An intriguing e-learning programme that helps busy healthcare practitioners stay abreast with changes in diabetes management
Medical science has reattached limbs and replaced human hearts, yet the challenge of diabetes remains to be conquered. Globally, nearly 600 million people are expected to have diabetes by 2035, according to the International Diabetes Federation. The World Health Organisation (WHO) estimates 60 million people in the European Region have diabetes (3 to 4 million in the UK), representing about 10% of the population over age 25. In the UK and across Europe, these numbers are expected to rise steadily in the coming decade without a comparable increase in medical specialists who focus on managing this disease.
This necessitates training of more general practitioners (GPs), nurse specialists and other healthcare professionals to fill the gap. “For a treatment regimen to be effective, diabetes care must be closely individualised for the patient and carefully monitored over time,” notes Dr Tim Heise, Lead Scientist at Profil, an international diabetes research institute based in Germany.
Too often, people with diabetes face long delays in diagnosis and poor control of their symptoms. The disease is dangerous and often deadly if not managed properly. The National Diabetes Audit reports upwards of 24,000 needless deaths in the UK due to diabetes each year. WHO projects a doubling of death rates from diabetes between the years 2005 and 2030. Of those who lose their lives to diabetes, over half are under the age of 60. Advocacy organisation Diabetes UK estimates that these deaths – and over 7,000 amputations annually – could be avoided if patients had better management of their disease. As pioneer diabetes specialist E.P. Joslin once observed, “The diabetic [patient] who knows the most, lives the longest.”
Why is it so hard to gain control over diabetes? Keeping up with changes in diabetes treatment is like trying to follow a moving target, says Dr Heise. “A number of anti-diabetic agents have become available recently which expand treatment options, but also require detailed knowledge on their efficacy, limitations and side-effects to optimise diabetes treatment according to the needs of each individual patient,” he explains. “Unfortunately, the increasing complexity in diabetes treatment has aggravated clinical inertia – doctors do not react adequately to findings of unsatisfactory glucose control in their patients.”
London-based medical education company Liberum IME set out to meet this challenge by allowing healthcare providers to tailor their diabetes education in a way that best fits their own learning styles. “Most GPs cannot spare time away from their practices to travel to conventions,” explains Liberum Managing Director Celeste Kolanko. E-learning has soared in popularity, but some people still like a traditional format – read and respond to questions – and others prefer an interactive, collaborative approach. Liberum’s Diabetes Knowledge in Practice website allows learners to pick and choose among diabetes topics and learning formats that best meet their needs. The choices include a Journal Club, latest conference coverage, expert panel discussions and a unique do-it-yourself programme called “CME-in-a-box” that is exclusive to Liberum.
“What if you want to use cutting-edge E-learning resources, but you also prefer to share ideas and strategies with your colleagues?” Ms Kolanko asks. CME-in-a-box allows learners to download a toolkit with slides, handouts and discussion questions and then customise these materials to fit their needs. “It makes it easy for the user to design and run his or her own accredited meeting for colleagues,” she notes. This might work well for a doctor who needs to update his or her practice team, a nurse running a training session, or a medical student organising a study group with friends. The site provides accredited education both through EACCME and ACCME, primarily in the English language, but more multilingual options and regionally tailored programmes are in the works.
“Diabetes is now a world pandemic,” acknowledges Prof David Matthews, Professor of Diabetic Medicine at University of Oxford and Chair of the Journal Club on Diabetes Knowledge in Practice. “Because so many healthcare professionals need to grow their expertise in managing this disease, there is a vital need for easily available educational tools, materials and resources.”
To remain relevant, diabetes education needs to keep up with the latest changes. Diabetes practice guidelines are revised almost yearly, as new medications are introduced and new strategies evaluated. Not long ago, the diabetes treatment paradigm shifted dramatically with the introduction of agents that modulate incretin, a hormone that stimulates insulin secretion in response to food. Incretin mimetics include multiple classes of drugs, some oral and some injected, often used in combination.
Determining how and when to use insulin is another complex challenge – multiple formulations are available and vary based on the onset and duration of action, the timing of meals, the need for overnight blood sugar control and other factors. “I am particularly impressed with the interactive aspect of CME-in-a-box,” says Dr Ronald Goldenberg, a Canadian diabetes expert who chairs that section. “It asks you to make decisions you might face in your own practice and then helps you to evaluate whether that is the best decision.”
Centuries ago, physicians used to smell or even taste their patients’ urine to detect excess sugar that might signal diabetes. Today, diabetes management is highly sophisticated – but it must be applied optimally to keep patients’ blood sugar under control and prevent serious complications such as vision loss, limb amputation and cardiac complications like heart attack or stroke.
“Online education platforms like Diabetes Knowledge in Practice provide state-of-the-art learning that helps clinicians stay abreast of current information that can be accessed at any time and any place,” Dr Goldenberg adds. “By consolidating a wealth of data into a single ‘one-stopping shopping’ format, web-based materials are ideal for the busy provider.”
Diabetes Knowledge in Practice is open to grant support from multiple organisations. The current content is supported by a grant from Novo Nordisk, which has no influence on the content. Educational materials are developed by an independent steering committee comprised of international diabetes experts in conjunction with Liberum IME.
“Because so many healthcare professionals need to grow their expertise in managing this disease, there is a vital need for easily available educational tools, materials and resources”
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