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Aims To develop a patient-centred, group based self-management programme (X-PERT), based on theories of empowerment and discovery learning, and evaluate the effectiveness of the programme on clinical, lifestyle and psychosocial outcomes.Methods Adults with type 2 diabetes (n = 314), living in Burnley, Pendle or Rossendale, Lancashire, UK were randomised to either individual appointments (controls) (n=157) or the X-PERT Programme (n=157). X-PERT patients were invited to attend six, two hour group sessions of self-management education. Outcomes were assessed at baseline, four and 14 months.Results 149 participants (95%) attended the X-PERT Programme with 128 (82%) attending ≥4 sessions. By 14 months the X-PERT group compared with controls showed significant improvements in the mean HbA 1c (-0.6% versus +0.1%, repeated measures ANOVA, P<0.001). The number needed to treat (NNT) for preventing diabetes medication increase was 4 (95% CI: 3 to 7) and NNT for reducing diabetes medication was 7 (95% CI: 5 to 11). Statistically significant improvements were also shown in the X-PERT patients compared to the control patients for body weight, BMI, waist circumference, total cholesterol, selfempowerment; diabetes knowledge; physical activity levels; foot care; fruit and vegetable intake; enjoyment of food; treatment satisfaction.Conclusions Participation in the X-PERT Programme by adults with type 2 diabetes was shown at 14 months to have led to improved glycaemic control; reduced total cholesterol level, body weight, BMI and waist circumference; reduced requirement for diabetes medication; increased consumption of fruit and vegetables, enjoyment of food, knowledge of diabetes, self-empowerment, self-management skills and treatment satisfaction.WORDS 249

This article summarizes the Diabetes UK evidence-based guidelines for the prevention of Type 2 diabetes and nutritional management of diabetes. It describes the development of the recommendations and highlights the key changes from previous guidelines. The nutrition guidelines include a series of recommendations for the prevention of Type 2 diabetes, nutritional management of Type 1 and Type 2 diabetes, weight management, management of microvascular and macrovascular disease, hypoglycaemia management, and additional considerations such as nutrition support, end-of-life care, disorders of the pancreas, care of the older person with diabetes, nutrition provided by external agencies and fasting. The evidence-based recommendations were graded using the Scottish Intercollegiate Guidelines Network methodology and, in a small number of topic areas, where strong evidence was lacking, the recommendations were reached by consensus. The Diabetes UK 2011 guidelines place an emphasis on carbohydrate management and a more flexible approach to weight loss, unlike previous guidelines which were expressed in terms of recommendations for individual nutrient intakes. Additionally, the guidelines for alcohol have been aligned to national recommendations. The full evidence-based nutrition guidelines for the prevention and management of diabetes are available from: http://www.diabetes.org.uk/nutrition-guidelines.

Aims To assess whether the Expert Patient Programme (EPP), adapted for people with Type 2 diabetes, can be used to promote healthy eating to improve glycaemic control.Methods Adults with Type 2 diabetes (n = 317) were randomized to receive either a diabetes-specific EPP (n = 162) or individual one-off appointments with a dietitian (control group) (n = 155). The diabetes-specific EPP followed the standard National Health Service programme although all participants in the group had diabetes only, rather than a mix of chronic conditions. Participants attended a group session for 2 h once per week for 6 weeks. In addition, a final seventh-week 2-h session was included that was specific to issues concerning diabetes. Outcomes were assessed at baseline, 6 and 12 months.Results There were no statistically significant differences between the control and the intervention group in any of the clinical outcomes measured. There was no significant difference between the groups in any dietary outcome. There was a higher starch intake in the EPP group, although this did not reach statistical significance (effect size for starch adjusted for baseline values 8.8 g; 95% CI )1.3 to 18.9). There was some loss of participants between baseline measurement and randomization, although this did not appear to have had an important impact on baseline balance.

Type 2 diabetes (T2DM) is a growing health issue globally, which, until recently, was considered to be both chronic and progressive. Although having lifestyle and dietary changes as core components, treatments have focused on optimising glycaemic control using pharmaceutical agents. With data from bariatric surgery and, more recently, total diet replacement (TDR) studies that have set out to achieve remission, remission of T2DM has emerged as a treatment goal. A group of specialist dietitians and medical practitioners was convened, supported by the British Dietetic Association and Diabetes UK, to discuss dietary approaches to T2DM and consequently undertook a review of the available clinical trial and practice audit data regarding dietary approaches to remission of T2DM. Current available evidence suggests that a range of dietary approaches, including low energy diets (mostly using TDR) and low carbohydrate diets, can be used to support the achievement of euglycaemia and potentially remission. The most significant predictor of remission is weight loss and, although euglycaemia may occur on a low carbohydrate diet without weight loss, which does not meet some definitions of remission, it may rather constitute a ‘state of mitigation’ of T2DM. This technical point may not be considered as important for people living with T2DM, aside from that it may only last as long as the carbohydrate restriction is maintained. The possibility of actively treating T2DM along with the possibility of achieving remission should be discussed by healthcare professionals with people living with T2DM, along with a range of different dietary approaches that can help to achieve this.