Trillium Health Centre’s unique programs help reduce complications due to diabetes

What disease causes heart and kidney disease, blindness, amputation and stroke, and is a leading cause of death in Canada? The answer is diabetes.

Diabetes is a chronic disease that has no cure. More than two million Canadians have diabetes, and 60,000 new cases are diagnosed in Canada each year. As the incidence rate of diabetes rapidly rises, diabetes education is essential in reducing the chance of developing complications.

Trillium Health Centre is a leader in reducing the number of patients admitted to hospital with complications due to diabetes. In fact, Trillium has the third lowest rate of all hospitals in Canada. Trillium’s low incidence of complications is attributed to the Diabetes Education Centre (DEC), which offers a range of unique and comprehensive programs targeting diabetes education and complication prevention.

“Trillium’s Diabetes Education Centre receives more than 14,000 patient visits each year,” says Stacey Horodezny, clinical leader, DEC. “Our interdisciplinary team of endocrinologists, nurses, dieticians and a social worker educate and treat a large portion of our community in order to delay or prevent complications.”

The DEC’s programs educate patients on diabetes control and management. Programs offered include the gestational diabetes program, insulin classes, impaired glucose tolerance classes, insulin pump training, individual counselling with a nurse and dietician, the Healthy Heart Program and Healthy Feet Clinic.

Healthy feet clinic John Johnson has first-hand experience with the complications diabetics face when their diabetes is improperly managed or left untreated. “Before I came to the Healthy Feet Clinic, I really didn’t pay much attention to my feet,” says Mr. Johnson.

People living with diabetes often do not recognize the importance of diabetic foot care, making the risk for complications such as ulcers and foot or leg amputation very urgent. Mr. Johnson was referred to Trillium’s DEC by his general practitioner, following the discovery of a recurring foot ulcer.

In addition to his immediate treatment, Mr. Johnson was introduced to the DEC’s Healthy Feet Clinic as a continued method of diabetes education and preventative care.

The first of its kind in Canada, the Healthy Feet Clinic consists of a full-time RN specializing in diabetic foot care. The majority of patients are elderly and unable to practice proper foot and nail care due to decreased vision, neuropathy, arthritis or lack of flexibility. The Clinic receives 1800 patient visits per year, providing professional foot care services such as nail trimming, reduction of corns and calluses, and education and advice on foot care.

Through the Healthy Feet Clinic, Mr. Johnson has improved the condition of his feet while learning the importance of proper foot care. He has continued to visit the clinic on a regular basis since it opened in 1995. “The Clinic has taught me to take better care of my feet so that I can avoid any serious complications down the road,” says Mr. Johnson.

Insulin dose adjusting line (a.k.a. Phone Nurse) Diabetes education and treatment continues with Trillium’s Insulin Dose Adjusting Line, affectionately known as the Phone Nurse, the only phone line program in Canada dedicated to diabetes management and adjusting insulin dosages.

The Insulin Dose Adjusting Line was created to reduce the high rate of follow-up appointments needed to aid patients in their insulin dose adjusting. Five days a week, patients can access diabetes information and adjust their insulin levels by speaking to a member of the DEC’s nursing staff via telephone. As a result, appointments that would normally occupy more than one full-time nursing position for a week and a half are instead attended to by telephone in 20 hours a week.

“By providing frequent access to insulin adjustment, patients no longer have a lengthy wait for their next visit,” says Carm O’Brien, RN, DEC. “The program improves control over blood sugar levels, thus reducing the chance of complications.”The Phone Nurse program receives more than 200 calls per week, and serves a wide audience, including patients taking insulin, community health care nurses calling on behalf of their diabetic patients, family physicians seeking advise on patient issues, and patients looking for answers to other diabetes-related questions.”The phone line improves patient care and safety by providing greater patient access to professional help to deal with their diabetes, “says Ms. O’Brien. “Patients know that support is only a phone call away.”

Paediatric programs Diabetes support is also only an e-mail away. Trillium’s Paediatric Diabetes Centre offers unique programs for children with diabetes, including an online support system, in which paediatric patients can e-mail clinic staff regarding their diabetes questions and concerns.

For patients and their families looking for a group atmosphere, Trillium is the only hospital in Ontario to offer support groups for paediatric patients with diabetes. Children between the ages of eight to twelve years form the children’s group, which focuses on diabetes education through a variety of story telling and games, such as Diabetes Trivial Pursuit. The teenage group consists of youth between the ages of thirteen to eighteen years, and involves information sessions on diabetes and other issues relevant to their age group, including pregnancy, alcohol and drug abuse. Meetings are confidential, allowing patients to raise questions they might be afraid to ask other adults.

“The paediatric support groups focus on positive diabetes awareness and management,” says Isolina Varano, social worker, Paediatric Diabetes Centre. “The isolation children often feel due to diabetes is alleviated in this educational and supportive environment.”

As diabetes continues to be a significant health concern in Canada, diabetes education plays a crucial role in reducing the chance of complications. Trillium’s unique diabetes awareness and management programs will consequently become increasingly essential in the daily lives of patients living with diabetes.