Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care

Abstract

Objective To measure whether the benefits of a single education and self management structured programme for people with newly diagnosed type 2 diabetes mellitus are sustained at three years.Design Three year follow-up of a 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 731 of the 824 participants included in the original trial were eligible for follow-up. Biomedical data were collected on 604 (82.6%) and questionnaire data on 513 (70.1%) participants.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 measuresThe primary outcome was glycated haemoglobin (HbA 1c ) levels. The secondary outcomes were blood pressure, weight, blood lipid levels, smoking status, physical activity, quality of life, beliefs about illness, depression, emotional impact of diabetes, and drug use at three years. ResultsHbA 1c levels at three years had decreased in both groups. After adjusting for baseline and cluster the difference was not significant (difference −0.02, 95% confidence interval −0.22 to 0.17). The groups did not differ for the other biomedical and lifestyle outcomes and drug use. The significant benefits in the intervention group across four out of five health beliefs seen at 12 months were sustained at three years (P<0.01). Depression scores and quality of life did not differ at three years.Conclusion A single programme for people with newly diagnosed type 2 diabetes mellitus showed no difference in biomedical or lifestyle outcomes at three years although there were sustained improvements in some illness beliefs. Trial registration Current Controlled Trials ISRCTN17844016. IntroductionType 2 diabetes mellitus is a serious, progressive condition presenting with chronic hyperglycaemia, and its prevalence is increasing globally. In the short term, type 2 diabetes may lead to symptoms and debility and in the long term to serious complications, including blindness, renal failure, and amputation.1 Furthermore, three quarters of people with type 2 Research RESEARCH diabetes will die from cardiovascular disease. 2 Traditionally, treatment for the condition has centred on drug interventions to stabilise hyperglycaemia and to manage cardiovascular risk factors, including blood pressure and lipids, to prevent associated symptoms and reduce the risk of vascular complications over time.3 Long term follow-up data from the United Kingdom Prospective Diabetes Study has shown that despite early successes, metabolic control progressively worsens with time, warranting exploration of alternative approaches for long term management of type 2 diabetes. 4 Anyone with diabetes, including type 2 diabetes, has to make multiple daily choices about the management of their condition, such as appropriate dietary intake, physical activity, and adherence to drugs, often with m...

Effects of Structured Diabetes Education Program on diabetes knowledge and metabolic control in insulin-treated diabetes patients from Republic of Macedonia

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Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

“…1 and Table 2). [30][31][32][33][34][35] We summarize the key study characteristics for these studies [30][31][32][33][34][35] in Appendix Table 5. No study evaluated mortality as a primary outcome.…”

Low attendance at structured education for people with newly diagnosed type 2 diabetes: General practice characteristics and individual patient factors predict uptake

“…The United Kingdom's (UK) landmark multicentre trial of 824 participants randomised to Diabetes Education for Ongoing and Newly Diagnosed (DESMOND), a one day group course compared to attention control demonstrated improvements in weight, lipids and psychological variables but not glycaemic control 12 months later [3], although the benefits had reduced by 3 years [4]. This is in contrast to a recent systematic review and meta-analysis of 21 randomised controlled trials (RCT) (total n=2833) of group based DSME which concluded that HbA1c was significantly reduced by an average of 5mmol/mol at 6 and 12 months compared with the control group [5].…”