Presentation meeting 4 Steno Diabetes Centre

Steno Diabetes CenterBaltic areaParliamentary visit13 November 2014Martin Ridderstråle,Vice president andHead of Patient Care1Agenda14.30 Presentation of Steno Diabetes Center and Patient Care by VP Martin Ridderstråle- Private – Public partnership- Research and educational activities- Effectiveness and outcomes of diabetes management15.40 Presentation of Health Promotion Research by VP Bjarne Bruun-Jensen- Putting the patient in the centre in patient education- Community-based diabetes prevention16.10 Discussion and question session17.00 End of meeting or small tour of the CampusFounded in 1932 to improve clinical careof patients and to understand diabetesFour major areas at StenoResearch Health Promotion ResearchPatient Care Education4Steno ResearchPathophysiologySystems MedicineComplicationsEpidemiologyOur vision is to become leaders in diabetescare and translational research with focus onearly disease and preventionPublic Private PartnershipStrategic AlliancesWhy collaborate?• Denmark is a little country (Population of 5 million)• Allows us to concentrate on our competitive advantage• Develop competencies that may be even more widely relevant• Allows us to foster linkages which expand collaboration• Assist in developing an influence over policy• Increased mobility of scientists / Talent attractionPatient CarePatient CareA unique public-private partnership Collaborative Clinical Care for 5600 patients Screening for and treating Complications Team-based care delivery Education of patients One-stop shopDiabetes ComplicationsMicrovascular MacrovascularLeading causeof blindnessDiabetic Strokein working ageRetinopathyadultsDiabeticNephropathy CardiovascularDiseaseLeading causeof end-stage 2 to 4 foldrenal disease increase incardiovascularDiabeticmortalityNeuropathyand strokeLeading causeof non-traumaticlower extremity amputationsCosts of complications: The Helsinki Study6000055057DKK50000424324000030000Without complications24x With Complications2000012x10000364422590Excess cost of Type 2 Excess cost of Type 1diabetes diabetesPatient CareThe HbA level has never been this low – Type 1 Diabetes1c)lom/lomm(AbHc1Patient CareThe HbA level has never been this low – Type 2 Diabetes1c100%90%SDC Baseline80%70% SDC After 9months **60%GP 201250%40%30%20%10%0%ABC* A1c Systolic BP Diastolic BP LDL<53 <140 mm <90 mmHg cholesterolmmol/mol Hg <2.6 mmol/lABC control: A1c<53 mmol/mol, BP<140/<90 and LDL <2.6 mmol/l.Data from GP not available. ** p<.0001.EASD 2014)%(tnemniattalaoGPatient CareAs easy as ABC...Safai N et al. EASD 2014Patient CareAligning competenciesPatient CareAligning competenciesPatient CareInnovating Diabetes Care DeliveryPatient CarePatient CarePatient CareInnovating Diabetes Care DeliveryDocumentation“Den Gyldne Skalpel 2014”IKAS Akkreditering 2014ISO Akkreditering 2014Sundhedsstyrelsens tilsynsbesøg 2014Patient CareCreating a value adding even flowSpecialistAmbulatory Day HospitalAmbulatoryPatient CareSpecial attention to special needsType 2Clinic24 hr PhoneFoot ClinicServiceHomeEye ClinicServicePregnancy AdolescentClinic ClinicInsulin PumpClinicPatient CareSpecial attention to special needsEye ClinicPatient CareEye ClinicPatient CareSpecial attention to special needsThree podiatristsOrthopedic consultant weeklyAssessments of risk patientsOrthopedic foot wareTreatment of ulcersObservation, examination and educationPatient CareFoot Therapist of the Year!Steno Research - EpidemiologyReduction in Diabetes MorbiditiesSteno Research - EpidemiologyReduction in Diabetes MorbiditiesT1 diabetes T2 diabetesCardiovascular- 12 % - 30 %DiseaseMajor amputations -70 % - 82 %Severe retinopathy - 18 % -34 %Steno Research - EpidemiologyReduction in Diabetes MortalitySteno Research - EpidemiologyReduction in Diabetes MortalityT1DNon-DMT1D T2Dwithout(DK)nephropathyMen 4.6 % 8.6 % 5.1 % 2.5 %Women 2.5 % 3.5 % 2.6 % 1.8 %Published: Diabetologia, 16 August 2013Time trends in mortality