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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

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2333 (Published 26 April 2012) Cite this as: BMJ 2012;344:e2333
  1. Kamlesh Khunti, professor of primary care diabetes and vascular medicine1,
  2. Laura J Gray, lecturer of population and public health sciences1,
  3. Timothy Skinner, director rural clinical school2,
  4. Marian E Carey, national director; DESMOND programme3,
  5. Kathryn Realf, research assistant3,
  6. Helen Dallosso, research associate3,
  7. Harriet Fisher, research assistant1,
  8. Michael Campbell, professor of medical statistics4,
  9. Simon Heller, professor of clinical diabetes5,
  10. Melanie J Davies, professor in diabetes medicine6
  1. 1Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK
  2. 2Rural Clinical School, University of Tasmania, Tasmania, Australia
  3. 3Diabetes Research, University Hospitals of Leicester, Leicester, UK
  4. 4Health Services Research, ScHARR, University of Sheffield, Sheffield, UK
  5. 5Department of Human Metabolism, University of Sheffield, Sheffield, UK
  6. 6Department of Cardiovascular Sciences, University of Leicester
  1. Correspondence to: K Khunti kk22{at}le.ac.uk
  • Accepted 1 March 2012

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 measures The primary outcome was glycated haemoglobin (HbA1c) 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.

Results HbA1c 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.

Footnotes

  • We thank the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care—Leicestershire, Northamptonshire, and Rutland, and the Biomedical Research Unit.

  • Contributors: KK was the principal investigator of the three year follow-up study and drafted the paper. LG analysed the data and drafted the paper. TCS was involved in the conception of the DESMOND programme and reviewed the paper. MEC was the project manager of the 12 months DESMOND trial and reviewed the paper. KR collated the data. HD was senior researcher and collated data and drafted the paper. HF drafted the paper. MC was involved in the design, analysis, and interpretation of the data. SH was involved in the conception of the DESMOND programme and reviewed the paper. MJD was the principal investigator for the DESMOND trial, designed the trial, and reviewed the paper.

  • Funding: This study was funded by a grant from Diabetes UK secured by a joint team from Leicester University and the University Hospitals of Leicester NHS Trust. The writing of the report and the decision to submit the article for publication was entirely independent of the funder. The study funder had no input into the study design or analysis, nor the interpretation of data.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any company for the submitted work; no financial relationships with any companies that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the Huntingdon local research ethics committee and was carried out in accordance with the principles of the 1996 Helsinki declaration.

  • Data sharing: No additional data available.

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