DIABETES INTEGRATION PROJECT

BACKGROUND

In 1997 First Nations Leaders in Manitoba declared Diabetes an epidemic. In 1999, the Manitoba First Nations Diabetes Leadership Council (MFNDLC), was formed and mandated by the AMC Chiefs-In-Assembly to develop a strategy to address the growing epidemic of diabetes.

In 1999 the MFNDLC developed “The Manitoba First Nation Diabetes Strategy: A Call to Action” to address the diabetes epidemic in Manitoba First Nations. The strategy has five priority areas; Prevention and Promotion, Care and Treatment, Gestational Diabetes, Research, Surveillance and Evaluation, and Policy/Infrastructure. The Care and Treatment component led to the development of the Diabetes Integration Project (DIP) which was supported by First Nation Leadership through a resolution passed at the AMC Chiefs-In-Assembly held in August 2006.

The DIP joined Nanaandawewigamig, the First Nations Health and Social Secretariat of Manitoba (FNHSSM) in April 1, 2016 and is situated on the 6th floor at 275 Portage Avenue in Winnipeg.

Manitoba First Nations Diabetes Strategy

PURPOSE OF THE PROJECT

The DIP is a mobile diabetes care and treatment model that was developed to provide services on-reserve to support First Nation adults living with Type 2 Diabetes to prevent or delay the complications of diabetes.

The services delivered are designed to assist adult clients in monitoring their diabetes status, screen for complications, provide diabetes education to support client self-management and to refer clients to other health care providers based on their assessment findings (needs). Services that are provided by the DIP include the following:

Client Education on Nutrition, Physical Activity, Medications and diabetes self-management support.
Complication Risk Factor Assessment to identify the client’s risk for developing diabetes complications of the Eyes, Cardiovascular (), Kidneys and Limbs.
Diabetes complications screening using the Point of Care Testing analyzers (machines) to test blood glucose (sugar), kidney function and for kidney damage using a finger poke blood sample and a sample of urine.Test results are available within 6 – 12 minutes and the nurse will explain the results to the clients and discuss what they can do and support clients in making changes that will help better control their blood glucose (sugar).
Referrals to a primary care physician, dietitian, foot care nurse, community nurse, community services, mental health services and specialists will be made based on the client’s needs.

Purpose

COMMUNITIES RECEIVING SERVICES

The Diabetes Integration Project currently has 3 Teams delivering these services in Manitoba. The Winnipeg Team travels to the following 5 First Nations communities to deliver services:

Hollow Water
Sandy Bay
Swan Lake
Long Plain
Peguis

The Dauphin Team travels to the following 8 communities:

Pine Creek
Skownan
Ebb & Flow
Ochichakkosippi
Rolling River
Keeseekoowenin
Gambler
Tootinaowaziibeeng

The Thompson Team travels to the following 6 communities:

Nelson House
Chemawawin
Split Lake
God’s River
God’s Lake
Oxford House

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Receiving Service

DIABETES INTEGRATION PROJECT COMMUNITY CLINICS

The Diabetes Integration Project Team travels to each community 4 times a year and holds clinics for 2 or 3 days in the community.

HOW TO ACCESS DIP SERVICES

First Nations members living with type 2 diabetes are encouraged to use these services and can contact their Community Health Nurse, Community Health Representative, or the ADI Worker in their community to make an appointment for the next Diabetes Integration Project Clinic to be held in their community. If you have any questions about the project you can ask the ADI Worker in the community or call:

Diabetes Integration Project

First Nation Health & Social Secretariat of Manitoba

600 - 275 Portage Avenue

Winnipeg, MB R3B 2B3

Phone: (204) 942-9400

Website: www.fnhssm.com

DIP REFFERAL FORMS

Winnipeg Team Referral Form

Dauphin Team Referral Form

Thompson Team Referral Form - Currently Unavailable

DIP CLINIC CALENDERS

Winnipeg Team Community Visit Schedule

Dauphin Team Community Visit Schedule

DIP Dietitian Community Visit Schedule

Thompson Team Community Visit Schedule - Currently Vacant

DIP Clinics

How to Access

DIP Calendars

REFERRAL FORMS

QUALITY ASSURANCE PROGRAM - DIABETES INTEGRATION PROJECT

The Diabetes Integration Project is a mobile diabetes secondary screening program that uses specially trained nurses for the “finger stick” blood testing of patients for hemoglobin A1c, glucose and the testing of urine for the determination of the albumin to creatinine ratio.

