Diabetes Mellitus, Type 2, Patient Education as Topic
Conditions
Keywords
health education, patient reported outcome measures, type 2 diabetes mellitus, patient education as topic
Brief summary
The goal of this clinical feasibility trial is to test the impact of differing completion rates of a face-to-face diabetes self-management education programme on patient-reported outcomes measuring self-care, diabetes distress and quality of life in people with type 2 diabetes. The main question it aims to answer is: 1\. What is the impact of differing completion rates of DSME programmes on ability to self-care (primary outcome), diabetes distress and health related quality of life in type 2 diabetes. Researchers will compare participants across four study groups (Group 1 will receive a full DSME programme, Group 2 will receive 60%, Group 3 will receive 10% and Group 4 will have delayed education) to see if patients who attend minimal aspects (10%) of diabetes self-management education programmes gain clinically significant improvements in ability to self-care compared to those who do not attend and if the nationally accepted 60 % completion rate is as effective as 100% completion. Participants will: * complete three validated patient reported outcome measures testing self care activities, diabetes distress and health related quality of life. * Attend structured diabetes self-management education of differing completion rates dependent on the group they have been allocated to. * repeat the same three patient reported outcome measures 2-4 months after intervention. For participants in group 4 this will be 3-4 months from baseline.
Detailed description
Structured diabetes self-management education (DSME) is internationally recommended for all people with newly diagnosed type 2 diabetes and is designed to support patients in self-managing their condition and prevent associated long-term complications. DSME is proven to be as effective as pharmacotherapy in preventing diabetes associated morbidity and premature mortality but attendance at both a national and local level remains poor. Local records suggest that of those that start DSME (9%) only 12.6% complete the programme. Attendance at DSME is currently benchmarked as having completed a registration form and had at least one active engagement with a programmes content, with 'completion' measured against ≥60% completion despite landmark trials reporting outcomes based on the full completion of a programme. Little is known, of the effectiveness of DSME on the psychological and emotional health of people with diabetes who complete less than the full DSME programme. This feasibility study will test the impact of differing completion rates of a face-to-face DSME programme on patient reported outcomes measuring self-care, diabetes distress and quality of life in people with type 2 diabetes. Using a quantitative approach, a single centre, randomised feasibility study will be conducted, aiming to recruit 120 eligible people with type 2 diabetes due to attend a secondary care diabetes clinic in the Northwest UK for specialist support, education and advice. Participants will be randomised into one of four groups: Group 1 will receive a full DSME programme, Group 2 will receive 60%, Group 3 will receive 10% and Group 4 will have delayed education. Normal clinical care will continue. Preliminary outcomes (psychometric questionnaire scores measuring ability to self-care, diabetes distress and health related quality of life) will be evaluated at baseline and 3-4 months post-intervention. Measures of feasibility (eligibility, recruitment and retention rates) will be reported. Whilst the current literature evidences the clear benefits for people with type 2 diabetes attending DSME programmes, there is minimal understanding of the benefits of partial DSME completion on a person's ability to self-care despite national consensus accepting 60% attendance as 'completed'. The proposed research aims to test the feasibility of conducting a full randomised control trial to evaluate the effectiveness of DSME programmes on psychometric outcomes with differing completion rates
Interventions
Structured diabetes self management education programme designed to support those with type 2 diabetes self care and prevent long term associated complications.
Sponsors
Study design
Eligibility
Inclusion criteria
* All patients with a diagnosis of type 2 diabetes aged ≥18 years of age referred to the Diabetes centre who are able to provide informed consent and are responsible for daily management of their diabetes will be screened for entry into the study
Exclusion criteria
The following patients will be excluded entry into the study: * Lack capacity to make an informed decision. * A diagnosis of type 1, type 3c, Maturity-onset diabetes of the young (MODY) or gestational diabetes. * Received structured education for their diabetes within the last 12 months either online or face to face. * Require 1:1 education support e.g., requires interpreter. * Patients unable to attend for structured classroom education e.g., housebound.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in DSMQ Diabetes Self Management Questionnaire Measuring Diabetes Self Management Skills Pre and Post Intervention | 3-4 months post baseline | Diabetes self management questionnaire with good interrater reliability. Higher score indicates better self management. 20 item questionnaire, scale 0-10 with some items reversed scored. Total score added together and then divided by 60. Scores can range form 0-10. A higher score indicates better self management. To calculate the change between baseline and follow up (4 months) we calculated the value at follow up minus baseline score. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Diabetes Distress (Pre and Post Intervention) Using the Problem Areas in Diabetes (PAID) Tool | Measured at baseline and 3-4 months after intervention | Validated tool measuring diabetes distress. Lower score indicates lower diabetes distress (better outcome). 20 item questionnaire, scale 0-100. Scores ≥40 indicate risk of emotional burnout. To calculate the change between baseline and follow up (4 months) we calculated the value at follow up minus baseline score. |
| • Mental Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale | Measured at baseline and 3-4 months after intervention | Validated tool measuring health related quality of life. The PROMIS Global-10 is a 10-item patient-reported questionnaire in which the response options are presented as 5-point (as well as a single 11-point) rating scales. The results of the questions are used to calculate two summary scores: a Global Physical Health Score and a Global Mental Health score. These scores are then standardized to the general population, using the T-Score. The average T-Score for the United States population is 50 points, with a standard deviation of 10 points. Higher scores indicate a healthier patient. T-score \<50 worse than average, \>50 better than average. To calculate the change between baseline and follow up (4 months) we calculated the value at follow up minus baseline score. |
| Physical Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale | 3-4 months post baseline | Validated tool measuring health related quality of life. The PROMIS Global-10 is a 10-item patient-reported questionnaire in which the response options are presented as 5-point (as well as a single 11-point) rating scales. The results of the questions are used to calculate two summary scores: a Global Physical Health Score and a Global Mental Health score. These scores are then standardized to the general population, using the T-Score. The average T-Score for the United States population is 50 points, with a standard deviation of 10 points. Higher scores indicate a healthier patient. T-score \<50 worse than average, \>50 better than average. To calculate the change between baseline and follow up (4 months) we calculated the value at follow up minus baseline score. |
Countries
United Kingdom
Participant flow
Recruitment details
120 participants consented and were randomised between May 2024 and February 2025 (30 per group). 68% of these were from secondary care clinics, 32% from primary care services (GP referrals and shared care reports).