rates in type 1 diabetes from 2002 to 2011,Marit E. Jørgensen, Thomas P. Almdal and Bendix CarstensenPatient CarePatient SatisfactionPatient CarePatient Satisfaction“Safe taking home”“Good overall impression”“Informed about life style”Innovating Diabetes CareDiabetesLifeLab TechnologyPlatformInnovating Diabetes CareInnovating Diabetes CareEuropean Diabetes Technology CourseSteno Research - EpidemiologyInnovating Diabetes CareLifeLab – personalising evidence based medicineInnovating Diabetes CareHealthy person Pre-diab. Diabetes ComplicatedSteno Research - EpidemiologyThe Addition-Pro Study: Progression to diabetesADDITION-PRO Follow-up 2009-1011Screening status Non-NGT iIFG iIGT IFG+IGT SDM KDM Total2001-2006 classifiablen % N % N % N % N % N % N % NLow risk 11 5.7 149 76.8 18 9.3 5 2.6 3 1.6 5 2.6 3 1.6 194Normoglycaemia 21 1.9 741 67.4 109 9.9 77 7.0 52 4.7 60 5.5 40 3.6 1100iIFG 0 0 101 28.0 84 23.3 13 3.6 29 8.0 29 8.0 105 29.1 361iIGT 3 1.2 60 23.5 13 5.1 39 13.3 36 14.1 37 14.5 67 26.2 255IFG+IGT 3 1.6 20 10.9 8 4.3 11 6.0 22 12.0 25 13.7 94 51.4 18338 1071 232 145 142 156 309 2093Steno Research - EpidemiologyWhitehall II study: Latent class trajectory analysisVistisen et al. PLOS Medicine 2014Steno Research - EpidemiologyGreenland studies: genetic riskMoltke et al. Nature 2014Steno Research - PathophysiologyLuleåUmeåOsloStockholmEarly No majorcomplications complications GothenburgGentofteMalmöDuration 5-15 years Duration >30 years– protective genes in diabetic complicationsP R L N Gand longevitySteno Research - Complications50% age adjusted reduction in mortality1983-2002P<0.052000-2010G Andrésdóttir et al Diabetes Care, 2014cJun;37(6):1660-7Steno Research - ComplicationsExisting markersNew markerEarly and robustSteno Research - ComplicationsMass SpectrometryCapillary ElectrophoresisIonizationData StorageandEvaluationUrineSampleDisease specificDiagnosticBiomarker patternReportOMICS: from genes to metabolitesGENOME DNA What is possibleTRANSCRIPTOME mRNA What appears to behappeningPROTEOME PROTEINS What makes ithappenMETABOLOME METABOLITES What is happeningSteno Research – Systems MedicineEducation50Since 2000, the STAR programme has been the centraleducation platform The goal of the programme isto increase knowledge aboutdiabetes in developingcountries Courses are taught in China,India, the Middle East, South-East Asia and Latin America More than 8,000 HCPs havebeen trained through the STARprogramme The programme is funded bythe Novo Nordisk Foundation51With the REACH programme, Education aims tosignificantly scale up training of HCPs The REACH programme will target approximately 9,200 HCPs annually, corresponding to reaching500,000 patients per daySteno Diabetes Center REACH Programme Diabetes education for HCPs, training trainers Combines face-to-face training with e-learning Starts in South-East Asia and extends to LatinAmerica Creates a new network of Steno satellites52The SDC satellite will teach doctors and HCPs inMalaysia and nearby countriesMalaysia Satellite Target group Partners Kuala Lumpur Doctors Ministry of Health Satellite can also HCPs Academic institutionserve nearbycountriesSteno as global partner in Cities ChangingDiabetes“We will find solutions that will make a realdifference for people with diabetes and thosewho are at risk” Steno becomes global partner in Novo Nordisk’sCities Changing Diabetes project together with UCL We support the project with our experience andexpertise in fields such as Education Epidemiology Health Promotion The aim of the project is in line with our vision andstrategy to strengthen focus on prevention anddiabetes careHealth Promotion ResearchHead and professor Bjarne Bruun JensenHealth Promotion ResearchHEALTHPROMOTION RESEARCHSecretariatVP + 2 PAPatient Education PreventionResearch Group Research Group11 fulltime academics 7 fulltime academics2 PhD students 3 PhD studentsMaster’s students and interns Master’s students and internsPatient Education