes (DKQ2 test), quality of life (DQoL test), and adherence to self-care (SCI-R test).
Results
One year after T1D onset (age 27.3±7.4 years, 41 males, A1c at onset 11.9+3.0%) we
evaluated 54 patients with the following results: A1c 6.8+1.1%, p< 0.001 hypoglycaemia
unawareness in 4 patients (Clarke test score > 4), 2 severe hypoglycaemia events in 2
different patients, score of DKQ2 knowledge test 28/35, score of the 4 scales of Diabetes Quality of life Perception (The lower score the better perception) : Satisfaction
(29.8±9.8); Impact (30.8±7.9); Social Worry (12.6 ± 6.9); and Diabetes Worry (8.8 ± 3.1);
The percentage of the self-care SCI-R test was: 72.3%+13.7 % . Adherence to self-care
correlated negatively with A1c (r = -0.421*) and 3 scales of DQoL: Impact (r = -0.371*),
Social Worry (r = -0.362*) and Diabetes Worry (r = -0.379*).p< 0.05*
Conclusions
High adherence rates to self-care one year after T1D diagnosis has a positive impact on
not only metabolic control but also quality of life. The long-term effect on the prognosis
of the disease remains to be elucidated.
23
Poster Abstracts
7
THE NUMBER OF PREGNANT WOMEN WITH GESTATIONAL
DIABETES SIGNIFICANTLY INCREASES USING NEW IADPSG
CRITERIA
Freund S., Kolarić V., Prašek M. MD, Vučić Lovrenčić M. PhD Biochemistry
Merkur University Hospital, Vuk Vrhovac University Clinic, Zagreb, Croatia
Background
The diagnosis of gestational diabetes (GDM) adversely affects pregnancy, foetus and the
mother's and child's future. Many studies have demonstrated the association of diabetes
onset with preterm birth of infants with macrosomia, and with stillbirth and neonatal
death. The diagnosis is made by oral glucose tolerance (OGT) test. World Health Organisation (WHO) diagnostic criteria have been used in Croatia since 2006, but new International Association of the Diabetes and Pregnancy Study Group (IADPSG) criteria
have been proposed to improve care of pregnant women.
Aim
Compare WHO and IADPSG criteria in determining the prevalence of GDM.
Method
A three-month period (Oct.-Dec.2011) during which 468 healthy pregnant women visited the Vuk Vrhovac Clinic was investigated. A 75-g OGTT was performed and the results compared according to the WHO and IADPSG criteria.
Results
Clinical characteristics of the studied 468 women were: mean age 30(16-42) yrs.,
29th(26-33) week of gestation, BMI at the beginning of pregnancy 22.8(20.7 – 25.7) kg/
m², and mean HBA1c 5.2%(5.1-5.4).
Using WHO diagnostic criteria, 17.9%(N=84) of the pregnant women were diagnosed
with GDM, whereas 82.1% (N=384) had a normal finding. Applying IADPSG criteria,
47.6%( N=223) of the women had GDM, and in 52.4%(N=245) of them the finding was
normal.
Conclusion
The results indicate that a significantly higher percentage of gestational diabetes can be
expected with the use of IADPSG criteria. Although this points to a greater need for investment in the prevention and early detection of GDM, it significantly reduces the risk
of pregnancy and labour complications.
GDM therapy includes a 1800Kcal-2000Kcal daily diet, a 12kg-recommended increase in
body weight from the 12th gestational week, moderate physical activity (unless there is a
danger from spontaneous abortion), introduction of insulin therapy if fasting glycaemia
rises to > 6.0 mmol/l and postprandial to > 8.0 mmol/l , regular control of glycaemic
profiles (fasting, 2 hours after breakfast, lunch and dinner). Control OGTT should be
carried out 3-6 months after childbirth. Such a therapy is much less expensive than the
pathological outcome of pregnancy. .
24
Poster Abstracts
8
PSYCHOMETRIC EVALUATION OF THE
“FEAR OF COMPLICATIONS QUESTIONNAIRE”
Olsen M, PhD student1, Anderbro T, lic. psychologist, PhD student2,3, Amsberg S,
PhD2,3, Leksell J, PhD1,4, Moberg E, MD, Assoc professor5, Lisspers J, lic. psychologist, professor5, Gudbjörnsdottir S7, MD, Assoc professor, Johansson U-B,
Assoc professor2,3
1 School of Health and Social Sciences, Högskolan Dalarna, Falun,
2 Sophiahemmet University College, Stockholm
3 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm,
4 Uppsala University, Uppsala
5 Karolinska Institutet, Department of Medicine, Huddinge
6 Department of Social Sciences, Mid Sweden University Campus Östersund
7 Gothenburg University, Gothenburg, Sweden.
Background
It is important to identify and evaluate patients' perceptions of medical as well as psychological problems. Previous studies have shown that symptoms of anxiety and depression are common in people with diabetes. The Fear of complications questionnaire
(FCQ), captures items regarding fear of complications in people with diabetes. The questionnaire needs further scientific evaluation and cultural adaptation.
Aim
The aim of this study was to evaluate the psychometric properties of the Swedish version of the FCQ.
Method
The FAQ was translated using the forward-backward translation method and was thereafter answered by 467 patients with type 1 diabetes from two university hospitals in
Stockholm, Sweden, age ≥ 18 years and duration of diabetes ≥ 1 year.
Descriptive statistics were performed for demographic and clinical characteristics, factor
analysis and Cronbach’s alpha. The Swedish Hypoglycemia Fear Survey (Swe-HFS) and
Hospital Anxiety and Depression Scale (HADS) were used to test convergent validity.
Result
A total of 467 patients (235 women and 232 men) with a mean age of 47 years (SD=14),
a mean duration of diabetes of 31.0 years (SD=14.2) and a mean HbA1c of 6.9%
(SD=1.0) (reference value < 5.0%) responded to the questionnaires. Cronbach’s alpha
was satisfactory 0.96 for the total FCQ. The FCQ correlated significantly positively with
HADS and Swe-HFS, p-value < 0.0001.
Conclusion
The results of the present study suggest that FAQ as a one factor scale seems to be a
reliable and valid measure for identifying fear of complications in patients with type 1
diabetes, although further testing of the FAQ with different populations is needed.
25
Poster Abstracts
9
LIFE SATISFACTION AND TYPE 2 DIABETES
F. Bakomitrou1, S. Bousmpoulas2, F. Spyropoulou3, E. Karadimas4, A. KalantziAzizi5, P. Vergidou, A. Grozou6, V. Spinaris7, S. Pappas8.
1 Clinical psychology-psychotherapist (MSc., PhDc.), Diabetes Centre Manager, General Hospital Nice, Athens, Greece ∙ University of Athens, Athens, Greece.
2 Pathologist - Diabetologist, Associate Director, C. Department of Internal Medicine,
Diabetes Centre Manager, General Hospital Nice, Athens.
3 Psychology, University of Athens, Athens, Greece.
4 Associated Professor of Health Clinical Psychology, University of Crete, Crete,
Greece.5 Professor of Clinical Psychology, University of Athens, Athens, Greece.
6 Health visitor, General Hospital Nice, Athens. 7 Psychiatry, Director, C. Department of
Internal Medicine, General Hospital Nice, Athens. 8 Pathologist - Diabetologist, Director,
C. Department of Internal Medicine, Diabetes Centre Manager, General Hospital Nice,
Athens.
Background: According to recent epidemiological data there is a rapid increase in diabetes mellitus incidence, with the number of patients launched globally in 366 million,
while in Greece it is estimated that there are now more than 10%. Under the general
concern for the aforementioned increase, and given the importance of health in a person’s quality of life as well as the satisfaction deriving from the latter, it has been considered appropriate to conduct this study in order to estimate some related data concerning the Greek population.
Aim: This research, refers to Diabetes and Life satisfaction. In particular, it is a descriptive study of differences in levels of life satisfaction in Greek outpatient incidents with
Type 2 Diabetes Mellitus.