CEQAL has been contracted to provide the Quality Assurance Program component. The Quality Assurance Program is very comprehensive and requires all staff to be diligent in performing the Internal Quality Control and client testing process.

Pre - Release Evaluation of Analyzers

The Diabetes Integration Project will operate the following Point of Care analyzers: DCA Vantage and Abaxis Piccolo Express analyzers. Each mobile team will utilize two DCA and one Piccolo analyzer.

CEQAL has assessed the analytical performance of the Point of Care Testing analyzers that are being used by the North, Dauphin and South Mobile Teams. The performance assessment utilized sample sets of human serum covering the clinical range of interest with accuracy target values assigned by credentialed reference methods.

POINT OF CARE TESTING ANALYZERS

PICCOLO EXPRESS

DCA VANTAGE

INTERNAL QUALITY CONTROL TESTING

The day-to-day analytical performance of the analyzers is monitored in the field through the use of an Internal Quality Control (IQC) program with known performance limits and accuracy targets. IQC testing results will be entered into an excel spreadsheet. If data entry turns green, analysis is within the acceptable IQC limits and client testing may proceed. However, if the data turns red, the mobile teams cannot proceed with client testing. Corrective action is required until the IQC data turns green. The North/South/Dauphin Mobile Teams will perform Internal Quality Control testing in the morning prior to client testing to ensure the analyzers are performing as required.

All data are entered into the excel spreadsheet provided by CEQAL. On a monthly basis, the spreadsheets are sent to CEQAL to review the data to ensure the analyzers are operating in accordance with the performance standards for the project.

QUALITY & COMPETENCE

All Diabetes Integration Project mobile teams must meet competency requirements prior to going out in the field. To ensure quality and competency requirements are met, CEQAL has provided a Point of Care Testing Training Manual. All mobile teams will be required to read over the manual, practice the internal quality control testing, data entry, and “finger stick” blood sampling techniques. A satisfactory demonstration is required to ensure all staff meets competency requirements. Training, certification and recertification of Point of Care Testing operators will be required every two years to ensure ongoing competency.

The Point of Care Testing Training and Capacity Building includes the following:

Collection of Diagnostic Capillary Blood Specimens
- Skin Puncture Techniques
Measurement of Hemoglobin A1c in Whole Blood Using the Siemens DCA Analyzers
Measurement of Albumin and Creatinine in Urine Using the Siemens DCA Analyzers; Determination of the Albumin:Creatinine Ratio (ACR)
Measurement of egfr to determine kidney function
Excel Spreadsheets
- Instrument Maintenance-troubleshooting records
- DCA Instrument-reagent evaluation (data collection template)
- Piccolo Instrument – reagent evaluation (data collection template)
- Temperature Monitoring Chart

Quality Assurance

data management

DATA MANAGEMENT

The Diabetes Integration Project Quality Assurance Program will contain a data management component for Point of Care Testing Results. The data will provide useful information in monitoring of system operators training and capacity building, maintenance of equipment and supplies as well as error types and frequency. Overall, the data will assist in improving the entire process from start to finish.

LETTER TO PHYSICIANS

A letter from CEQAL has been provided on the website so that physicians can familiarize themselves with the Quality Assurance Program and processes.

CEQAL Letter to Physicians

PARTNERS

19 First Nations Communities
Manitoba First Nations Diabetes Leadership Council
First Nation and Inuit Health, Manitoba Region
Assembly of Manitoba Chiefs
Manitoba Retinal Vision Screening Program
Ongomiizwin Health Services (Northern Medical Unit) http://umanitoba.ca/faculties/health_sciences/indigenous/institute/background.html
Quality Assurance Program – CEQAL: https://www.ceqal.com/
Specialists: To date, a number of specialists have been consulted and are in full support of the project as follows: