Reducing the Risk of, and Clinical Presentation of Micro Vascular Complications Including Nephropathy, Retinopathy and Erectile Dysfunction

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1 Mini EDEN Module Reducing the Risk of, and Clinical Presentation of Micro Vascular Complications Including Nephropathy, Retinopathy and Erectile Dysfunction YOUR WORKBOOK. Not to be reproduced in whole or in part without the permission of the copyright owner. V1.0 May 2015 This series of promotional meetings has been developed by AstraZeneca and Eden. AstraZeneca has fully funded the meetings and is responsible for the content, logistics and selection of speakers. The agenda has been developed jointly with Eden. E F F E C T I V E D I A B E T E S E D U C A T I O N N O W!

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3 Contents of this Mini EDEN Workbook Page Introduction 4 About EDEN 4 Mentorship Guidance 5 Learning Outcomes 7 Diabetic Nephropathy 8 Retinopathy 10 Sexual Dysfunction 12 Review and Evaluation: Reducing the Risk of, and Clinical Presentation of Micro Vascular Complications 14 Reading List: Reducing the Risk of, and Clinical Presentation of Micro Vascular Complications 16 Assessment of Clinical Competency 17 Achieving and Maintaining Competency 18 Competencies: Reducing the Risk of, and Clinical Presentation of Micro Vascular Complications 19 Page 3

4 Introduction This workbook is intended for healthcare professionals attending a series of five Mini EDEN sessions that have been commissioned by Staffordshire CCG delivered through interactive sessions and case studies. Attendance Certification Attendance at 80% of the five sessions entitles healthcare professionals to a Mini EDEN course certificate stating which specific areas of care were covered. Please ensure your full details (title, forename, surname, practice name and address) are left with the administrators. The five sessions include: Hypoglycaemia Obesity and lifestyle changes Reducing the risk of, and clinical presentation of micro vascular complications Clinical management of blood glucose control including new and advanced treatments Prevention, screening, classification and diagnosis About EDEN Effective Diabetes Education Now (EDEN) is a comprehensive training package which aims to up-skill healthcare professionals to provide high levels of diabetes care, and reduce hospital admissions and referrals to specialist care. This education programme is delivered by Leicester Diabetes Centre ( through a combination of training, mentoring, CPD and masters accredited training, e-learning, and technology to assess knowledge and confidence and provide personalised training recommendations. We offer both one and two day mini modules covering topics such as insulin management to shorter study evenings or days. For the full range of our courses, please contact EDEN@uhl-tr.nhs.uk or visit our website. Details of new courses are also announced on our Twitter feed (twitter.com/eden_leicester). These courses are delivered at our purpose built training facility in Leicester or can be offered bespoke at a training venue of your choosing. We hope you enjoy your Mini EDEN sessions with us over the coming months, and we hope to have the opportunity to meet you again in the future Page 4

5 Mentorship Guidance Objectives: In order to obtain competency we recommend that you identify a mentor for support and guidance as this will help with the competency component of the session The competencies will help to assess and identify your individual needs What is your role? To identify your own mentor To agree the framework for your mentorship: when, where, how it will take place To establish competency Be accurate in your own clinical practice in relation to your relevant code of professional conduct Assessment of competency: The competency record document will be used with your mentor, so that they are able to provide the appropriate support What is the role of the mentor? To provide support between taught study days to explore options for you to achieve competency To support you using assessment documentation to identify areas requiring support and where that support might come from It is not the mentor s responsibility to organise mentorship or to ensure you achieve competency - this is your role! Elements for achieving competency may include the following: Observing / shadowing other clinicians Supervised practice Exploring the literature / media Role play Case study discussions Reflective practice using a formal model Clinical supervision This is a formal process between two practising professionals to facilitate your professional development. This may be your mentor but you might use several people for your development. This should include self assessment, analytical and reflective skills. Who can be a mentor? Mentorship can be provided by a Clinician who themselves are competent in this area of practice, for example: - Diabetes Specialist Nurse (Hospital or Community) - Consultant or GPwSI (Diabetes) / locality lead for diabetes - A Pharmacist / Dietitian may be able to mentor and sign off competencies relating to their specialist skills and practice Page 5