Method: The survey involved 120 patients, women and men in random ratio, aged between 30 to 80 years old who visited the Diabetes Clinic of the General State Hospital
of Nikaia- Piraeus. The systematic sampling method was used in order to collect the
sample. A tripartite questionnaire was granted which included a demographic data questionnaire, the Diabetes Attitude Scale – 3- DAS and the Life Satisfaction Index –LSI. The
statistical methods T-Test Groups and one factor analysis of variance (One-Way
ANOVA) with Bonferroni correction were also used.
Result: According to the findings emerging from the data analysis, it appears that despite the daily sugar measurement, only 40% of the patients can keep their blood sugar
levels low. Regarding the occurrence of problems due to diabetes, a considerable percentage presented ophthalmological disorders while 30% had high blood pressure, decreased stamina and heart problems. However, unlike other studies, the majority of patients showed no complications from diabetes and had no problems other than diabetes.
Conclusion: Finally, major findings are that life satisfaction is particularly affected by the
unemployment and the frequency of visits to the doctor and that the attitude of patients
to the psychosocial impact of diabetes is significantly influenced by the presence of complications in their health such as hypoglycemic shock or neural dysfunction and by the
maintenance of their blood sugar lower than 200mg/dL.
26
Poster Abstracts
10
EVALUATION OF THE AUTONOMY OF CHILDREN WITH DIABETES ATTENDING THE 2011 RABAC SUMMER CAMP
Iris Britvar, Snježana Gaćina
Merkur University Hospital, Vuk Vrhovac University Clinic for Diabetes, Endocrinology
and Metabolic Diseases, Dugi dol, 4a Zagreb, Croatia
Background
The study was carried out at the Rabac Summer Camp for Children with Diabetes in
2011. Data were collected from children and their parents using a 12-item questionnaire
designed for this research asking about the children's autonomy.
Aim
Describe the sample using descriptive statistics, assess the frequency of identical answers
given by children and parents, and establish whether HbA1c levels and diabetes (DM)
duration depend on correspondence between children's and parents' answers about the
children's autonomy.
Method
T-test was used for the hypothesis for corresponding expecations of A1c and DM duration. F-test was employed to confirm the homogeneity of variance. Result: A total of 21
pairs of children and parents were investigated. Mean child age was 13.05 ± 1.43 yrs.,
DM duration 3.65±2.27 yrs., and mean A1c value was 8.21±2.3 %. There were 62% of
boys and 38% of girls. With respect to the type of therapy, 24% of children were on two
insulin doses, 62% on intensified therapy and 14% were on insulin pump.
Result
Parents and children agreed most (86%) on the question “Do you differentiate between
the categories of foodstuff?”, and the least (24%) on “How would you assess your readiness to gain new knowledge?”. Children whose answer to the question about autonomy
in blood glucose self-control differed from that of their parents had longer DM duration
on average (assumption on homogeneity of variance was satisfied p=0.128). Children
who responded differently from their parents had mean diabetes duration of 4.89± 2.56
yrs., whereas those whose answers were equal had diabetes for a mean of 2.72 ± 1.55
yrs. The hypothesis that children from both parent-children pairs who gave identical answers or those who answered differently have equal mean A1c cannot be rejected (assumption on homogeneity of variance was satisfied p=0.439).
Conclusion
Average correspondence between parents’ and children’s answers was 44%, indicating
good concordance in the assessment of autonomy. DM duration and A1c levels did not
affect agreement on autonomy evaluation. Parents should be encouraged to accept
autonomy of their children, as they are ready for a greater independence than assessed
by their parents.
27
Poster Abstracts
11
(withdrawn)
Poster Abstracts
12
WHEN, WHY AND HOW: A MULTIDISCIPLINARY GUIDELINE
ABOUT THE SELF MONITORING OF BLOOD GLUCOSES BY
PEOPLE WITH DIABETES.
Hensbergen J.F.1, Beer H. de2, Campmans M.3, Hoogma R.4, Jansen R.5, Koppert
H.6, Meima F.7, Vos C.8,
1 Diabetes Nurse Specialist EADV VUmc Amsterdam, 2 Senior Investigator TNO
Utrecht, 3 Dietician DNO, Clinical Epidemiologist UMC Utrecht, 4 Endocrinologist NIV
Groene Hart ziekenhuis Gouda, 5 Clinical chemist NVKCInstitute of Quality Control
Medical laboratorium diagnostics Nijmegen, 6 diabetespatient DVN Nieuwegein, 7
General Practitioner Diabetes DiHAG, Bathmen, 8 Diabetes Nurse Specialist EADV
Evean Zorg Zaanstreek Waterland, Netherlands
Background
Although almost all of our patients with insulin therapy and some of them with only oral
medication perform self monitoring of blood glucoses (smbg), there is hardly any evidence for the benefit of it. That’s why we developed an evidence based, multidisciplinary
guideline about this subject. Our main questions were: is it useful and if yes, how often,
which times of the day? What education is necessary and how should we teach our patients to perform smbg?
Aim
To provide diabetes health care professionals (HCP’s) with recommendations in their
daily practice with smbg so that they can give advice about indication, frequency, moments of the day, education & instruction about smbg to their patients. Further aims are
to avoid useless smbg and to stimulate patients smbg-goal setting, including time paths
and evaluations.
Methods
We asked a variety of diabetes HCP’s to participate in the guideline development team.
Than we explored ‘the field’ about their thoughts and believes concerning smbg. After
collecting all the reactions, we distracted 5 main problems and started a literature
search. The conclusions of the literature were discussed in the multidisciplinary team. We
tried to translate the findings to the Dutch situation, to find out what were the consequences for patients, HCP’s and the financial consequences. Finally, we put all the comments together and formulated our recommendations.
Result
We developed an evidence based, multidisciplinary guideline for diabetes HCP’s about
smbg for people with diabetes. Besides, we developed some extra documents to make it
easier for HCP’s to use the guidelines in daily practice.
Conclusions
Smbg is useful but in certain circumstances. Diabetes patients, together with their HCP’s,
should set goals and evaluate smbg. Without structured education, smbg should not be
advised. We must instruct our patients to wash and dry their hands before performing
smbg and use the first drop of blood.
28
29
Poster Abstracts
13
SYMPTOMS AND PRE-HOSPITAL DELAY IN MYOCARDIAL
INFARCTION. SIMILARITIES AND DIFFERENCES BETWEEN
PATIENTS WITH AND WITHOUT DIABETES
Hellström Ängerud K.1,2, Brulin C.1 Professor, Näslund U.2,3, MD Professor, Eliasson M.3,4, MD Professor
1 Department of Nursing, Umeå University, Umeå, Sweden
2 Department of Cardiology, Heart Centre, University Hospital, Umeå, Sweden,
3 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
4 Department of Medicine, Sunderby Hospital, Luleå, Sweden
Background
Mortality from myocardial infarction (MI) is elevated in patients with diabetes compared
with patients without diabetes. Reperfusion therapy in MI reduces both morbidity and
mortality and greatest benefits have patients with short time to received treatment. Despite the time-dependent effectiveness of reperfusion therapy, more than half of the patients with MI delay in seeking medical care by more than 2 hours from symptom onset.
Analysis of patterns in symptoms and pre-hospital delay in men and women with and
without diabetes are important and may improve patient education aiming to reduce delay times in MI.
Aims
To describe symptoms and pre-hospital delay in a first myocardial infarction among men
and women with and without diabetes.
These population based studies consisted of 4028 and 4266 people aged 25–74 years
with MI, registered in the Northern Sweden MONICA myocardial infarction registry between 2000 and 2008.
Results
Patients with diabetes had longer pre-hospital delay in MI compared to patients without
diabetes. For patients with diabetes, a higher proportion had delay times ≥ 2 h compared
to patients without diabetes. Typical MI symptoms were common and there were no major differences in symptoms of MI between patients with and without diabetes. There
were no significant differences in symptoms and delay times ≥ 2 h between men and
women with diabetes.
Poster Abstracts
14
OBSTACLES FOR TURNING POINTS IN SELF-MANAGEMENT
OF TYPE 2 DIABETES
Jutterström L., Hörnsten Å.
