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.

Nudge for Environmental Restructuring in Diabetes Self-Management: Comment on Existing Systematic Reviews

“…For instance, the features of primary trials can be classified by trial context, mode of delivery, and target behaviors, following the use of BCTTv1. 12 Although our knowledge is based on a small number of systematic reviews and their partial primary trials, the 4 primary trials cited in the systematic reviews allowed us to scrutinize them [13][14][15][16] (Supplemental Table 2).…”

“…Another BCT "Restructuring the social environment" was applicable to healthcare providers working in prompt or repeated educational sessions and also reminder calls. [14][15][16] The social restructuring for diabetes management seemed to be a reconstructed healthcare system for care access. If such resource persons are available, the mode of delivery should be adjusted to each clinical context.…”

Level of Treatment Adherence in Patients with Type 2 Diabetes in Primary Care

“…The glycemic control in diabetes is a very important challenge in the health system, which requires the attention of a multidisciplinary group of specialists. Previous studies conclude that education through a structured program in newly diagnosed patients results in improvements in weight control, knowledge of the disease, promotes a decrease in tobacco and alcohol consumption, and improves HbA1c levels and lifestyle [3], being group and individual interventions greater than 10 hours those associated with greater change in HbA1c [4], associating the lack of pharmacological adherence to higher health care costs, increased hospitalizations and emergency room admissions and lifestyle with glycemic values, large increases in the IMEVID questionnaire score in any of its domains correspond to small decreases in blood glucose [5]. Many governmental strategies have been implemented in Mexico such as, PREVENIMSS, PREVENISSSTE, Mutual Aid Groups and Chronic Disease Specialized Medical Units, in order to sensitize the patient in the control and prevention complications of Diabetes, as a result of that, it is estimated that the prevalence of the glycemic control via glycated hemoglobin a1c in patients only reaches 50% in patients and it is related to a non-favorable lifestyle and a low adherence to the treatment.…”