Why structured education & its benefits
It is widely known that Type 2 diabetes is a serious, progressive, chronic disease and that by 2035 it is expected to account for 17% of UK National Health Service (NHS) expenditure[1].
A substantial evidence-base has developed over recent years for the use of diabetes structured education programmes and the National Institute for health and Care Excellence (NICE)2 have developed recommendations for this.
But what exactly is it?
“Diabetes structured education (DSE) is quality assured training that provides people with diabetes, their family and their carers with the knowledge and confidence to self-manage a long-term condition. DSE courses deliver information, training and support on how to manage diabetes through diet, physical activity and medication. Essentially, they are providing the foundation support for diabetes self-management”[2].
Evidence shows DSE to be:
cost-effective[3]
associated with improved biomedical outcomes (e.g. HbA1c, lipids, weight, blood pressure)4-6
associated with improvements in psychosocial outcomes (e.g. depression, quality of life, hypoglycaemia rates)4-6
associated with improvement in behavioural outcomes[4-6]
positively associated with medication outcomes[4-6]
However, despite this, and the fact that that DSE is a national priority7, rates of uptake of DSE for those with Type 2 diabetes have remained largely low.
Positively, the National Diabetes Audit (NDA) has shown a year-on-year increase in referral rates over recent years, with 74% in 2018 being offered DSE within 12 months of diagnosis8; however this is only half the story. The same NDA shows that only 12.4% attended the DSE they were referred to; there are obviously a number of barriers and enablers that can play a big part in this limited attendance. Some of these are outlined in references 9 -11 below and this is where our DESMOND Embed portal plays its part.
References
Hex, N., et al., Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabetic Medicine, 2012. 29(7): p. 855-862
National Institute for health and Care Excellence, Guidance on the use of patient-education models for diabetes.Technology appraisal, 2003. 60. (Now superceded by National Institute for Health and Care Excellence, Type 2 diabetes in adults: management. NICE guidelines [NG28]. May 2017. )
Gillett, M., et al., Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis. Bmj, 2010. 341: p. c4093.
Davies, M.J., et al., 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. Bmj, 2008. 336(7642): p. 491-495.
Deakin, T., et al., Structured patient education: the Diabetes X‐PERT Programme makes a difference. Diabetic Medicine, 2006. 23(9): p. 944-954
Trento, M., et al., Rethink Organization to iMprove Education and Outcomes (ROMEO) A multicenter randomized trial of lifestyle intervention by group care to manage type 2 diabetes. Diabetes care, 2010. 33(4): p. 745-747.
National Institute for Health and Care Excellence, Hypertension: clinical management of primary hypertension in adults.
National Institute for Clinical Excellence, London, 2011.Health and Social Care Information Centre, National Diabetes Audit, 2018-19. Report 1: Care Processes and Treatment Targets. England and Wales December 2019,. 2019.
All-Party Parliamentary Group for Diabetes, Taking control: supporting people to self-manage their diabetes. 2015, Diabetes UK.
Winkley, K., et al., Patient explanations for non‐attendance at structured diabetes education sessions for newly diagnosed Type 2 diabetes: a qualitative study. Diabetic Medicine, 2015. 32(1): p. 120-128.
Carey, M., K. Khunti, and M. Davies, Structured education in diabetes: A review of the evidence. Diabetes & Primary Care, 2012. 14(3).