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One-off diabetes education programmes make little long-term difference

Caroline White

Friday, 27 April 2012

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The health benefits of a one-off group education programme for people with newly diagnosed type 2 diabetes are not sustained over the long term, concludes a study published on bmj.com today.

The Diabetes National Service Framework and NICE promote structured education for all newly diagnosed patients with the condition.

A previous trial showed that the DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) programme changed patients’ attitudes towards their condition and improved their health over 12 months, but it was not known if there was any longer-term impact.

The researchers therefore assessed 731 of the 824 patients who took part in the original DESMOND trial three years after their diagnosis.

The DESMOND group had taken part in a six-hour structured group education programme, delivered by two trained healthcare professional educators. The comparison group received usual care from their primary health care team.

Information on HbA1c , cholesterol, and body weight were collected and patients were asked about their lifestyle, quality of life, illness beliefs, depressive symptoms, emotional impact of diabetes, and medication use.

After three years, it was clear that patients in the DESMOND group had a greater understanding of their illness and its seriousness, as well as their ability to alter the course of their disease.

But there were no differences between the two groups in terms of clinical parameters or lifestyle, including smoking and physical activity levels. There was also no difference in levels of depressive symptoms or quality of life between the two groups.

The findings prompt the authors to suggest that perhaps a more sustained approach to educational programmes is needed.

A second study published today in bmj.com also found that a programme called Talking Diabetes, which aims to improve healthcare professionals’ consulting skills for children with type 1 diabetes, had no effect on blood sugar levels or quality of life at 12 months.

“It is well recognised that people with diabetes, both young ones with type 1 disease and adults with type 2 diabetes, need to develop skills in self management to manage their condition successfully,” comments Professor Frank Snoek, of the Department of Medical Psychology, VU University Medical Centre, Amsterdam, in an accompanying editorial.

That both the DESMOND and the Talking Diabetes trials were carried out in routine practice adds to the external validity of their findings, he says.

Glycaemic control is important, he emphasises, pointing out that the “generally poor glycaemic control found in the Talking Diabetes study is worrying (mean HbA1c of 75 mmol/mol).”

“Perhaps we should focus again on the setting of appropriate targets by professionals who care for patients with diabetes and the patients themselves,” he concludes. “Is it time to raise the bar?”

BMJ 2012; 344: e2333 doi 10.1136/bmj.e2333 (DESMOND)
BMJ 2012; 344: e2359 doi 10.1136/bmj.e2359 (Talking Diabetes)
BMJ 2012; 344; e2673 doi 10.1136/bmj.e2673 (editorial)

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