6 Mini EDEN: Reducing the Risk of, and Clinical Presentation of Micro Vascular Complications Including Nephropathy, Retinopathy and Erectile Dysfunction Welcome and Introduction Learning Outcomes: At the end of the session a successful learner should be able to: Know staff related to the mini module Recognise their own module expectations and concerns Understand general housekeeping issues Understand the structure and content of the course handbook/materials Understand the importance of signing the taught day registers Recognise the importance of working together and things that will nurture this process Your Notes Self-directed Study Review course handbook and course materials Note down queries and concerns to ask the module leader Page 6

7 Reducing the Risk of, and Clinical Presentation of Micro Vascular Complications Learning Outcomes Overall Learning Outcomes: At the end of the session a successful learner should be able to: Discuss microvascular disease in people with diabetes and implications for management Review the screening, diagnosis and management of diabetic retinopathy Outline the management diabetic nephropathy Relate the screening, prevention, classification and management of people with diabetic nephropathy Understand the relevance and management of sexual health in people with diabetes Page 7

8 Diabetic Nephropathy Learning Outcomes: At the end of the session a successful learner should be able to: Summarise appropriate treatment strategies to prevent cardio-renal risk factors and reduce the progression of diabetic nephropathy Refer to local and national guidance for the treatment and management of diabetic nephropathy Explain the screening processes for people with diabetes who have developed nephropathy Review the management of blood pressure in people with diabetes in relation to nephropathy Personal learning objective for this session Questions / comments on the presentation Page 8

9 Thoughts / ideas / case studies / experience related to the presentation Key messages from the session How will your practice change as a result of what you have learned? Self-directed Study Review guidelines for the treatment of diabetic nephropathy Understand the different stages of diabetic nephropathy and the treatment options available for each stage Review guidelines for the management of glycaemia, and blood pressure in Type 2 diabetes Self Assessment Describe the assessment and screening process for diabetic nephropathy Identify your role in the above process Page 9

10 Retinopathy Learning Outcomes: At the end of the session a successful learner should be able to: Describe the risk factors associated with the development of diabetic retinopathy Describe the screening and management of diabetic retinopathy Describe how to support and advise patients undergoing laser therapy and experiencing visual loss Personal learning objective for this session Questions / comments on the presentation Page 10

11 Thoughts / ideas / case studies / experience related to the presentation Key messages from the session How will your practice change as a result of what you have learned? Self-directed Study Review national and local guidelines for diabetes and retinopathy Describe the stages of diabetic retinopathy as you now understand them Consider the driving regulations as they apply to patients with loss of visual acuity due to diabetic retinopathy or maculopathy Self Assessment Review the audit data for retinal screening in your clinical practice Consider how you identify and manage patients newly diagnosed or undergoing treatment for retinopathy. What further support and management might they need to prevent progression of retinopathy? Page 11

12 Sexual Dysfunction Learning Outcomes: At the end of the session a successful learner should be able to: Describe the screening and treatment options for sexual dysfunction in both men and women Describe when is it appropriate to refer on to specialist services for erectile dysfunction Personal learning objective for this session Questions / comments on the presentation Page 12

13 Thoughts / ideas / case studies / experience related to the presentation Key messages from the session How will your practice change as a result of what you have learned? Self-directed Study Read fact sheet 33 - Visit the NHS Diabetes website at on erectile dysfunction as a marker of risk for cardiovascular disease Self Assessment Review how and when you currently assess people with diabetes for sexual dysfunction Review your clinical management of men with diabetes and ED for pharmacotherapy and specialist referral Page 13

14 Review and Evaluation: Reducing the Risk of, and Clinical Presentation of Micro Vascular Complications Overall Learning Outcomes: At the end of the session a successful learner should be able to: Have the opportunity to ask questions in relation to the various sessions Review any areas of the timetable that you have not fully understood and gain self-directed study to assist learning in these areas Have the opportunity to provide feedback on the various sessions Your Comments Page 14

15 Your Questions Self-directed Study Complete all session evaluation forms Self Assessment Reflect on session and ascertain future learning needs Page 15

