Steno Diabetes Center

Steno Diabetes Center Atención integral para la diabetes Ulla Bjerre-Christensen MD,Ph.D Head of Education, Steno Diabetes Center

Diabetes Care in Denmark Secondary care (Steno and hospital): All type 1, Complicated type 2 Shared : Unknown number Primary care (GP): 85 % Type 2, Few type 1

Steno Diabetes Center- founded 1932 To improve clinical care of patients and to understand diabetes

Steno Concepts on Integrated Care Based upon organisation of care Competency sliding Optimizing care through improvement in clinical quality Involvement of users people with diabetes

Interprofessional collaboration with the patient in the center. Health Promotion Research Research in Patient Education and Prevention Clinic Research Complications, Epidemiology, Metabolomics, Clinical Research Unit Business Support IT, Finance, HR, Communication / PR Education Healthcare professionals in DK and international, REACH, STAR

In total approximately 5,700 patients 3,450 with type 1 diabetes 2,200 with type 2 diabetes: more complicated 150 with other types of diabetes

Organisation of Diabetes Care Focus Areas and Documentation Innovation of Diabetes Care Delivery Clinical Quality Data Morbidity and Mortality Patient Satisfaction Innovation of Diabetes Care

Steno Clinic Innovating Diabetes Care Delivery

Steno Clinic Creating a value adding even flow Ambulatory Day Hospital Specialist Ambulatory

Eye screening Pump Clinic Pregnancy Clinic Telephone service Foot Clinic Patient Care Day Hospital Adolescent Clinic Home visit service Type 2 Clinic Food Lab

Competency Sliding and Interprofessional learning

Trainee Programme for Nurses at SDC Runs for two years Structured programme covering different areas of patient care at Steno - both theoretical and practical Provide the nurse with specialized individual competencies Insulin adjustment Individual consultations Eye screening Ends up with a diploma examination

Steno Clinic Special attention to special needs Eye Clinic

Steno Clinic Eye Clinic

Steno Clinic Special attention to special needs Three podiatrists Orthopedic consultant weekly Assessments of risk patients Orthopedic foot ware Treatment of ulcers Observation, examination, and education

Steno Clinic Special attention to special needs

NCQA: National Committee for Quality Assurance Steno Clinic Improvements based on common agreements

Steno Clinic Improvements based on common agreements Type 2 Share of patients with: Goals Mar June Sep Dec Mar June 2014 2014 2014 2014 2014 2015 2015 HbA1c > 75 mmol/mol 15% 17,1 17,8 16,3 15,9 15,2 14,4 HbA1c < 53 mmol/mol > 30% 26,9 27,7 27,5 27,6 27,2 27,4 HbA1c < 64 mmol/mol > 65% 58,8 59,4 60,3 59,9 60,0 61,2 BT > 140/90 10% 7,9 7,2 6,2 6,2 6,9 6,6 BT < 130/80 > 25% 28,4 29,9 35,4 33,3 31,5 30,8 Eyes screened-yearly > 60% 70,8 70,6 67,7 69,9 72,3 73,5 Smoking status > 85% 95,7 94,7 94,3 96,5 96,6 97,4 LDL chol > 3,3 35% 12,3 12,4 10,8 9,9 8,2 7,9 LDL chol < 2,6 > 80% 70,5 70,5 73,5 76,1 77,2 77,0 Nephropathy exams > 85% 97,5 97 96,4 97,0 96,8 96,4 Feet exams > 80% 87,1 86,7 85,0 87,5 88,6 86,3

Steno Clinic Improvements based on common agreements From: MTRD (Martin Ridderstråle) Sent: 30. august 2015 16:11 Kære alle, ugens tal! Til læge: 349 patienter (type 1: 207; type 2: 132): 52 type 1 patienter (25% ) og 37 type 2 patienter (28% ) en HbA1c under 53 mmol/mol. 32 type 1 patienter (15% ) og 22 type 2 patienter (17% ) en HbA1c over 75 mmol/mol. Der er 53 type 1 patienter over 40 år med LDL > 2,6 mmol/l (74% <2.6 eller ikke aktuelle for behandling ). Der er 33 type 2 patienter med LDL > 2,6 mmol/l (75% <2.6 ). Der er 2 type 1 patienter med blodtryk over 140/85 som ikke er i antihypertensiv behandling og 4 type 2 patienter med blodtryk over 140/85 som ikke er i antihypertensiv behandling. ABC kontrol (<53 + <2.6 + <140/<85): Der er vi denne uge på 19% for T1D og 14% for T2D. Der er 5 T1D patienter (2% ) og 7 T2D patienter (5% ) som helt mangler ABC-kontrol. Torsdag den her uge er der midtvejsbesøg fra IKAS (dvs for vores akkreditering), men jeg tror næppe I vil møde dem ude i klinikken. Mvh, Martin

Steno Clinic Optimizing care A for HbA1c <53 mmol/mol (<7%) B for Blood pressure <140/<85 mm Hg C for LDL-Cholesterol <2.6 mmol/liter

Goal attainment (%) Steno Clinic B C A ABC Non-ABC

Steno Clinic: long-term outcomes Reduction in Diabetes Morbidities Cardiovascular Disease Major amputations Severe retinopathy T1 diabetes T2 diabetes - 12 % - 30 % -70 % - 82 % - 18 % -34 % Ostri C, la Cour M, Lund-Andersen H. Acta Ophthalmol. 2013 Aug 3

Costs of complications: The Helsinki Study 60000 DKK 55057 50000 42432 40000 30000 20000 24x 12x Without complications With Complications 10000 0 2259 Excess cost of Type 2 diabetes 3644 Excess cost of Type 1 diabetes

Steno Clinic Patient Satisfaction

Education of Health care professionals Since 2000 trained > 13.500 in diabetes in more than 40 countries

Practical Diabetology International Teambased interprofessional patient centered care Steno Diabetes Center faculty (doctors/nurses/pyschologist/ dietitians) Organisation of care/clinical updates Diabetes teams (e.g. doctors/nurses/dietitians) Steno Diabetes Center Novo Nordisk Fonden Logistical support- NN affiliates 3-day course Lectures/workshops/group work/experiential learning

Steno Concepts on Integrated Care Based upon organisation of care Competency sliding Optimizing care through improvement in clinical quality Involvement of users people with diabetes Close collaboration across all areas of Steno

Thank you for your attention www.steno.dk