3 All shared a concern regarding lack of good, structured educati

3 All shared a concern regarding lack of good, structured education for people with type 2 diabetes and from an informal beginning the momentum has grown. What is important about this approach is that it is truly patient centred and derives PD-166866 from the work of Anderson and Funnell

and is underpinned by a number of psychological theories of learning.4–7 The DESMOND newly diagnosed programme is delivered as a six-hour group programme with a formal written curriculum starting with the patient’s story and finishing with facilitating people in developing a personal plan. Undertaking research and evaluating the impact of such interventions are a feat in themselves, and it has been recognised for some time that we are very poor at both

describing and evaluating such interventions, which means it is very difficult for them to Fluorouracil order be replicated and this results in a poor evidence base.8 Having developed a theory for the programme and modelling its effect on key components, an exploratory pilot study was performed and this informed a definitive randomised controlled trial (RCT). The results of this showed that, whilst all biomedical parameters improved, there was no significant effect of the intervention on HbA1c in these newly diagnosed patients. However, there was a significant improvement in triglycerides at eight months and a significant improvement in self-reported physical activity at four months, There was a significant improvement in smoking status with a favourable odds ratio of 3.6, and there was a clinically significant reduction in body weight at four and 12 months. Using the UK Prospective Diabetes Study (UKPDS) risk engine, the intervention group showed a significantly greater improvement in 10-year risk

status and a greater percentage having a less than 15% risk at 10 years. The psychological results showed a significant reduction in depression at 12 months and three of the key illness beliefs – illness coherence, timeline and seriousness – were all significantly improved at 12 months. This means that participants who received the DESMOND programme had a greater understanding of their illness and its seriousness, and a better perception of its duration.9 Furthermore, a robust cost-effectiveness assessment of the DESMOND intervention, both in the context of the trial and delivery in Benzatropine the current primary care setting, showed that the real world cost for delivering a DESMOND course in a typical primary care trust (PCT) was £82 compared to £209 in the trial.10 The more expensive costs in the trial setting were largely due to residential training courses and, now that DESMOND has been implemented, there are benefits from the economies of scale. Looking at the real world costs, the incremental costs per QALY is £2092. These data were based on assumptions; however, three-year results will help to further accurately predict cost effectiveness.

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