16 Reading List: Reducing the Risk of, and Clinical Presentation of Micro Vascular Complications Boussageon, R. et al. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials BMJ 2011; 343: d4169. Cheung, N., Mitchell, P., Wong, T.Y. Diabetic retinopathy. The Lancet 2010; 375 (9735): Minet, L., Moller, S., Vach, W., Wagner, L., Henriksen, J.E. Mediating the effect of self-care management intervention in type 2 diabetes: a meta-analysis of 47 randomised controlled trials. Patient Education and Counselling 2010; 80 (1): Type 2 diabetes: the management of type 2 diabetes Clinical Guideline 87. London: NICE National Institute for Clinical Excellence, Hypertension, clinical management of primary hypertension in adults CG 127. London: NICE National Institute for Clinical Excellence. The ACCORD Study Group, Effects of intensive blood-pressure control in type 2 diabetes mellitus. The New England Journal of Medicine 2010; 362 (17): The ACCORD Trial Group, Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. The Lancet 2010; 376 (9739): Diabetic Neuropathy Callaghan, B.C., Little, A.A., Feldman, E.L., Hughes, R.A. Enhanced glucose control for preventing and treating diabetic neuropathy Cochrane Systematic Review 2012; 13: CD Resources Used Cochrane Library Internet NHS Evidence Obtaining Full Text Articles Some of the references supplied may be available online in full text. Please note if there is an online link in the reference lists (just below each abstract if available). Click on the links and you will be prompted for either your Athens password or (if you are sent to a publisher s web page) a UHL library password. You can register for an NHS Athens password here: To obtain full text articles via UHL libraries at LGH or GH, you can print a request form from the library website. Please contact the library for help with obtaining full text articles. Yudkin, J.S., Richter, B., Gale, E.A.M. Intensified glucose control in type 2 diabetes whose agenda? The Lancet 2011; 377: Diabetic Retinopathy NICE Guidance from 2013 on Macular oedema (diabetic) - ranibizumab. Diabetic Nephropathy The 2012 update of the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Diabetes and Chronic Kidney Disease (CKD). Jicheng, L.V., Perkovic, V., Foote, C., Craig, M.E., Craig, J.C. Giovanni, F.M. Antihypertensive agents for preventing diabetic kidney disease Cochrane Systematic Review 2012; 12: CD Page 16

17 Assessment of Clinical Competency: Reducing the Risk of, and Clinical Presentation of Micro Vascular Complications The following assessment document may be used for two purposes: Firstly, to allow you to assess your competence in managing patients with diabetes in line with the knowledge and skills required for competency Secondly, to allow you to prioritise the support required to become competent During the module you will have the opportunity to identify clinical supervision to establish competency in relation to your personal needs (See Mentorship Guidance p.5). On the assessment document, please indicate which best describes your competency in each of the given areas. NB. A competency defines the knowledge, understanding and skill required to perform a specific task ( Where am I with this module? (including documentation) What do I still need to do? Page 17

18 Achieving and Maintaining Competency What will stop me? How can I overcome this? How do I intend to maintain my competency? Page 18

19 Competencies: Reducing the Risk of, and Clinical Presentation of Micro Vascular Complications Name: Place of work: Mentor s Name: Contact No: Areas of competency Are you competent? If no, what further support is required / action agreed? If yes, evidence of competency Meets competency/ date and mentor signature Able to describe the guidelines for screening people with diabetes for retinopathy Yes / No Demonstrates knowledge of the referral pathways for the retinal screening Yes / No Demonstrates an awareness of the treatments available for retinopathy Yes / No Demonstrates a knowledge of the evidence with regard to delaying the onset and progression of retinopathy through optimal diabetes control Yes / No Able to advise and support patients with retinopathy to delay progression by optimising diabetes control Yes / No Demonstrates an awareness of the treatment strategies to prevent the onset and progression of nephropathy Yes / No Page 19

20 Areas of competency Are you competent? If no, what further support is required / action agreed? If yes, evidence of competency Meets competency/ date and mentor signature Able to describe the screening processes for nephropathy available to people with diabetes Yes / No Participates in and is able to describe the assessment process for sexual dysfunction Yes / No Can advise and explain appropriate strategies to assist people with diabetes to manage their sexual dysfunction Yes / No Page 20

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