Agreements, care and start-up process

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.

Agreement 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. Since this new agreement, the glucose test material can consist of:

• 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. For Group A patients, the cost of the material is covered by the convention. From 1 July 2023, there will be reimbursement of the sensor method for a proportion of patients in group B, provided certain criteria are met and always with the approval of the diabetes team and the treating endocrinologist. Group C patients who want to use the sensor method can obtain the material subject to a co-payment.

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?

• Type 1 diabetes patients in whom correctly implemented conventional treatment, via intensive insulin therapy and education, does not result in adequate glycaemic control.
• Type 1 diabetes patients with severe and recurrent hypoglycaemias or loss of hypo sensation.
• 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 an irregular lifestyle (shift work, frequent travel, extremely variable physical strain) as a result of irregular work environments.
• Patients with type 1 diabetes who suffer from the DAWN or dawn phenomenon. This is the involuntary and uncontrolled rise in blood sugars by 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 transplant.
• Type 1 diabetes patients who personally choose to pursue 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 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 in the best possible way.
• 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?

• Type 2 diabetes patients who inject insulin or incretin once or twice a day.
• Type 2 diabetes patients on maximum blood sugar-lowering tablets and who will switch 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 programme, you will receive self-care materials four times a year as prescribed by your GP.
• Right to free education by a diabetes educator at home (up to five times a year).
• All copayments 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 your 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.
• 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.

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. That is on prescription of the GP, in case of a complex problem.

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.
• Right to free education by a diabetes educator at home (up to five times a year).