Pre-assignment details
Patients with a recorded clinical diagnosis of type 2 diabetes aged ≥18 years who met local and national eligibility criteria for DSME who could provide written informed consent and were responsible for daily management of their diabetes. Exclusion criteria include: * Lack capacity to make an informed decision. * Type 1, type 3c, monogenic or gestational diabetes. * Received structured education for diabetes within last 12 months either online or face to face. * Require 1:1 education
Participants by arm
| Arm | Count |
|---|---|
| Group 1 100% of a face to face 6 hour structured diabetes self management education session | 30 |
| Group 2 60% of a face to face 6 hour structured diabetes self management education session. Total attendance will be 3 hours 36 minutes. | 27 |
| Group 3 10% of a face to face 6 hour structured diabetes self management education session. Total attendance will be 36 minutes. | 28 |
| Group 4 Will not attend a face to face 6 hour structured diabetes self management education session | 28 |
| Total | 113 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Lost to Follow-up | 0 | 0 | 2 | 1 |
| Overall Study | Protocol Violation | 0 | 3 | 0 | 1 |
Baseline characteristics
| Characteristic | Group 1 | Group 2 | Group 3 | Group 4 | Total |
|---|---|---|---|---|---|
| Age, Continuous | 60 year STANDARD_DEVIATION 13 | 62 year STANDARD_DEVIATION 12 | 62 year STANDARD_DEVIATION 17 | 60 year STANDARD_DEVIATION 16 | 61 year STANDARD_DEVIATION 14 |
| Charlson Comorbidity index | 3 units on a scale STANDARD_DEVIATION 2 | 3 units on a scale STANDARD_DEVIATION 2 | 3 units on a scale STANDARD_DEVIATION 2 | 3 units on a scale STANDARD_DEVIATION 4 | 3 units on a scale STANDARD_DEVIATION 2 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 30 Participants | 27 Participants | 28 Participants | 28 Participants | 113 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Index of multiple deprivation (IMD) | 3 units on a scale STANDARD_DEVIATION 5 | 3 units on a scale STANDARD_DEVIATION 4 | 2 units on a scale STANDARD_DEVIATION 4 | 3 units on a scale STANDARD_DEVIATION 4 | 3 units on a scale STANDARD_DEVIATION 4 |
| Sex: Female, Male Female | 17 Participants | 14 Participants | 9 Participants | 16 Participants | 56 Participants |
| Sex: Female, Male Male | 13 Participants | 13 Participants | 19 Participants | 12 Participants | 57 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 30 | 0 / 27 | 0 / 28 | 0 / 28 |
| other Total, other adverse events | 0 / 30 | 0 / 27 | 0 / 28 | 0 / 28 |
| serious Total, serious adverse events | 3 / 30 | 0 / 27 | 0 / 28 | 1 / 28 |
Outcome results
Change in DSMQ Diabetes Self Management Questionnaire Measuring Diabetes Self Management Skills Pre and Post Intervention
Diabetes self management questionnaire with good interrater reliability. Higher score indicates better self management. 20 item questionnaire, scale 0-10 with some items reversed scored. Total score added together and then divided by 60. Scores can range form 0-10. A higher score indicates better self management. To calculate the change between baseline and follow up (4 months) we calculated the value at follow up minus baseline score.
