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BERTIE
  BERTIE
 
Bournemouth Diabetes and Endocrine Centre
Bournemouth type 1 Intensive Education (BERTIE) Programme
  BERTIE

Bournemouth Insulin Dose Adjustment Course - BIDAC (For health professionals)

What is BERTIE?
BERTIE is a four week course for people with type 1 diabetes, which involves attending a 6-hour group education programme once a week for four consecutive weeks.  The time between sessions is used for participants to put their newly-learned skills into practice. The aims of the course are

  • for participants to achieve their own goals relating to their diabetes
  • for participants to learn how to adjust their insulin according to their lifestyle and not vice versa
  • for participants to learn how diabetes can affect their health, and what they can do to stay healthy

It is essential that participants attend the whole programme, and agree to do the required “homework” to gain full benefit form the course.

How was BERTIE developed?
In 1998 we were aware that many patients with type 1 diabetes struggled with erratic blood glucose levels and frequent hypos.  As a result many people were trying to fit their lifestyle around their diabetes and insulin doses. We felt there was a need for people to learn how to manage their diabetes in a way that fitted their lifestyle, while avoiding hypoglycaemia.
We studied education programmes in Holland and Germany, as well as the teaching involved for patients on insulin pumps (which were very rare in the UK at that stage).  We felt that the 5-day programme in Dusseldorf had similar objectives to our own, but that there would be benefits in spreading the course over a longer time period, to enable people to learn in their everyday life, rather t han just in a classroom.  We therefore developed a novel programme which included the following main elements:

  • information on diabetes, how it is treated
  • information on how it can affect health and how these effects can be avoided
  • how to recognise and count carbohydrates in food
  • how to work out background and meal-time insulin doses
  • a meal during each session to provide practical experience, including a meal out in the final session
  • keeping records on food intake, blood glucose levels and insulin doses between sessions   
  • exercise between sessions to learn the effect on blood glucose levels

How has BERTIE changed since 1999?
The main objectives are very similar but we now place a much higher emphasis on helping participants set their own goals art the start of each programme.  We refer to these goals as the programme progresses to try and ensure it remains relevant to all participants.
We have learnt a huge amount from participants over the years and have used this to adapt the programme where necessary.
We have re-written the curriculum consistent with Social Learning Theory.  This means that we encourage participants:

  • to work out their own solutions to problems (either individually of by discussion with fellow participants) rather than provide set solutions which may not work for an individual
  • to try out different strategies for managing their diabetes, to find out what works best for them
  • to learn from each others experiences

Who can attend BERTIE?
Anyone with type 1 diabetes, who:

  • is over the age of 16
  • is motivated to learn more about how to manage their diabetes
  • is on multiple daily injections (MDI), or is willing to switch to MDI

We also welcome people with Type 2 diabetes who are treated with multiple-daily injections and who feel they who would benefit from this approach. 

How do i get on a course?
If you already attend BDEC, contact Jacky Ryder 01202 704888 or Jacqueline.ryder@rbch.nhs.uk who arrange to see you to e xplain more about the course and how you might benefit from it.
If you are not an existing BDEC patient or if you live outside the Bournemouth area) please ask your GP to refer you to BDEC so that we can see you in our clinics first.  This will enable us to make any necessary changes to your treatment to ensure you can get the most benefit from the course.

Do i have to change my type of insulin?
The course is designed for people who take fast acting insulin analogues with meals (eg Novorapid, Humalog, Apidra) and a long acting basal insulin ( eg Levemir or Lantus). This is often referred to as multiple daily injections or MDI for short.  We would encourage people on different insulins to switch to these before the course, but if that is not possible, we may still include them if at all possible

Does BERTIE meet national quality criteria?
BERTIE meets all the criteria laid down by the Department of Health for diabetes patient education programmes.  This means that we have:

  • a patient-centred philosophy
  • a written curriculum
  • fully trained educators
  • a quality assurance programme
  • regular audits

What do the audits show?
We continuously audit the progress of people who have attended BERTIE, as well as specific audits on different issues.  These have shown that, after attending the course

  • over 80% of participants meet their goals
  • over 95% of participants feel they benefitted form attending the course
  • average HbA1c levels fall for up to six years
  • many participants have less hypoglycaemia

Can I attend a BERTIE programme elsewhere?
We have trained diabetes teams from all over the country in how to deliver education for type 1 diabetes.  Over 40 centres in all parts of the UK offer a programme which is based upon BERTIE, but which may have been adapted to meet local needs.  We do not accredit such programmes or authorise the use of the BERTIE name, but most belong to the Diabetes Education Network and adhere to its philosophy, as we do.

Is there an online version of BERTIE?
We have developed an online learning programme based on the part of the BERTIE programme which covers carbohydrate counting and insulin dose adjustment.  It is freely accessible on www.bdec-e-learning.com and has been used by thousands of people from all over the world who do not have access to a local programme.  It has been reviewed by Diabetes UK who provide a link from their website. 

Schedule for forthcoming BERTIE programmes

schedule

Education for people with newly diagnosed type 1 diabetes
Patients with new-onset type 1 diabetes are seen within 24 hours atBDEC (unless at weekends) by a diabetes nurse specialist who will provide immediate support, basic education and information. He or she will be also be reviewed by a diabetes dietitian
and a senior doctor within one month. They will then be invited to attend a group session, once every three months (first Wednesday of January, April, July and October) for the following year.

These sessions comprise of discussions, led by different members of multi-disciplinary team (nurse, psychologist, doctor and dietitian) for the first hour. Each participant is reviewed individually by a doctor and any other member of the team who the patient wishes to see.

The aim of these sessions is for newly diagnosed patients to talk to their peers, to learn the principles of c arbohydrate counting and insulin dose adjustment and to enable regular review by the team to help with other aspects of diabetes management.
After the first year, an invitation to attend the structured education programme, BERTIE, will be given.