Department of Nursing, Umeå University, Umeå, Sweden
Background
To live with type 2 diabetes without complications often requires lifestyle changes which
can be demanding. A problem is that on the one hand well-being deteriorates due to the
demands of self-management of the illness. On the other hand well-being decrease when
complications occurs due to the illness. A paradox is that in order to live well, selfmanagement activities must be performed. Triggers for turning points in self-management
have previously been described as experiences of being in a life and death struggle; being
at a crossroad with no return; being the one who decide and being the one who can
change the outcome. There is lacking existing literature about aspects that prevent turning points to happen in self-management of type 2 diabetes. Therefore, the aim of this
study was to describe obstacles for such turning points.
Method
A secondary analysis of interviews about turning points in self-management among
eighteen people diagnosed with type 2 diabetes within two years was performed. The
interviews were analyzed using qualitative content analysis.
Result
The preliminary result shows that obstacles for turning point in self-management of type
2 diabetes were insufficiently processed and integrated illness; ambiguity about the severity of diabetes and finally shame, doubt and guilt connected to having diabetes.
Conclusion
Integrating illness in daily life is time consuming. Feelings of shame and doubt can
lengthen the illness integration process. Diabetes specialty nurses preferably use patients’ views of diabetes and its severity as well as feelings of shame and doubt in consultations with patients in order to support them sufficiently.
Keywords
Illness integration, Self-management, Turning point, Type 2 diabetes
Conclusion
Patients with diabetes had longer pre-hospital delay times in MI compared to patients
without diabetes, although there were no differences in MI symptoms. It indicates that
the process from symptom onset to the decision to seek medical care is complex and it
raises the question if the decision making process to seek care for MI differs for patients
with diabetes.
30
31
Poster Abstracts
Poster Abstracts
15
NURSING RESEARCH IN THE NORDIC COUNTRIES – AN
OVERVIEW OF THE LITERATURE, 1979–2009
16
DOES TYPE 2 DIABETES AFFECT SEXUAL FUNCTION IN
WOMEN?
Graue M. PhD1, Iversen M.M. PhD1, Sigurdardottir A.K. PhD2, Zoffmann V. MPH,
PhD3, Smide B. PhD4, Leksell J. PhD4
1 Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway
2 Department of Health Sciences, University of Akureyri, Iceland
3 Steno Diabetes Center, Gentofte, Denmark
4 Department of Medical Sciences, Uppsala University, Sweden
Demirgoz Bal M.1, Dereli Yilmaz S.2, Celik S.3, Dinccag N.3, Kizilkaya Beji N.4, Yalcin O.5
1 Health College of Karamanoglu Mehmetbey University, Karaman, Turkey
2 Department of Midwifery, Faculty of Health Sciences, Selcuk University, Turkey
3 Istanbul University, Istanbul Faculty of Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey
4 Department of Gynecologic and Obstetrics Nursing of Florence Nightingale Nursing
Faculty, Istanbul University, Istanbul, Turkey
5 Istanbul University, Istanbul Faculty of Medicine , Department of Obstetrics and Gynecology, Istanbul, Turkey
Background
The literature is a way of disseminating new knowledge from research studies to clinicians. It is essential that the literature report on findings that can inform practice, and
that others use the knowledge to further build evidence for practice.
Aim
To scrutinize the total number of scientific articles on diabetes nursing research in
Denmark, Iceland, Norway and Sweden over a period of 30 years.
Method
The search strategy was designed to retrieve publications related to the development of
diabetes nursing research as a substantial contribution to multidisciplinary research in
diabetes care. An electronic search was performed for potentially relevant articles between January 1, 1979 and December 31, 2009 using the MEDLINE, Medline in process,
EMBASE, CINAHL, PsycINFO and Cochrane databases.
Results
A total of 132 publications were included from the electronic search, and 32 articles resulting from manual search. Thus, this study examined 164 publications; 52% of the publications were from Sweden (n = 86), 28% from Norway (n = 45), 14% from Denmark (n
= 23) and 6% from Iceland (n = 10). With the production weighted according to population, Iceland, Norway and Sweden were above average, and Denmark far below average.
The 164 papers were published in 63 journals, with most published in multidisciplinary
journals (70%). Significant contributions were given only by a few nurses within each
country; one forth had published five or more papers, Most studies originated from a
single country, with 26 of 164 including international co-authors.
Conclusion
To fulfill knowledge gaps in practice, action is needed to build stronger groups of nurse
researchers. Attention must be given to the benefits of international cooperation in research and to designing multicenter research trials.i
Background: Type 2 diabetes is an important systemic disease in women, which affects
sexual functions.
Aim: This study was aimed at assessing the sexual life of women with type 2 diabetes
aged between 24 and 47years.
Material-Method: Among the women with type 2 diabetes,who applied to the Diabetes Outpatient Clinic in Istanbul Faculty of Medicine,Istanbul University,72 women
with active sexual life and had no other systemic disease than diabetes,were included as
the study group,while 100 women with active sexual life,who had no systemic disease,were included as the control group. Data were collected using International Female
Sexual Function/IFSF(short form) and a questionnaire that determines the factors associated with the socio-demographic, diabetic and obstetric symptoms of women,which
was prepared by the authors. Approval of the ethical committee of the institution was
obtained for the study. Analysis were assessed using chi-square and student t test.
Results: The mean age of the diabetes and control groups was (n:76)41,47±5,5 and
(n:100)36,52 ±8,13years,respectively.When IFSF scores of the study and control group
were compared, there was a significant difference(Table 1).
Table 1: Mean IFSF scores of diabetic women and control group
Diabetic women
Mean score
Normal women
Mean score
Value
Sexual relationhip satisfaction
4.53±3.97
8.69±1.96
p<0.0001*
Desire
3.92±2.43
7.09±1.91
p<0.0001*
Satisfaction sexual function
4.06±2.65
8.14±2.23
p<0.0001*
Degree lubrication
2.50±2.28
4.36±1.05
p<0.0001*
Ability achieve orgasm
2.05±1.33
3.89±1.20
p<0.0001*
Clitoral sensation
2.02±1.29
3.51±1.02
p<0.0001*
Total IFSF
18.94±11.62
34.84±8.43
p<0.0001*
*student t test 32
(contd over)
33
Poster Abstracts
When they were compared considering that the diabetic women with total IFSF score of
30 or less were assessed as having low sexual function(+), a significant difference was obtained in terms of HbA1c,BMI and diabetes duration(p<0.0001).
Conclusion: Our study results showed that type 2 diabetes in women had a significant
negative effect on their sexual functions.Thus, the healthcare professionals, who are
studying diabetes,should also consider their sexual functions,which is an important parameter of their life quality,with due care and provide consultation services and refer to
the related units,if required.
Poster Abstracts
17
DEVELOPING PARTICIPATORY PATIENT EDUCATION –
WHAT ARE THE NEEDS OF HEALTH CARE PROFESSIONALS
(HCP)?
Glindorf M., Selzer Terkildsen R., Trustrup U., Rasmussen A. Podiatrist, Vinther L.
Dietician, Voigt J.R.
Steno Diabetes Center, Gentofte, Denmark
Background: Since 2000 the Type 2 Clinic has performed a concept, based on the results of the Steno 2 Study. Patients are referred for an 8 months educational course,
witch focuses on individual risk assessment and multifaktoriel intervention with partly
group based, motivating patient education. The clinic works as a multidisciplinary team,
with nurses in a key position as anchorwomen. The clinic wants to develop the pedagogical aspect from a more traditional educational approach, into a new participatory
health educational approach, developed locally in collaboration between HCP and researchers.
Aim: A key purpose of the project is to develop a competence development programme for HCP teaching participatory diabetes patient education.
Method: The data are collected through qualitative methods: Observations, focus
groups, individual interviews with patients, workshops, as well as video recordings of
education sessions, desk research and a critical inquiry. In the analyses we applied a
health professional, a patient, and a researcher perspective.
Results: The challenge is to change the mindset of the HCP. We change a traditional
setup with focus on providing information on diabetes to a problem- based approach
with participation and dialogue. Developing the role of the HCP is crucial when performing participatory patient education. We find the following key elements crucial for
competence development:
•
•
•
•
Explore HCP self perceived needs for new competences. A model for competence development was used as a tool for reflections on the different roles in the
teaching process
Introduce and test new dialogue based tools and methods
Explore educational challenges in facilitating group sessions
Challenge the role of being an expert in diabetes
The development of competences has to be an ongoing process. The process seems to
change the mindset and the perceived competences fundamentally.
