Establishment of a type 1 diabetes structured education programme suitable for Chinese patients: Type 1 Diabetes Education in Lifestyle and Self Adjustment (TELSA)

Abstract

Background: Various guidelines recommend that all adults diagnosed with type 1 diabetes (T1D) should be offered an evidence based, structured education programme (SEP) to optimize selfmanagement care. China has a 13,000 annual increase in newly diagnosed T1D cases and is now the fourth largest country in the number of new T1D cases per year. However, there is yet no validated SEP targeted to T1D patients in China. The purpose of this study is to establish a structured T1D selfmanagement education programme-'Type 1 Diabetes Education in Lifestyle and Self Adjustment' (TELSA) that is adapted to medical and cultural practices in China. Methods: TELSA programme was developed based on the ADDIE model, following three steps: i) Semi-structured interviews were administered to 10 healthcare professionals (HCPs) and 13 T1D patients. Different topic guides, focusing on 4 dimensions including goals, contents, format of delivery, and quality assurance, were designed for either HCPs or patients. The interviews were recorded and analysed with thematic analysis. ii) Extracted themes were modified according to Delphi consultation. iii) Preliminary courses were conducted as pilot study to evaluate the effects of TELSA and optimization of the curriculum was finalized accordingly. Results: A total of 18 themes in 4 dimensions of the programme design were identified in the final version: i) goals: 'behaviour modification' and 'outcome improvement'; ii) contents: 'living with T1D', 'self-monitoring of blood glucose', 'knowing insulin', 'insulin dose adjustment', 'carbohydrates and carbohydrate counting ', 'hypoglycaemia', 'complications', 'managing psychological issues', 'physical activities', and 'question-and-answer'; iii) format: 'multidisciplinary team combined with peer support', 'face-to-face education followed with distal learning', and '2-day programme held on weekends'; and iv) quality assurance: 'after-class quiz', 'patients' feedback', and 'long-term evaluation on effectiveness'. Conclusions: A type 1 diabetes structured education programme in China was set up and shown to be applicable under local medical, social, and cultural environment. BackgroundType 1 diabetes (T1D) patients suffer from continuous loss of pancreatic β-cell function and needs life-long exogenous insulin treatment. Since insulin requirements are affected by various internal and 4 external factors, maintaining glycaemic control in target with a flexible daily routine remains an enormous challenge in T1D management. Diabetes self-management education (DSME) is critical for patients to achieve HbA1c targets, minimise hypoglycaemia, and optimise quality of life. Selfmanagement training courses such as dose adjustment for normal eating (DAFNE) and the diabetes teaching and treatment programmes (DTTP) have consistently demonstrated positive outcomes in diabetes control as well as quality of life in multiple studies [1][2][3][4]. Therefore, consensus has been reached across various guidelines that all adults diagnosed with T1D should be offered an evidence...