Research GroupPatient Education ResearchPsychosocial health,Innovative patient Diabetessocial supporteducation models and the workplaceand diabetesPatient Education Research GroupNEED: Family DAWN 2: Diabetes andNext education interventions in Diabetes WP: RegisterT1D attitudes, wishes based studiesand needsEMMA:Empowerment,motivation andmedical adherencePsychosocial health,Innovative patient Diabetessocial supporteducation models and the workplaceDEEP: and diabetesDiet andeducation inethnic PakistanisABCDiabetes: Vulnerable Psychosocial Psychological AddressingPatient people with health and problems in diabetes amongeducation in T2 diabetes social support diabetes high risk groupsclinic, Steno in T1D consultations at workplacePrevention Research GroupPrevention ResearchYoung people Family and Pre-diabetesand schools community health and risk groupsPrevention Research GroupTEACH-OUT: PULSE: Social network analysis:Physical activity Health promotion Prevention strategyat Danish exhibition targeting people at risk‘outdoor schools’ targeting familiesIMove:Promotingphysical activityamong childrenYoung people Family and Pre-diabetesand schools community health and risk groupsMEL:Move, Eat, Learnamong schoolchildrenHEPCOM: SOL/Supersetting: JOM MAMA:Promoting healthy Integrated community Prevention among younglifestyles among intervention at couples in Malaysiachildren in Europe BornholmProfile with innovation in focus:“2+3+5”Field: Two focus areas• Patient education and PreventionR & D: Three criteria• Practice-orientation, Interdisciplinarity & CollaborationIntervention Paradigm: Five guiding principles• Participation and active involvement of the target group• Positive and broad concept of health• Action competence and empowerment• A ’Settings’ perspective• Equity in healthNEED: Next EducationNEED: Next Education- feasibility studyBackground• Participation and dialogue are core values in patient education• A participatory approach is a challenge for professionalsObjective• to examine if the toolbox enhances participation and dialogue bothamong patients and between patients and educatorsDesign• 45+ different settings throughout DK were involved• Questionnaire about educator experiences (n=432)• Observation of education sessions (n=19)• In-depth interviews with educators (n=18)NEED: Next Education- feasibility studyNEED: Next Education- feasibility studyFour categories emerged• Icebreaker (educators and patients less shy/nervous)• Patient centeredness (patients defining the starting point)• Group interactivity (patients feeling inspired by each other)• Flexibility (enable educators to include new themes and tools)Conclusion• Toolkit efficient in facilitating participation and dialogueNext step• Effect evaluation (2014/2015)EMMA study at StenoEMMA: Empowerment, Motivation & MedicalAdherence - Dialogue tools for diabetesconsultationsStart at Steno: EMMA training 11⁄2 day, Sept./Oct. 2014 Participants - 3 nurses and 1 physician EMMA in outpatient – fidelity/feasibility RCT (n=270) + qualitative evaluationTools for vulnerable people with diabetesGrant from Danish Ministry of HealthWith Danish Diabetes Association and Regionof Southern DenmarkFeasibility test finalised (80 HCPs) Questionnaires Observations InterviewsData analysis ongoingThe ‘Supersetting’ approach- a community prevention approachThe ‘Supersetting’ approachDay carePrimary schoolWorksitePrivate homeHospital Nursing homeSUPERSETTING: BORNHOLMAim: To improve health and quality of life for familieswith small childrenThe intervention aims at facilitating synergy between:• Schools and daycare institutions• Media: Local TV (TV2 Bornholm)• SupermarketsAction research and co-creationOutcomes: local ownership, TV-watching, selling ofhealthy products, knowledge and attitudes etc.Control: Odsherred MunicipalityExamples of newHealth Promotion conceptsThe Balancing PersonThe Health Educational JugglerSupersettingHealth IdentityHealth Promotion ResearchThank you!