Conclusion: A participatory research approach, based on workshops can be a fruitful
part of the learning processes in competence development. The process has to be tailored to the local context and culture to make it successful. Training and getting experiences with dialogue and facilitation is extremely important to HCP.
34
35
Poster Abstracts
Poster Abstracts
18
PATIENTS WITH FIRST SYMPTOMS OF DIABETIC FOOT –
WHO TAKES CARE OF THEM?
19
EFFECT OF RAMADAN FASTING ON GOOD METABOLIC
CONTROL IN PATIENT WITH TYPE 2 DIABETES
Šutić N., Zeljković M.
Merkur University Hospital, Vuk Vrhovac University Clinic, Zagreb, Croatia
Celik S.¹, Pinar R.², Kubat Uzum A.¹, Salman S.³ , Satman I.¹
¹ Istanbul University, Istanbul Faculty of Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey
² Faculty of Health Sciences, Department of Nursing and Health Services, Yeditepe
University, Istanbul Turkey
³ Acıbadem University, Department of Internal Medicine, Endocrinology and Metabolism Clinic, Istanbul, Turkey
Background
Due to a lack of an appropriate curriculum, podiatric practices are not a part of diabetes
care in Croatia.
Aim
This study aimed to determine the degree of self-care and help-seeking behaviour in patients with first symptoms of diabetic foot without an active process on foot, and to
identify prevailing forms of foot care in this risk patient group.
Background
Fasting continues for thirty days and may cause metabolic worsening in diabetic patients.
Although diabetic Muslim patients are exempt from fasting, they mostly stand out to fast.
Method
Sixty-three patients hospitalized for regular annual check-up (25% with T1DM, 87% with
neuropathy, 47% female, aged 58 yrs ± 11, diabetes duration 18 yrs ± 10, HbA1C 7.4% ±
1.1) were assessed for foot self-care using the corresponding subscale of the Summary
of Diabetes Self Care Activities (SDSCA), and asked to fill in a questionnaire inquiring
into their worry about foot complications, availability of related health services and their
usage of them. Chi-square was used to compare the obtained results with respect to
gender. Associations between help-seeking behaviour and diabetes-related variables were
determined by Kendall Tau correlations.
Aim
We aimed to assess the fasting situation and changes on good metabolic control in patient with type 2 diabetes.
Results
The obtained SDSCA score indicated that 58% of the reported one week-period was
covered by self-care activities. Eighty-one percent of the examined patients expressed
worries about a possible diabetic foot development. However, only a part of them reported using chiropody (29%), orthopaedic (16%) and surgeon services (11%). Use of
orthopaedic aids was reported in 37% cases. No gender differences were found in foot
self-care or in seeking chiropody and surgeon services (all p>0.05). Female patients used
orthopaedic services more frequently (30% vs 7.5% Chi-square =4.16 p=0.04).
Utilisation of orthopaedic services was associated with foot self-care and worry (Kendall
Tau = 0.21 and 0.27 respectively p<0.05), and with the utilisation of chiropody services
(0.26 p<0.05).
Results
Study group was composed of 18 females (69,2%;mean age 55,8±6,1 years) and 8 males
(30,8%;mean age 62,1±7,3 years). Mean HbA1c, BMI was 6.8 % and 31,8±3,5kg/
m2,respectively. Seventeen patients (65,4%) were recieving oral antidiabetic drugs. Mean
duration of diabetes was 8.9±7.1years (ranged 1 to 30). Mean duration of fasting was
26,8±4,6 days(ranged 8 to 29). Twenty-three (88,5%) patients pointed out that they arranged morning and evening medications according to fasting hours and skipped the
doses between dawn and sunset. Five patients (19,2%) changed their medication schedule, 22(84,6%) changed diet routine and four (15,3%) changed their daily physical activities during fasting. Eleven patients (42,3 %) changed sleeping hours, 16(61,5%) changed
eating habits and food preferences. Fifteen patients (57,7%) experienced at least one episode of hypoglycemia, all hypoglycemia experiences were mild during fasting period in
Ramadan and no emergent health problem was noted. Weight, HbA1c, fructosamine, Cpeptide, lipid profile did not change before and after Ramadan.
Conclusion
Utilisation of health services in patients at risk for foot complications is considered
suboptimal. Psychological variables including foot self-care and worry were associated
with treatment-seeking behaviour better than the disease-related variables.
Conclusion
Ramadan seems not to effect metabolic control in patients who are compliant to disease
management. Informing the patients about importance of self monitoring blood glucose
and closer follow-up during fasting is needed.
Utilisation of chiropody services was shown to be inversely associated with the presence of neuropathy (Kendall Tau = -0.29 p<0.05) and positively with a utilisation of orthopaedic services (Kendall Tau = 0.30 p<0.05).
36
Methods
Twenty-six good metabolic controlled patients with type 2 diabetes who were followedup in Diabetes Outpatient Clinic of a University Hospital were asked about changes in
life style, drug use and eating habit and hypoglycemia just 10 days before Ramadan
started and 10 days after Ramadan lasted. Also, weight, HbA1c, fructosamine, C-peptide,
insulin, lipid profile were compared.
37
Poster Abstracts
Poster Abstracts
20
LOWER URINARY TRACT SYMPTOMS IN DIABETIC WOMEN
WITH AND WITHOUT URINARY INCONTINENCE
21
DETERMINATION OF LOWER URINARY TRACT SYMPTOMS
OF WOMEN WITH AND WITHOUT DIABETES
Dereli Yilmaz S.1, Demirgoz Bal M.2, Celik S.3, Kizilkaya Beji N.4, Dinccag N.3,
Yalcin O.5
1 The Department of Midwifery, Faculty of Health Sciences, Selcuk University, Konya,
Turkey.
2 Health College of Karamanoglu Mehmetbey University, Karaman, Turkey.
3 Istanbul University, Istanbul Faculty of Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey. 4 Department of Gynecologic and Obstetrics Nursing of
Florence Nightingale Nursing Faculty, Istanbul University, Istanbul, Turkey.
5 Istanbul University, Istanbul Faculty of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey.
Dereli Yilmaz S.1, Demirgoz Bal M.2, Celik S.3, Rathfisch G.4, Kizilkaya Beji N.4,
Dinccag N.3, Yalcin O.5
1 The Department of Midwifery, Faculty of Health Sciences, Selcuk University, Konya,
Turkey.
2 Health College of Karamanoglu Mehmetbey University, Karaman, Turkey.
3 Istanbul University, Istanbul Faculty of Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkey
4 Department of Gynecologic and Obstetrics Nursing of Florence Nightingale Nursing
Faculty, Istanbul University, Istanbul, Turkey.
5 Istanbul University, Istanbul Faculty of Medicine , Department of Obstetrics and Gynecology, Istanbul, Turkey.
Background: It is important to determine lower urinary tract symptoms(LUTS) in
diabetic women with having urinary incontinence for prevention of infection.
Aim: To compare LUTS of diabetic continent and incontinent women and related factors.
Methods: Applying to the Diabetes Outpatient Clinic in Istanbul Faculty of Medicine,
Istanbul University between May-December 2011, 77 diabetic incontinent women and 88
diabetic continent women were included into the descriptive study. The data were collected via a questionnaire prepared by researchers, including sociodemographic,diabetic,obstetric and gynecologic features of women,and factors regarding
urinary symptoms, and the scale of The Bristol Female Lower Urinary Tract Symptoms
(BFLUTS-SF). For the study,permission was obtained from the ethical board.To evaluate
the data,percentage,standard deviation,t-test and correlation analysis were used.
Results: No statistically significant difference was present between diabetic continent
and incontinent women as regards age,BMI and duration of diabetes (i:56.2±8.6,
c:56.0±10.5;i:31.6±4.6,c:30.5±4.5;i:10.6±6.7,c:10.6±7.7,respectively)(p>0.05).In incontinent women, fasting and postprandial blood glucose levels, and HbA1c were statistically
and significantly higher(i:168.4±84.6,c:133.2±36.1;i:181.2±75.1,
c:152.0±40.3;i:7.8±1.6,c:6.9±0.9,respectively)(p<0.05).Between two groups,a statistically
significant difference was present in terms of average scores of BFLUTS-SF total and
subscales(p<0.05). In light of logistic regression analysis, level ofHbA1c was determined
to be associated at intermediate level with microalbuminuria, total BFLUTS-SF and such
subscales as filling,voiding, incontinence symptoms, sexual function and quality of life
(r=0.461,0.276,0.243,0.171,0.260,0.185,0.212, respectively). A strong correlation was
found between level of microalbuminuria and symptom of voiding (r=0.649). In those
with the complaints of hypertension, dysuria, the history of frequent vaginal infections
and itching, total score of BFLUTS-SF was statistically and significantly higher(p<0.05).
