Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial

Abstract

Objective To evaluate the effectiveness of a structured group education programme on biomedical, psychosocial, and lifestyle measures in people with newly diagnosed type 2 diabetes. Design Multicentre cluster randomised controlled trial in primary care with randomisation at practice level. Setting 207 general practices in 13 primary care sites in the United Kingdom. Participants 824 adults (55% men, mean age 59.5 years). Intervention A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care. Main outcome measures Haemoglobin A 1c levels, blood pressure, weight, blood lipid levels, smoking status, physical activity, quality of life, beliefs about illness, depression, and emotional impact of diabetes at baseline and up to 12 months. Main results Haemoglobin A 1c levels at 12 months had decreased by 1.49% in the intervention group compared with 1.21% in the control group. After adjusting for baseline and cluster, the difference was not significant: 0.05% (95% confidence interval −0.10% to 0.20%). The intervention group showed a greater weight loss: −2.98 kg (95% confidence interval −3.54 to −2.41) compared with 1.86 kg (−2.44 to −1.28), P=0.027 at 12 months. The odds of not smoking were 3.56 (95% confidence interval 1.11 to 11.45), P=0.033 higher in the intervention group at 12 months. The intervention group showed significantly greater changes in illness belief scores (P=0.001); directions of change were positive indicating greater understanding of diabetes. The intervention group had a lower depression score at 12 months: mean difference was −0.50 (95% confidence interval −0.96 to −0.04); P=0.032. A positive association was found between change in perceived personal responsibility and weight loss at 12 months (β=0.12; P=0.008). Conclusion A structured group education programme for patients with newly diagnosed type 2 diabetes resulted in greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but no difference in haemoglobin A 1c levels up to 12 months after diagnosis. Trial registration Current Controlled Trials ISRCTN17844016.

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

“…Barriers outside the person's control are acknowledged, but the role of the facilitator or educator is to encourage the participant to explore his/her motivations for self-management or engaging in health promoting behaviours, rather than telling them what to do; the former set of behaviours can be attributed to being 'DESMOND' 251 and the later are non-DESMOND. Further details of the methods used to assess educator behaviour and the DESMOND 251 and non-DESMOND 251 approach, are outlined below (see Preliminary assessment of educator behaviour, and Table 38). …”

“…This stage took place between January and March 2014, and included observations of DESMOND 251 -based programmes and attendance at a core DESMOND 251 training day. This provided an introduction to the theoretical basis, philosophy and core skills of DESMOND.…”

“…This provided an introduction to the theoretical basis, philosophy and core skills of DESMOND. 251 Second, the educators attended an initial study-specific training day in April 2014, when they were introduced to the theoretical component, content, structure and delivery of the STOP Diabetes education programme (see Table 37). This was followed by a second study-specific day in June 2014.…”

“…The Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) 251 model of structured education, 251 which underpins work conducted in this chapter, draws on theoretical and philosophical perspectives from both health psychology and education; [252][253][254] patient empowerment is at its centre. DESMOND programmes meet nationally agreed quality criteria 255 for patient education, including delivery by trained and accredited educators, and quality assurance.…”

Multiple Logistic Regression Analysis on the Health Checkup Data and the Lifestyle Habits of Medicated Residents: A Population-Based Cohort Study

“…Previous studies [20][21][22][23][24][25][26][27][28][29][30] investigating the relationship between smoking and diabetes mellitus clarified the importance of smoking cessation for risk management of cardiovascular disease.…”