DESMOND helps diabetes patients make key changes to lifestyle
The NSF for Diabetes recommends the use of structured education programmes for patients with diabetes.
One of the most successful of the recommended interventions is DESMOND (Diabetes Education and Self Management for Ongoing and Newly Diagnosed). DESMOND uses several psychological theories of dynamic learning and helps to empower patients to change established behaviour and beliefs. It is delivered by trained diabetes specialist nurses and takes a standard format of six hours of education over one or two days.
A cluster randomised controlled trial, in the BMJ, has evaluated DESMOND. It is the first trial of this type of intervention.
The trial was set in 207 general practices in 13 primary care areas of the UK, of which 162 actively referred patients. In total, 824 patients with newly diagnosed diabetes participated, of whom 55% were men. The mean age at baseline was 59.5 years.
Patients were referred within four weeks of diagnosis and were randomised to DESMOND or care as usual. Patients randomised to DESMOND participated in the intervention within 12 weeks.
The intervention and control groups were followed up at baseline, four, eight and 12 months. Physical parameters, such as weight, blood pressure, HbA1c and lipids were measured. Lifestyle and psychosocial data gathered included smoking status, exercise levels, depression scores and an illness perception questionnaire.
The results showed no overall significant difference between the two groups for HbA1c, lipids or blood pressure. However, the intervention group showed a modest but significant reduction in weight compared with the control group.
The number of smokers was significantly reduced in the intervention group, and the difference maintained at 12 months. Self-reported exercise levels were higher in the intervention group at four months compared with controls but this difference was not sustained.
The four illness belief scores (coherence, timeline, personal responsibility and seriousness) all showed a better understanding and perception of diabetes in patients in the intervention arm. Depression scores were also significantly reduced in the intervention group compared with controls. These changes persisted to the end of the study.
Type 2 diabetes is the end point of a series of pathological changes caused by central obesity. This in turn is the result of poor lifestyle choices, especially about diet and exercise. By the time diabetes is finally diagnosed, these choices are deeply ingrained habits. The ability to embrace lifestyle changes is not only a good foundation for drug therapy but also creates positive beliefs about chronic illness and the ability to live with it.
Although physical parameters were not improved in patients who received the DESMOND intervention compared with controls, both groups were subject to the same primary care and were being treated to QOF targets. The psychosocial measurements seem to argue that DESMOND may lay good foundations for long-term care to flourish, and that it performs well in a robust, real world, primary care study.
Davies MJ, Heller S, Skinner TC. 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;336:491-5Reviewer
Dr Matthew Lockyer
GP, Suffolk and hospital practitioner in diabetic medicine