Aim
The study was planned to determine lower urinary tract symptoms(LUTS) of women
with type 2 diabetes(DM) and healthy controls.
Methods
Applying to the Diabetes Outpatient Clinic in Istanbul Faculty of Medicine, Istanbul University, 249 women with type 2DM and 376 healthy controls, total 625 women were included into the study. Data were collected via a data collection form prepared by researchers to determine sociodemographic,diabetic,obstetric and gyneacologic features
of women, and Bristol Female Lower Urinary Symptoms (BFLUTS-SF)to define urinary
symptoms.Approval was obtained from the ethical board. In the assessment of the data,mean,standard deviation,Mean (Min-Max),t test and Mann-Whitney U tests were used.
Results
Mean age rates of diabetic women and healthy controls were 55.1±10.0 and 41.9±13.8,
respectively.Among diabetic women, 31.6% and 22.7% of controls had given four births
and over. Mean fasting blood glucose, postprandial blood glucose and HbA1c rates of
diabetic women were 163.9mg/dl(75-560),186.5mg/dl (75-500) and 8.0mg/dL(1.1-13.6),
respectively. Compared to LUTS in both groups,a significant difference was found to be
present as to filling, voiding, incontinence,sexual function and quality of life as subscores
of BFLUTS-SF,and total BFLUTS-SF scores(p<0.05).
(contd over)
Conclusion: Consequently, it may be suggested that LUTS in women whose DM is
poorly managed are increased. Therefore, healthcare professionals are proposed to follow diabetic women more meticulously and to evaluate as to LUTS.
38
39
Poster Abstracts
Poster Abstracts
Table-1:Comparison of LUTS in women with type 2 DM and healthy controls [Mean (MinMax)]
DiabeticWomen
Healthy Controls
p*
Filling
6.07 (3-15)
3.24 (0-13)
<0.001
Voiding
3.47 (3-11)
1.24 (0-9)
<0.001
Incontinence
6.53 (5-20)
1.15 (0-11)
<0.001
Sexual Function
2.05 (2-5)
0.33 (0-4)
<0.001
Quality of Life
6.10 (5-19)
1.77 (0-16)
<0.001
Total BFLUTS
24.17 (18-58)
7.73 (0-38)
<0.001
* In the comparison of data, Mann-Whitney U test was used.
Conclusion
As a result, diabetes with good progression could be suggested to increase LUTS in diabetic women. Therefore, healthcare professionals are suggested to follow diabetic population more meticulously and to evaluate them in terms of LUTS.
22
ADDITIONAL RISK FACTORS OF A TEN-YEAR CARDIOVASCULAR RISK IN PATIENTS WITH DIABETES MELLITUS
Snježana Gaćina
Merkur University Hospital, Vuk Vrhovac University Clinic for Diabetes, Endocrinology
and Metabolic Diseases, Dugi dol, 4a Zagreb, Croatia
Aim
To identify variables which affect a 10-yr risk of cardiovascular diseases in persons with
diabetes using descriptive statistics.
Method
The study included 140 patients admitted to the Clinic. An 8-item CVD Risk knowledge
test was applied and biometric data collected. Ten-year cardiovascular risk was calculated
by Framingham's formula which includes respondent's years of age, sex, systolic pressure,
smoking status, left ventricle hypertrophy, total and HDL cholesterol, and diabetes mellitus. Logistic regression was used to assess whether and how diabetes duration, A1c, BMI
and knowledge as assessed by the questionnaire affect the 10-yr cardiovascular risk in
patients with diabetes.
Result
There were 41% of women and 59% of men, aged 58.68 ± 11.52 yrs, of whom 19% had
type 1 DM and 81% type 2 DM, and 22% of whom were smokers. Mean systolic pressure
was 141.36 ± 18.67 mmHg, diabetes duration 16.57 ± 9.94 yrs, and knowledge score
3.39 ± 1.6. Stressful life events over the previous year were reported by 59% respondents; cardiovascular risk was low in 24% of the patients, medium in 34% and high in
42%; BMI was low in 1% of the respondents, normal in 25% and high in 74%; and A1c was
normal in 21% of the patients, medium in 29%, and high in 51%. Logistic regression indicated that BMI and knowledge significantly affected the 10-yr cardiovascular risk
(p<0.0001; p=0.0405), whereas DM and A1c did not have a significant influence
(p=0.4918; p=0.1931). The odds ratio for an increase in patient's risk rises by 14.31 times
with each increase in BMI category. With each correct answer in the total knowledge
score the odds ratio for an increased cardiovascular risk decreases by 0.8 times.
Conclusion
To reduce a 10-yr cardiovascular risk in persons with diabetes, attention should be
turned to decreasing BMI and increasing knowledge about cardiovascular risks in addition to conventional risk reduction measures.
40
41
Poster Abstracts
Poster Abstracts
23
EFFECT OF TELEMEDICINE CONSULTATION OF LEG AND
FOOT ULCERS: A SYSTEMATIC REVIEW
cand1,
MSc1
PhD1, 2
Henanger MT, MSc
Nordheim LV,
Iversen MM,
1 Centre of Evidence-Based Practice, Bergen University College, Bergen, Norway.
2 Department of Medicine, Section of Endocrinology, Stavanger University Hospital,
Norway.
Background
The Norwegian Coordination Reform promotes the use of information and communication technology to improve access and delivery of health care.
Aim: To assess the effect of telemedicine on clinical, behavioral and care coordination
outcomes in patients with leg and foot ulcers.
Method
We performed a systematic review of randomized and quasi-randomized controlled trials, controlled before-and-after studies, and prospective cohort studies. Electronic databases were searched for relevant studies. Retrieved publications were assessed against
predefined inclusion criteria and relevant studies were independently assessed by two
persons using the Cochrane Collaborations’ risk-of-bias tool. A narrative synthesis of the
results was undertaken and their robustness was assessed by using GRADE.
Result
Two studies met the inclusion criteria. In a prospective cohort study diabetic ulcer
status was assessed by two independent physicians, either on-site or remote via the Web
by transmitting digital images of the ulcers. Moreover, change in patient attitudes to telemedicine and consultation time was measured. A controlled before-and-after
study measured the effect of real-time interactive video consultation in management of
diabetes-related foot ulceration, with healing as outcome. None of the studies found significant differences in outcomes between patients receiving telemedicine and traditional
follow-up. However, both studies had a high risk of bias.
Conclusion
There is insufficient evidence to provide an unambiguous answer to whether telemedicine consultation of leg and foot ulcers is effective when compared with traditional
follow-up.
24
STRESS AND TYPE 2 DIABETES
S. Bousmpoulas1, F. Bakomitrou2, K. Tolia3, A. Kalantzi-Azizi4, E. Karadimas5,
A. Katopodi6, V. Spinaris7, S. Galinaki8, A. Papazafeiropoulou9, G. Lyrakos10,
S. Pappas11.
1 Pathologist - Diabetologist, Associate Director, C. Department of Internal Medicine,
Diabetes Centre Manager, General Hospital Nice, Athens.
2 Clinical psychology-psychotherapist (MSc., PhDc.), Diabetes Centre Manager, General Hospital Nice, Athens, Greece ∙ University of Athens, Athens, Greece.
3 Psychology, University of Athens, Athens, Greece.
4 Professor of Clinical Psychology, University of Athens, Athens, Greece.
5 Associated Professor of Health Clinical Psychology, University of Crete, Crete,
Greece.