Time frame: 3-4 months post baseline
Population: 3 lost to follow up, 4 removed as not per protocol
| Arm | Measure | Value (MEDIAN) | Dispersion |
|---|---|---|---|
| Group 1 | Change in DSMQ Diabetes Self Management Questionnaire Measuring Diabetes Self Management Skills Pre and Post Intervention | .96 change score (difference in pre-post) | Standard Deviation 2.75 |
| Group 2 | Change in DSMQ Diabetes Self Management Questionnaire Measuring Diabetes Self Management Skills Pre and Post Intervention | 1.08 change score (difference in pre-post) | Standard Deviation 2 |
| Group 3 | Change in DSMQ Diabetes Self Management Questionnaire Measuring Diabetes Self Management Skills Pre and Post Intervention | .28 change score (difference in pre-post) | Standard Deviation 1.24 |
| Group 4 | Change in DSMQ Diabetes Self Management Questionnaire Measuring Diabetes Self Management Skills Pre and Post Intervention | -.17 change score (difference in pre-post) | Standard Deviation 1.38 |
Change in Diabetes Distress (Pre and Post Intervention) Using the Problem Areas in Diabetes (PAID) Tool
Validated tool measuring diabetes distress. Lower score indicates lower diabetes distress (better outcome). 20 item questionnaire, scale 0-100. Scores ≥40 indicate risk of emotional burnout. To calculate the change between baseline and follow up (4 months) we calculated the value at follow up minus baseline score.
Time frame: Measured at baseline and 3-4 months after intervention
Population: Four participants were not included in the final analysis due to protocol deviations: three attended Insulin safe start\[29\] structured education during the trial to meet their medical needs, one of whom was of mixed ethnicity, and another completed 100% DSME instead of the randomised 60%. A further 3 were lost to follow up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Group 1 | Change in Diabetes Distress (Pre and Post Intervention) Using the Problem Areas in Diabetes (PAID) Tool | 8.14 adjusted change score -dif in pre & post | Standard Error 2.44 |
| Group 2 | Change in Diabetes Distress (Pre and Post Intervention) Using the Problem Areas in Diabetes (PAID) Tool | 7.14 adjusted change score -dif in pre & post | Standard Error 2.53 |
| Group 3 | Change in Diabetes Distress (Pre and Post Intervention) Using the Problem Areas in Diabetes (PAID) Tool | 2.54 adjusted change score -dif in pre & post | Standard Error 2.52 |
| Group 4 | Change in Diabetes Distress (Pre and Post Intervention) Using the Problem Areas in Diabetes (PAID) Tool | -6.5 adjusted change score -dif in pre & post | Standard Error 2.48 |
• Mental Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale
Validated tool measuring health related quality of life. The PROMIS Global-10 is a 10-item patient-reported questionnaire in which the response options are presented as 5-point (as well as a single 11-point) rating scales. The results of the questions are used to calculate two summary scores: a Global Physical Health Score and a Global Mental Health score. These scores are then standardized to the general population, using the T-Score. The average T-Score for the United States population is 50 points, with a standard deviation of 10 points. Higher scores indicate a healthier patient. T-score \<50 worse than average, \>50 better than average. To calculate the change between baseline and follow up (4 months) we calculated the value at follow up minus baseline score.
Time frame: Measured at baseline and 3-4 months after intervention
Population: Four participants were not included in the final analysis due to protocol deviations: three attended Insulin safe start\[29\] structured education during the trial to meet their medical needs, one of whom was of mixed ethnicity, and another completed 100% DSME instead of the randomised 60%. A further 3 were lost to follow up
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Group 1 | • Mental Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale | 3.0 change score -dif in pre & post | Standard Deviation 6.18 |
| Group 2 | • Mental Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale | 1.07 change score -dif in pre & post | Standard Deviation 4.77 |
| Group 3 | • Mental Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale | -.88 change score -dif in pre & post | Standard Deviation 7.67 |
| Group 4 | • Mental Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale | -.61 change score -dif in pre & post | Standard Deviation 8.22 |
Physical Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale
Validated tool measuring health related quality of life. The PROMIS Global-10 is a 10-item patient-reported questionnaire in which the response options are presented as 5-point (as well as a single 11-point) rating scales. The results of the questions are used to calculate two summary scores: a Global Physical Health Score and a Global Mental Health score. These scores are then standardized to the general population, using the T-Score. The average T-Score for the United States population is 50 points, with a standard deviation of 10 points. Higher scores indicate a healthier patient. T-score \<50 worse than average, \>50 better than average. To calculate the change between baseline and follow up (4 months) we calculated the value at follow up minus baseline score.
Time frame: 3-4 months post baseline
Population: Mental health Quality of life outcome measures (pre and post intervention) using the PROMIS-Global Health V1.2 scale
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Group 1 | Physical Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale | 2.27 change score -dif in pre & post | Standard Deviation 6.95 |
| Group 2 | Physical Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale | 2.58 change score -dif in pre & post | Standard Deviation 4.92 |
| Group 3 | Physical Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale | -.67 change score -dif in pre & post | Standard Deviation 6.56 |
| Group 4 | Physical Health Quality of Life Outcome Measures (Pre and Post Intervention) Using the PROMIS-Global Health V1.2 Scale | .48 change score -dif in pre & post | Standard Deviation 7.15 |