Diabetes Education Can Aid Newly Diagnosed Patients

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Effectiveness of the Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomized controlled trial, by M.J. Davies and colleagues. BMJ 336:491-495, 2008

What is the problem and what is known about it so far?

People with diabetes often face difficulties managing their diabetes and following lifestyle advice given by their health care providers. Learning key self-management skills helps patients improve their diabetes control and quality of life and avoid complications. Although several education programs have been developed in Europe and North America, there has been little evidence of their effectiveness in the United Kingdom. There have also been few programs for primary care settings and none specifically designed for newly diagnosed patients.

Why did researchers do this particular study?

The researchers set out to fill the gap in patient education by designing and testing a structured patient education program called Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND). This study tested the effectiveness of the program in terms of medical, psychosocial, and lifestyle issues facing newly diagnosed patients.

Who was studied?

Subjects included 824 adults from 13 primary care sites in the United Kingdom. Participants were newly diagnosed with type 2 diabetes and had access to some diabetes education offered through their primary care centers, but not to a structured program.

How was the study done?

Subjects were referred within 4 weeks of diagnosis and divided into two groups, one participating in the education program within 12 weeks of diagnosis, and the other receiving standard care plus an amount of time with a health care provider equivalent to the time spent in the program. The education program lasted 6 hours and was facilitated by trained educators. Curriculum focused on lifestyle factors, such as food choices, physical activity, and cardiovascular risk factors, encouraged participants to consider medication as an option in their self-management strategies, and called for participants to select a specific achievable behavior change goal to work on. The researchers collected medical data at offices visits and psychosocial and quality-of life data through questionnaires at the start of the trial and 4, 8, and 12 months later.

What did the researchers find?

After 1 year, there were no significant differences in A1C reductions between the two groups. However, program participants had greater weight loss, a greater increase in physical activity, more improvement in levels of blood fats called triglycerides, and more success in quitting smoking than nonparticipants. They also had greater positive changes in illness belief scores, which meant they had a better understanding of diabetes. They also experienced less depression than nonparticipants. Finally, they showed a significantly greater improvement in their 10-year risk for cardiovascular disease.

What were the limitations of the study?

A1C levels and the number of women were higher among participants in the program than among nonparticipants, and this could have affected the results. Although the two groups seemed to be similar in terms of quality of life, this may have reflected a flaw in the tool used to measure quality of life.

What are the implications of the study?

A structured group education program such as DESMOND, which focuses on behavior change, can be duplicated at numerous health care centers to benefit more patients with diabetes. Such a program can successfully engage newly diagnosed patients and inspire them to make effective lifestyle changes that are still apparent after 12 months.

FOR MORE INFORMATION

Information for recently diagnosed patients

Healthy living with diabetes

Diabetes Self-Management