6 Health visitor, General Hospital Nice, Athens.
7 Psychiatry, Director, C. Department of Internal Medicine, General Hospital Nice, Athens.
8 Health Psychology MSc., University of Sussex, UK.
9 Pathologist - Diabetologist, General Hospital Nice, Athens.
10 Health Psychology MSc. PhDc., University of Athens, Greece.
11 Pathologist - Diabetologist, Director, C. Department of Internal Medicine, Diabetes
Centre Manager, General Hospital Nice, Athens.
Background
The World Health Organization reports that in 2006 the number of people suffering
from diabetes has surpassed the 170 million and is expected to double by 2030. In
Greece, 10% of the general population becomes ill with diabetes. The role that stress
plays in the appearance and the treatment of diabetes is a subject that has particularly
preoccupied the experts. Due to the general concern for the increase of diabetes, the
conduction of this research for the estimation of Greek data seemed appropriate.
Aim
This study concerns the attitude of patients towards Type 2 Diabetes and how patients
perceive stress. The correlation between the disorders and the demographic characteristics of the sample were also studied.
Method
The population that participated was 120 patients, men and women, in random analogy,
30 to 80 years old of the Diabetes clinic of the General State Hospital of Nikaia- Piraeus. For the sample collection, systematic sampling method was used.
To collect the data a single questionnaire was used, which was divided into three parts.
The first part consisted of an improvised questionnaire of demographic data. The second
part included the Diabetes Attitude Scale - 3, DAS, and the third part covered the Perceived Stress Scale (PSS).
(contd over)
42
43
Poster Abstracts
Poster Abstracts
Result
Based on the findings seems that despite the fact that the majority of the patients check
their blood sugar every day , they cannot keep their blood sugar low. Although according
to the bibliography, heart problems appear in great proportions in patients with diabetes,
in our sample only 7,02% have some sort of cardiac problems.
25
PATIENT`S PERCEPTIONS ABOUT DIABETES
Conclusion
However, stress levels are affected by health problems such as blood pressure, neuropathy, rheumatism, eye diseases, heart problems, diabetic coma and hypoglycaemic shock.
Finally, gender, time of disease onset, educational level and also the knowledge about diabetes appear to significantly affect the extent to which a person considers his life as a
demanding and stressful.
Background: Therapeutic Education is a fundamental tool for a better adherence to
chronic diseases’ treatment and it is considered by World Health Organization as a priority.
Zacarias L., Paiva A., Rebola A., Matos D., Nunes H., Correia I., Teixeira L., Serrabulho L. RN MED, Dingle M., Raposo J.D PhD
APDP – Diabetes Portugal, Lisbon, Portugal
One of the Therapeutic Education objectives is to know and better understand the person with diabetes, knowing their perceptions, needs and difficulties to better correspond
to their treatment priorities.
Aim: Evaluate patients’ perceptions about diabetes.
Method: We asked first time patients who came to APDP to write on a card: What
does Diabetes means to me? A qualitative study was conducted to analyze the perceptions.
Result: 102 persons with DM participated (46 female). Age average - 57 years. Diabetes evolution average - 9 years. HbA1c average 8,8%.
69 participants do oral medication, 19 do insulin therapy, 14 patients do both.
The main categories identified of the analysis were:
• Emotional Perceptions (38,2%) with two sub-categories:
- Negative (77%) - “Ungrateful and suffering disease” “My biggest headache”
- Positive (23,1%) - Positive attitude to everyday living by being more healthy.
• Diabetes Process (26%) with three sub-categories:
- Diabetes Seriousness (69,2%) – “A big health problem, very dangerous which can
lead to death”
- Pathofisiology Diabetes Process (23,1%) – “Lack of insulin and malfunctioning pancreas”
- Diabetes Chronicity (7,7%) – “A lifelong heritage”
• Diabetes restrictions (17,7%) with two sub-categories:
- Daily Activities (61,1%) – Permanent condition of a way of living
- Nutrition (39%) – “Have to follow a healthy diet plan, not having a free choice of
foods”
• Self-Control (10,8%) – “Glycemia evaluation and control, medication and carbon hydrates dosages”
• Diabetes Complications (5,9%) – “Amputations, blindness”
• Self-Monitoring (2%) – “Glycemia evaluations”
Conclusion: As for diabetes representations, patients involved in the study present
high levels of negative emotional representation and diabetes seriousness.
The knowledge of patients’ perceptions can help health care team to improve care and
contribute to the promotion of person with diabetes’ empowerment.
44
45
Poster Abstracts
26
HEALTH AFFECTING BEHAVIOUR CHANGES IN ADOLESCENTS WITH TYPE 1 DIABETES MELLITUS
V. Bulikaite RN MSPH
Lithuanian University of Health Sciences, Department of Nursing, Eivenių 2, Kaunas,
Lithuania
Aim
The objective of this research is to analyze changes of adolescents diabetes habits of nutrition, physical activity, smoking, and usage of alcohol before contracting diabetes and
when 3, 6 and 12 month pass after the contraction of diabetes.
Material and methods
The study was conducted in Children Endocrinology department, Hospital of Kaunas
University of Medicine. 90 adolescents of 13-17 years old with diabetes participated in
anonymous questionnaire survey. Pre-test and post-test design was used to conduct the
study. The Wilcoxon‘s paired sample test was used to determine the difference in
groups.
Results
The study revealed that 46% who participated in the study did not eat regular before
contracting diabetes. When 3, 6 and 12 months passed after the diagnosis of diabetes,
the number of patients eating regular significantly increased. Before contracting diabetes,
5,6% of adolescents did not attend any sports. When the survey was repeated after 3
months, 63% of the surveyed claimed that they did not do any additional sports. After 6
and 12 months, the number of adolescents not doing any sports decreased to 20% (p
<0,05). Before contracting diabetes, 42,8 % of adolescents were smoking. When 3
months passed from contracting, 22,7% were smoking, after 6 months – 30,4% were
smoking, and after 12 month – 39,7% admitted they were smoking. Before contracting
diabetes, 26,7 % of the surveyed were taking alcohol. After 3 months, 7,9% of the patients admitted they were taking alcohol during the last three months, i.e. after diabetes
had been diagnosed (p <0,05). After 6 and 12 months, 20% of the patients admitted they
were taking alcohol.
Conclusion
Three months after diagnosis of diabetes mellitus most of adolescents ate regularly,
there were less of those who smoked, consumed alcohol and the lowest number of
those who exercised when compared with findings of surveys conducted before diagnosis and after six or twelve months.
Poster Abstracts
27
EVALUATION OF A STRUCTURED GROUP EDUCATION
PROGRAMME FOR WOMEN WITH NEWLY DIAGNOSED
GESTATIONAL DIABETES IN IRELAND.
Moloney Y., CMS Diabetes, Slevin J., Consultant Obstetrician, O’Hare J., Consultant Endocrinologist
Department of Midwifery, Obstetrics and Endocrinology, Mid Western Regional Hospital’s, Limerick, Republic of Ireland.
Background
In 2008, the International Association of the Diabetes and Pregnancy Study Groups
IADPSG sponsored a conference on Gestational Diabetes diagnosis and classification;
they reviewed published results of works that examined associations of maternal glycaemia with perinatal and long-term outcomes. The IADPSG consensus panel concluded
with predefined values for diagnosis of Gestational Diabetes. A structured group education programme for women with newly diagnosed gestational diabetes may be useful
with the increasing numbers following the implementation of the IADPSG guidelines
(2010).
Aim
This evaluation aimed to use a pre and post knowledge questionnaire to evaluate the
effectiveness of a structured gestational diabetes group education programme.
Method
A convenience sample of women with newly diagnosed gestational diabetes in a Regional
Hospital in the Republic of Ireland was used, consisting of valid responses from (100%,
n=358) women attending the education programme delivered using facilitation skills.
Result
The attendance rate for the structured education programme was 93%.The mean age of
the women was 32 years, and a mean Body Mass Index of 30m2/kg. Using a 75gr Oral
Glucose Tolerance Test the mean results were 5.2 mmol /l, 10.5mmol/l, 7.4mmol/l. The
knowledge questionnaire contains twelve questions on diet, diabetes, pregnancy and fetal
wellbeing. An identical questionnaire was filled in by the women before and after the
education session. The women demonstrated a 19.7% increase in knowledge after the
session increasing from a mean mark of 7.6 to 9.1. 14.6% of the women required insulin
and 42.8% of the women required caesarian section .The mean baby weight was
3426g.54% of the women breastfed. 24% of the babies developed neonatal hypoglycaemia <2.6mmol/l and 26% of the required admission to the neonatal unit for various reasons.
Conclusion
In all, 358 (100%) completed the pre and post programme evaluation and demonstrated
positive outcomes in empowerment, knowledge and fetal outcomes at a group level.
46
47
Poster Abstracts
28
THE CONNECTION BETWEEN THE GLYCEMIC CONTROL,
BODY MASS INDEX AND BODY FAT TISSUE RATIO IN PATIENTS WITH TYPE 2 DIABETES
Nataša Kranvogel Solina RN, prim. Miro Čokolič MD
Univeristy Medical Centre, Maribor, Slovenia
Background
Patients with type 2 diabetes (T2DM), a lower body-mass index (BMI) and better regulated T2DM, have less potential for the onset of late complications of diabetes (DM). It is
assumed that the proportion of fat tissue in body significantly offsets late complications
of T2DM and influences quality of life.
Aim
The aim of the reasearch was to analise the determinated data, in order to find out if
patients with T2DM and lower HbA1C also have lower BMI and smaller proportion of
body fat tissue.
Method
20 female and 29 male patients with T2DM were randomly chosen for a dual X-ray absorptiometry – DXA (Hologic Explorer) measurements, additionally the whole body
scan was performed and percentage of body fat was measured.
BMI was calculated and glycemic control was checked based on HbA1C values (Bio Rad Variant II).
Results
The data analysis showed as follows:
• Patients with T2DM and better glycemic control, possess also a lower percentage of
fat tissue in the body (HbA1C < 6.5%, average share of fat 34%; HbA1C > 6.5%, average share of fat 38.85%),
• Patients with T2DM and better glycemic control, have lower BMI (HbA1C<6.5%,
BMI 29.6 kg/m2; HbA1C > 6.5%, BMI of 32.35 kg/m2).
Conclusion
The research results showed that patients with poorly controlled T2DM have higher
BMI index and more fat tissue in the body than those with well controlled T2DM. Regulation of diabetes, BMI and body fat tissue percentage of patients with diabetes are essential factors in prevention of late complications associated with diabetes , since they
are not important only from medical, but also from aesthetic and psychological perspective. Proper nutrition, healthy lifestyle and regular physical exercise can greatly improve
the quality of life and reduce the onset of long-term complications of diabetes. Therefore, promotion of physical activities, proper diet and a healthy lifestyle is the main task
of each diabetes team.
48
Poster Abstracts
28
THE IMPACT OF LAUGHTER YOGA ON BLOOD GLUCOSE
LEVELS
Simona Sternad RN, prim. Miro Čokolič MD, Špela Stangler Herodež PhD, assistant Proffesor, Martin Rakuša MD, Simona Krebs RN,
UMC Maribor and International Institute for Laughter, Slovenia
Introduction
Laughter yoga is a combination of breathing and movement exercises. One minute of
intense exercise with laughter from the heart, is equivalent to ten minutes of running or
rowing, or ten minutes of exercise at the fitness equipment.
Aim
The aim of the study was to examine the immediate effect of laughter on blood glucose
levels in people with type 2 diabetes (DB2), which is not treated with insulin and its impact on welfare.
Methods
On the day of the study, participants eat lighter meals till 10.00 hour in the morning.
Upon arrival (12.00), we measured their blood glucose levels, then they eat lunch (250
kcal). After 90 minutes presentation followed an intense 30 minutes exercise of laughter
yoga. After 120 minutes, we re-measured blood glucose levels. The control group consisted of participants without laughter exercise. With a questionnaire we also assessed if
the laughter yoga has an immediate effect on: enthusiasm, positive attitude, feeling of better ventilatory, energy level, mood, ability laughing for no reason, optimism, stress level
and the physical and mental relaxation.
Results
We analyzed the results of 69 participants (35 with laughter yoga). Results were statistically analyzed using the software VassarStats, where we tested the statistical differences
within and between observed groups using two sample equid variance Student’s t-Test.
The results showed that the glucose value remained unchanged after exercise (8.9
mmmol/l before and 8.9 mmmol/l after), but participants without training had a higher
glucose up by 0.7 mmol/l (10.1 mmol / l before and 10.8 mmol / l after, p = 0.01).
Conclusion
An intense 30 minutes of laughter yoga significantly reduced blood glucose levels immediately after exercise and has a positive impact on our health and wellbeing. Laughter
yoga should be a new complementary method of pre-existing therapy or self-help
method for people with DB2. It can certainly contribute to their better quality of life.
49
Awards
Next Conference
First Announcement
18th FEND Annual Conference
FEND AWARD DESG AWARD
1999 T. Birdsall
UK
2001 J. Leksell
Sweden
2000 D. Weisman
P. Nikkanen
Israel
Finland
2002 J. Charlton
Scotland
2003 M.Vidal
Spain
2001 A. Joergensen
Denmark
Germany
2002 A. Munzinger
B. Osterbrink
C. Nonn
Germany
2003 M.Vidal
Spain
2004 P. Banck-Petersen
Denmark
2005 E. Turner
UK
2004 B. Osterbrink
R. Jackie
G. Lange
M. Nichting
M. Wernsing
E. Donath
C. Nonn
A. Munzinger
2006 K. Alexandre
Switzerland
2005 L. Feulner-Krakow
Germany
2007 S. Amsberg
Sweden
2006 M. Jansa
Spain
2008 M. Graue
Norway
2007 L. Serrabulho
Portugal
2009 I. Lopes
Portugal
2008 M. Glindorf
Denmark
Norway
2009 E. Orvik
Norway
Conference Programme Enquiries
2010 A. Haugstvedt
2011 A. Faber
Netherlands
2010 M. Due Christensen
Denmark
2011 A. Paiva
Portugal
Mrs Deirdre Kyne-Grzebalski
37 Earls Drive
Denton Burn
Newcastle on Tyne
NE15 7AL
+44 (0)191 274 8088
[email protected]
On behalf of the Foundation of European Nurses in Diabetes we
cordially invite you to attend the 18th Annual Conference of FEND
presents:
AN IDEA SHARED
NEW VERSION
CAN CHANGE THE WORLD
Find out more about Care Challenge and visit
us at our Connecting Nurses booth
COM.DIA.12.07.01 09/12
As creative ideas have the potential to
impact significantly on healthcare worldwide, we
brought you Care Challenge.
We are back. Another opportunity for nurses to bring their ideas
to life and gain recognition for their profession across the globe.
Register now at:
50
Deirdre Kyne-Grzebalski FEND Chairman Anne-Marie Felton
FEND President
Conference Exhibition Enquiries
Nadine van Campenhout
Abdijmolenstraat 41
9031 Drongen Gent
Belgium
+32 479 66 13 06
[email protected]
FEND Membership & Conference Registration Enquiries
Kristin de Backer
[email protected]
[email protected]
With support from:
FROM SEPTEMBER 2012
www.care-challenge.com
www.fend.org
In our first year we saw such widespread creativity in nursing.
Get involved in Care Challenge and showcase
your creativity.
Fri-Sat 20-21 September 2013
Barcelona, Spain
in partnership with nursing organisations.
