| CODE | MED5100 | ||||||||||||
| TITLE | Management of Type 1 Diabetes | ||||||||||||
| UM LEVEL | 05 - Postgraduate Modular Diploma or Degree Course | ||||||||||||
| MQF LEVEL | 7 | ||||||||||||
| ECTS CREDITS | 5 | ||||||||||||
| DEPARTMENT | Medicine | ||||||||||||
| DESCRIPTION | Diabetes mellitus is a chronic non communicable disease which is associated with significant morbidity and mortality. Whilst disease control can be achieved, prevention remains one of the major challenges encountered by healthcare providers. A multidisciplinary faculty will introduce students to the growing evidence base regarding gene-environment interactions leading to T1DM. Students will be provided with information on dietary and exercise guidelines for persons with diabetes. Available educational programs and strategies for behaviour modification will be discussed. Different exercise modalities and the resultant impact on glucose homeostatsis in non-affected and affected subjects will be described. The pharmacological management of diabetes will be reviewed, with a focus on efficacy, beneficial and adverse aspects of different types of insulin and pramlinitide. Different treatment algorithmns and their effectiveness in helping those with T1 diabetes achieve satisfactory control will be appraised. The relative efficacy of multidose insulin regimes vs continuous subcutaneous insulin infusion will be analysed with regards to cost-benefit as well as the ability to achieve therapeutic targets with minimal adverse events such as hypoglycaemia. Cutting edge therapeutic options such as the artificial pancreas, immuno therapy, stem cell and whole organ transplantation offer hope for the future but the benefits, risks and costs of these newer interventions will be considered. Lectures, bedside teaching and on line case based discussions as well as seminars will be used as the main teaching and learning modalities. Study-unit Aims: The aim of this study-unit is to provide students with the knowledge and skills to establish holistic management plans for both the management of T1 diabetes as part of a multidisciplinary team. Utilising the available evidence base and relevant guidelines, students will able to plan strategies and algorithms of value in the prevention and treatment of T1 diabetes in general and tailored to the needs of individual subjects, such as paediatric, adolescent and the geriatric populations.The role of transition clinics to ensure that the changing needs of subjects a they progress through puberty, reproduction and senescence will be tackled will be highlighted as well as th evidence base behind guideline driven practice. Learning Outcomes: 1. Knowledge & Understanding: By the end of the study-unit the student will be able to: a.Understand the barriers and levers in the implementation of effective management strategies in a holistic effective and integrated healthcare system; b. Plan and provide health care that is patient centred, with due consideration of their needs, provision of adequate support and the development of individualised management plans with realistic targets appropriate to the needs of the person concerned; c. Apply the skills and competencies acquired to contribute to an integrated multidisciplinary approach to the management of T1 diabetes; d. Critically analyse the specific needs of individuals with T1 diabetes, the inequitable distribution of healthcare as well as regional differences in diabetes care and their drivers; e. Be familiar with landmark trials in the field of diabetes prevention and care including DCCT and its follow up study; f. Describe the importance of Self Monitoring of Blood glucose (SMBG) and self management with reference to achieving glycaemic control, avoidance of hypoglycaemia and management of hypoglycaemia unawareness; g. Understand the principles behind continuous blood glucose monitoring, the benefits, the limitations of currently available systems and the evidence supporting CGM; h. Discuss the contribution of exercise to achieving and maintaining glycaemic control, - including high intensity, strength and cardio training - as well as the efficacy of different sports activities - walking, swimming, etc; i. Explain the adjustments to fluid and carbohydrate intake essential pre, peri, and post exercise and the impact of differing exercise intensities and regimes on the adjustments necessary keeping normal exercise physiology as a point of reference; j. Appreciate the pharmacokinetics of different insulin formulations and the resulting impact on achieving blood glucose control. 2. Skills: By the end of the study-unit the student will be able to: a.Implement and review different management strategies; b. Practice the techniques essential to promote lifestyle changes; c. Manage diverse therapeutic options; d. Explain the importance of adjusting fast acting insulin in acute illness, in conjunction with carbohydrate counting and in response to elevations of preprandial insulin; e. Select and review medication charts; f. Utilise technological advances to empower patients to self monitor and self adjust treatment within certain prescribed parameters; g. Provide health care that is patient centred, with due consideration of their needs, provision of adequate support and the development of individualised management plans with realistic targets appropriate to the needs of the person concerned; h. Appraise SMBG, CGM, dietary and exercise programs in effectively achieving control; i. Identify the cause of failure to achieve or loss of glycaemic control in individuals and take the necessary steps to improve control in subjects with diabetes and in the presence of other co-morbidities. Main Text/s and any supplementary readings: Main texts - Griffin JE and Ojeda SR (2012) Textbook of Endocrine Physiology (6th Edition) Oxford. Oxford University Press. - Tobias ES, Connor M, Ferguson -Smith Malcolm 2011 Essential Medical Genetics 6th Editon. Wiley -Blackwell. - Holt RLG & Hanley NA 2012 Essential Endocrinology and Diabetes 6th Edition Wiley-Blackwell. Supplementary texts - International Diabetes Federation (2015) IDF Diabetes Atlas 7th ed. Available online at: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas.html - International Diabetes Federation (2015) IDF Diabetes Atlas 7th ed. interactive map Available online at:http://www.diabetesatlas.org/across-the-globe.html - NICE guideline on Type I Diabetes (2015) 鈥� NG17 - NICE (2016) Diabetes in Adults Available online at: https://www.nice.org.uk/guidance/qs6/resources/diabetes-in-adults-pdf-58299425989 - World Health Organisation (2016) Global Report on Diabetes World Health Organisation Press Geneva Available online at: http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf - American Diabetes Association (2017) Standards of Medical Care in Diabetes - 2017, Diabetes Care, 40(Suppl. 1) pp. S11鈥揝24, DOI: 10.2337/dc17-S005. - Calleja N., Azzopardi Muscat N., Reiff S., Fava S., Vassallo J., Torpiano J., Grixti M., Caruana M., Theuma R., Grixti M., Camilleri P., Zammit McKeon A. (2015) Diabetes: A National Public Health Priority; A National Strategy for Diabetes. Ministry of Health, Malta. Available online at: https://deputyprimeminister.gov.mt/en/Documents/National-Health-Strategies/NDS-EN.pdf |
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| STUDY-UNIT TYPE | Blended Learning | ||||||||||||
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The University makes every effort to ensure that the published Courses Plans, Programmes of Study and Study-Unit information are complete and up-to-date at the time of publication. The University reserves the right to make changes in case errors are detected after publication.
The availability of optional units may be subject to timetabling constraints. Units not attracting a sufficient number of registrations may be withdrawn without notice. It should be noted that all the information in the description above applies to study-units available during the academic year 2025/6. It may be subject to change in subsequent years. |
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