Lindsay Oliver

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

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 A1c 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 A1c 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 A1c levels up to 12 months after diagnosis. Trial registration Current Controlled Trials ISRCTN17844016.

Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes

A summary of the latest evidence‐based nutrition guidelines for the prevention and management of diabetes is presented. These guidelines are based on existing recommendations last published in 2011, and were formulated by an expert panel of specialist dietitians after a literature review of recent evidence. Recommendations have been made in terms of foods rather than nutrients wherever possible. Guidelines for education and care delivery, prevention of Type 2 diabetes, glycaemic control for Type 1 and Type 2 diabetes, cardiovascular disease risk management, management of diabetes‐related complications, other considerations including comorbidities, nutrition support, pregnancy and lactation, eating disorders, micronutrients, food supplements, functional foods, commercial diabetic foods and nutritive and non‐nutritive sweeteners are included. The sections on pregnancy and prevention of Type 2 diabetes have been enlarged and the weight management section modified to include considerations of remission of Type 2 diabetes. A section evaluating detailed considerations in ethnic minorities has been included as a new topic. The guidelines were graded using adapted ‘GRADE’ methodology and, where strong evidence was lacking, grading was not allocated. These 2018 guidelines emphasize a flexible, individualized approach to diabetes management and weight loss and highlight the emerging evidence for remission of Type 2 diabetes. The full guideline document is available at www.diabetes.org.uk/nutrition-guidelines.

Long-term biomedical and psychosocial outcomes following DAFNE (Dose Adjustment For Normal Eating) structured education to promote intensive insulin therapy in adults with sub-optimally controlled Type 1 diabetes

AIMS To explore long-term outcomes of participation in a Dose Adjustment For Normal Eating (DAFNE) training course, which provided one-off exposure to structured education in intensive insulin therapy to people with established Type 1 diabetes. METHODS A cohort design follow-up of original trial participants at a mean of 44 months (range: 37-51 months) in hospital diabetes clinics in three English health districts. 104 (74%) original participants provided biomedical data; 88 (63%) completed questionnaires including the ADDQoL, measuring impact of diabetes on quality of life (QoL). RESULTS At 44 months, mean improvement in HbA(1c) from baseline was 0.36% (9.32+/-1.1% to 8.96+/-1.2%, p<0.01) remaining significant but deteriorated from 12 months (p<0.05). Improvements in QoL seen at 12 months were sustained at 44 (e.g. impact of diabetes on dietary freedom: -1.78+/-2.33 at 44 months versus -4.27+/-2.94, baseline, p<0.0001; versus 1.80+/-2.32 at 12 months, ns). Similar results were obtained using last observation carried forward for patients not supplying follow-up data. CONCLUSIONS The impact of a single DAFNE course on glycaemic control remains apparent in the long term, although further interventions will be required to achieve recommended HbA(1c). In contrast, improvements in QoL and other patient-reported outcomes are well maintained over approximately 4 years.

'Educator talk' and patient change: some insights from the DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed) randomized controlled trial

Aims  To determine whether differences in the amount of time educators talk during a self‐management education programme relate to the degree of change in participants’ reported beliefs about diabetes.

Comparison of illness representations dimensions and illness representation clusters in predicting outcomes in the first year following diagnosis of type 2 diabetes: Results from the DESMOND trial

This article explores the utility of cluster analysis of illness representations, in comparison to analysing each dimension of the individuals illness representation, to predict an individuals response to diagnosis of type 2 diabetes. Participants in a large multi-centre randomised controlled trial of a self-management education intervention for people with type 2 diabetes, completed measures of illness beliefs (coherence, timeline, impact, seriousness, personal responsibility) and depression along with HbA1c and body mass index (BMI), at baseline 4, 8 and 12 months. The results of the cluster analysis were compared with an independent qualitative study of participants’ responses to diagnosis and participation in the study. The quantitative analysis of 564 participants for whom complete data were available, identified four clusters of illness representations as the most parsimonious description of the data. The mean profiles of these clusters were comparable with groups identified by the independent qualitative analysis, and predicted the trajectory of illness outcomes over the 1-year follow-up. Combining illness beliefs into discrete clusters may be more useful in understanding patterns of responding to illness than using analysis of illness beliefs dimensions independently.

Depressive symptoms in the first year from diagnosis of Type 2 diabetes: results from the DESMOND trial.

Diabet. Med. 27, 965–967 (2010)

The Dose Adjustment For Normal Eating (DAFNE) Trial: improvements in HbAlc still apparent and quality of life benefits well maintained at 4-year follow-up

withdrawn Clinical science: Hypoglycaemia

Year of Care: the key drivers and theoretical basis for a new approach in diabetes care

The Year of Care initiative aims to transform the annual review into a collaborative care planning consultation based on a partnership approach. It has been piloted across three centres in England.

House of care approach for patients with long term conditions works at the local level.

As members of the Year of Care team that developed the “house of care” we welcome Watt’s editorial on the challenge of multimorbidity.1 Although he correctly states that the original Year of Care pilot programme focused on diabetes, this was simply a starting point. Subsequently, as intended, we have helped various health communities to extend the learning and experience to people with other …

Whose diabetes is it anyway

PRACTICAL DIABETES VOL. 34 NO. 5 COPYRIGHT