49th EASD Annual Meeting
23-27 September 2013
www.easd.org
51
2,74 x 1,93
F+H
LH= 3.20
max. Bauhöhe= 3.00
LH=3.75
CEE 32 A
CEE 63 A
1
4
Medtronic
MF 1
2m x 5m
10 m2
Mendor
3
Mendor
MF 13
2m x 3m
6 m2
13
COFFEE-BAR
LH=2.00
2.47
LH=3.90
LH=2.00
2
D
LH=6.40
Sanofi
MF D
6m x 6m
36 m2
LH=6.40
BMS
MF 2+3
2m x 6m
12 m2
LH=2.70
3
CEE 32 A
CEE 16 A blau
Becton
Dickinson
MF 11+12
2m x 6m
12 m2
CEE 16 A blau
CEE 32 A
12
LH=2.70
11
LH=3.75
LH=2.00
LH=2.60
MO
( oben )
CEE 63 A
CEE 32 A
CEE 16 A blau
LICHTPLASTIK
15.71
LH=3.00
Bayer
MF 18
2m x 3m
6 m2
MITTELFOYER
FOYER 83
CEE 63 A
CEE 32 A
A
LH=2.70
Lilly
CEE 16 A blau
( oben )
Lilly
MF-A
4m x 9m
36m2
Freihalten für Kabelverlegung
17
Connecting Nurses
MF 17
2m x 3m
6 m2
2.58
18
C
LH=2.70
LH=3.00
F
F
3.23
Ypsomed
MF4+5
2m x 6m
12 m2
LH=2.75
CEE 32 A
CEE 16 A blau
LH=2.60
5
4
Ypsomed
LH=2.00
F
19
LH=3.75
Company
MF-B
6m x 6m
36 m2
LH=5.20
B
9
10
LH=2.60
Roche
MF 9+10
2m x 6m
12 m2
LH=3.75
F
LH=2.00
CEE 32 A
CEE 16 A blau
2.44
LH=2.00
Artsana
MF-6
2m x 3m
6 m2
6
2
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MF 7+8
2m x 6m
12 m2
7
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F+ H
F+H
200
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1.20
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Feuermelder
Notausgang
Anzahl Fluchtpersonen
Notausgangsbreite
Nummerierung Notausgang
Entfluchtungssymbol
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Feuerlöscher / Hydrant
HY
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Elektroanschluss
Elektroverteiler
Rot
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geändert:
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8
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19
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18
11
11
12
14
14
13
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17
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ICC
6
3
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Stellwand - Rosconi (doppelseitig)
Modulwand - (einseitig)
Modulwand - (doppelseitig)
Tisch für Wassergläser
Laptoptisch
Rednerpult
Beamer geflogen
21
6
3
Für die Messe Berlin geprüft und freigegeben:
3
5
2
Alle Maße sind vor Ort zu prüfen !
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Suedteing
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fest
4
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BW
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Veranstaltungszeit:
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Veranstaltung:
Tisch 140x70cm / 4 Personen
Stehtische d=70cm;
lichter Abstand > 120cm
2
S8
7-8
[VON - BIS]
Reihenbestuhlung
Tisch 70x70cm / 2 Personen
Medienkasten
RB
Deckenlautsprecher
Lautsprecher
MK
E
1
Elektroanschluss / Bodenauslass
Symbol Steckdose
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Schuko
220V
LSP
D
Telefon: +49 (0)30/3038-0
Telefax: +49 (0)30/3038-2325
E-Mail: [email protected]
4-5
Messe Berlin GmbH
Messedamm 22
14055 Berlin
E
ELT
Zuwasser / Abwasser
Rauchabzug
Ra
F Feuerlöscher
FM
W AW
01
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MO
LH=2.25
1
LH=2.01m
CEE 63A
( oben )
CEE 32 A
Zugang WC
[ Ebene Foyer 83 ]
Sperrfläche: Fläche ist für Fw freizuhalten!
8
LH=2.70
F
LH=3.60
B
SEITENFOYER OST
FOYER 84
MO
Freihalten für Kabelverlegung
Novo Nordisk
MF C
4m x 9m
36 m2
Sperrfläche: KEINE brennbaren Gegenstände zulässig!
LH=5.20
LH=2.60
LH=2.00
16
0.50
LH=3.75
2.70
2.91
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GI Dynamics
MF 15
2m x 3m
6 m2
Medientechnik
[ Saal 3 ]
Objektiv
To 12 7:1
LH=3.75
7 8 9 10 11 12 13
28
6
LH=2.75
BD
14
Novo
Nordisk
0.34
14.50
Roche
GI Dynamics
7 8 9 10 11 12 13 14 15 17
5 4 3 2 1 2 3 4 5
17 15 14 13 12 11 10 9 8 7
F+H
7 8 9 10 11 12 13 14 15 16
5 4 3 2 1 2 3 4 5
16 15 14 13 12 11 10 9 8 7
LH=2.01m
7 8 9 10 11 12 13 14 15 15
5 4 3 2 1 2 3 4 5
15 15 14 13 12 11 10 9 8 7
LH=2.25
7 8 9 10 11 12 13 14 15 13
5 4 3 2 1 2 3 4 5
13 15 14 13 12 11 10 9 8 7
3
Info
MK
7 8 9 10 11 27
5 4 3 2 1 2 3 4 5
13 12 11 10 9 8 7
28
7 8 9 10 11 24
5 4 3 2 1 2 3 4 5
24 11 10 9 8 7
7 8 9 10 11 23
5 4 3 2 1 2 3 4 5
23 11 10 9 8 7
7 8 9 10 11 22
5 4 3 2 1 2 3 4 5
22 11 10 9 8 7
7 8 9 10 11 12 13 14 15 21
5 4 3 2 1 2 3 4 5
21 15 14 13 12 11 10 9 8 7
7 8 9 10 11 26
5 4 3 2 1 2 3 4 5
27 11 10 9 8 7
7 8 9 10 11 12 13 14 15 20
5 4 3 2 1 2 3 4 5
20 15 14 13 12 11 10 9 8 7
7 8 9 10 11 25
5 4 3 2 1 2 3 4 5
26 11 10 9 8 7
7 8 9 10 11 12 13 14 15 19
5 4 3 2 1 2 3 4 5
19 15 14 13 12 11 10 9 8 7
6
5 4 3 2 1 2 3 4 5
25 11 10 9 8 7
7 8 9 10 11 12 13 14 15 18
5 4 3 2 1 2 3 4 5
18 15 14 13 12 11 10 9 8 7
LH=1.98m
LH=2.00m
LH=2.01m
7 8 9 10 11 12 13 14 15 16 12
5 4 3 2 1 2 3 4 5
12 16 15 14 13 12 11 10 9 8 7
1.77
2.01
7 8 9 10 11 12 13 14 15 14
5 4 3 2 1 2 3 4 5
14 15 14 13 12 11 10 9 8 7
Sanofi Aventis
1.77
2.01
7 8 9 10 11 12 13 14 15 16 11
S9
11 16 15 14 13 12 11 10 9 8 7
1
screen
2
S8
SEITENFOYER WEST
Connecting
FOYER 85
Nurses
Bayer
1
3
5 4 3 2 1 2 3 4 5
7 8 9 10 11 12 13 14 15 16 10
5 4 3 2 1 2 3 4 5
2
1
S7
Info
screen
2
10 16 15 14 13 12 11 10 9 8 7
7 8 9 10 11 12 13 14 15 7
5
5
3
7 8 9 10 11 12 13 14 15 16 9
3
S6
B
30x40
LH=2.75
1
4
13
B
30x40
2.65
2
5
5 4 3 2 1 2 3 4 5
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3
6
9 16 15 14 13 12 11 10 9 8 7
5 4 3 2 1 2 3 4 5
7 8 9 10 11 12 13 14 15 16 8
5 4 3 2 1 2 3 4 5
8 16 15 14 13 12 11 10 9 8 7
7 8 9 10 11 12 13 14 5
5 4 3 2 1 2 3 4 5
1
4
1
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5 14 13 12 11 10 9 8 7
7 8 9 10 11 12 13 14 15 6
5 4 3 2 1 2 3 4 5
6 15 14 13 12 11 10 9 8 7
6
7 15 14 13 12 11 10 9 8 7
2
5
LH=2.25
Abbott
3.23
Company
LH=2.01m
6
3
1
7
Hall 4/5 Masterclass (Saturday)
11
12
7
Ypsomed
8
Sanofi
S4
D
C
4
B
2
18
9
10
5
15
Abbott
3
5
4
Novo Nordisk
S3
Medtronic
1
7 8
Menarini
1
A
6
4
Artsana
Hall 3
Plenary
Sessions
2
1
5
Medtronic
3
A
Roche
6
(to lunch)
17
11-12
7
Lilly
18
S2
52
Becton Dickinson
1
FEND Conference
@ ICC
Bayer
4
Venue
Palais am Funkturm
Stand
4
19:30 Pre dinner cocktails
20:00 Conference Dinner
Company
7
FEND CONFERENCE DINNER
Friday 28 September
F+H
Conference Dinner
Location Plan
Stand
Poster
exhib
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