Contracts, care trajectory and preparatory steps

The diabetes contract is a rehabilitation agreement between the diabetes patient, the hospital and the health insurance.

Who qualifies?

• Patients with type 1 or type 2 diabetes who inject insulin or incretin at least twice a day.
• Patients with type 1 diabetes who are treated with an insulin pump.

Patients receive the necessary support, education and materials so that they are ready to control their disease largely independently by, among other things, checking their daily glucose readings. By signing the diabetes contract, a contract is formed between the diabetes patient and the hospital, which establish rights and obligations that both parties will have.

Contract groups:

Since 1 July 2016, there is a new agreement regarding the self-management of diabetes patients. Every contract patient is obligated to have a global medical chart with his or her GP. Dependent on the type of diabetes and on the number of daily injections, you will be included in the one of the following contract groups: group A, B, or C.This determines the type and quantity of material you will receive for your self-management. The new agreement provides for the following glucose test materials:

• the classic finger-prick method
• thesensor method. When using the sensor method, the glucose level is measured continuously using a subcutaneous sensor. The measurements are sent to a reading device. The contract will cover the cost of materials only group A diabetes patients. Group B or C patients may receive the materials needed for the sensor method by paying a portion themselves.

Maria Middelares General Hospital also has an insulin pump contract.

What is an insulin pump contract?

An insulin pump is a pump that administers a set amount of insulin so that the blood glucose level stays level and to keep the pancreas working naturally. The insulin pump does not automatically measure the blood glucose at the same time, so a glucometer must still be used. An insulin pump contract is an agreement between the diabetes patient, the hospital and the health insurance so that all the costs of insulin pump treatment are reimbursed. The insulin pump is purchased by the hospital and remains the property of the hospital. All materials needed for the treatment will be reimbursed. These include: reservoirs, catheters, batteries and protective covers.

Who qualifies?

• Patients with type 1 diabetes who do not have sufficient management of their glycaemia using correctly-performed conventional treatment, even after receiving intensive insulin therapy and education.
• Patients with type 1 diabetes who have severe and recurrent hypoglycaemia or who stop feeling hypoglycaemic.
• Women with gestational diabetes or diabetic women who would like to become pregnant.
• Patients with type 1 diabetes who have an extreme sensitivity to insulin.
• Patients with type 1 diabetes who have the start or, or who already have, complications from diabetes.
• Patients with type 1 diabetes who have irregular work environments or who have an irregular lifestyle (shift work, frequent travel, extremely variable physical tensions).
• Patients with type 1 diabetes who suffer from the DAWN or dawn phenomenon. This is an uncontrolled and adverse elevation of blood sugar in the morning.
• Diabetes patients who are in the preparatory phase or who are at the start of an initial period after a pancreas or islet cell transplantation.
• Patients with type 1 diabetes who personally choose to use this therapy option.

Conditions

If you decide to use an insulin pump, you must be well aware of the fact that you are taking responsibility for your own self-care. You must fulfil these conditions:

• You have a good insight into what diabetes is and what the treatment options are.
• You are ready to do check your blood glucose levels regularly. at least four times a day, before every meal and before going to bed.
• You are ready to learn how the insulin pump works so that you can use it optimally.
• You are ready to make insulin adjustments at the appropriate times.
• You understand the principles of a healthy diet and can make adjustments in your diet.
• You recognise the symptoms of hypoglycaemia, hyperglycaemia and ketoacidosis.
• You can change your catheter or injection site on a regular basis.
• You can perform emergency procedures in the event of pump defects.

Optimal support and follow-up care are provided by the endocrinologist and the Diabetes Team.

What is it?

Since 2009, Maria Middelares General Hospital has offered a care trajectory to patients with type 2 diabetes.

Who qualifies?

• Patients with type 2 diabetes, and who inject insulin or incretin once or twice a day.
• Patients with type 2 who are taking the maximum quantity of tablets to lower blood sugars and who will transfer over to insulin or incretin in the future.

Conditions

• have a global medical chart with his or her GP.
• have a consultation with the GP at least twice a year.
• You have a consultation with the endocrinologist at least once a year.

The care trajectory will be automatically extended every year, as long as these conditions are satisfied.

Advantages for you:

• by following our trajectory, you will receive self-care materials four times a year as prescribed by your GP.
• You have the right to free education at home by a diabetes educator.
• -all co-payments for the consultations with the GP and the endocrinologist will be fully reimbursed.
• If you need a dietitian to come to your home to provide training or if you need a podiatrist to come to the home for a consultation, then you must have the GP prescribe this. You will need to pay a small co-payment for this service. This can only be prescribed twice a year.

A diabetes care trajectory is usually started in the first line of care, though sometimes in the second line, during a hospitalisation. A diabetes patient with a care trajectory can switch over to group B of the contract if his or her care becomes more intensive. It is also possible to temporarily switch over to group C. This is done with the prescription of the GP when the problems are complex.

What is it?

The diabetes preparatory care trajectory started on 1 February 2016 in order to replace the diabetes card. The preparatory care trajectory is meant to provide better context to all patients with the diagnosis of type 2 diabetes, and who are not candidates for a care trajectory or a diabetes contract.

Who is it for?

Patients with type 2 diabetes who are not yet treated with injectable diabetes medication, but who do receive lifestyle recommendations and/or medications to lower their blood sugars.

Conditions:

The diabetes patient is obligated to have a global medical chart with his or her GP.

Advantages:

Full reimbursement of certain diabetic and podiatric tests or treatments, which the GP has prescribed.

• Individual diet evaluation and/or intervention: maximum of twice a year.
• Individual podiatric testing or podiatric treatment: maximum of twice a year for patients who belong to a risk group.