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NHS-backed diabetes programme has no impact on HbA1c

Specialists have backed an NHS-funded education and self-management programme for people with newly diagnosed diabetes, even though an evaluation failed to demonstrate a significant impact on HbA1c levels.

The DESMOND programme – Diabetes Education and Self Management for Ongoing and Newly Diagnosed - encourages new patients to set personal goals in managing their condition.

The evaluation, published online by the BMJ, studied 824 patients from 207 general practices in the UK enrolled in a structured group education programme for six hours, and then monitored for 12 months.

In the DESMOND group, patients had an average weight loss that was 38% greater than with standard care. They were also 69% more likely to have stopped smoking. But researchers found no clinically significant difference in HbA1c levels between patients managing their condition themselves and those treated by their GP.

Dr Marian Carey, national director of the DESMOND programme and a researcher on the study, said structured education programmes were important in changing patients' attitudes and behaviour, and so had a place in diabetes management.

‘There are different benefits associated with each type pf care. But in this population it would be very difficult to show significant reductions in HbA1c. We need to consider what is important to patients and we must not say just because its not blood glucose levels it's not important, because it is.'

Dr Roger Gadsby, a GPSI in diabetes in Nuneaton, Warwickshire, said: ‘Intervention outcomes and changes in behaviour are important, but it is disappointing that there was no impact on the hard outcome of HbA1c.'

In an accompanying BMJ editorial, Dr Sean Dineen, senior lecturer in medicine at the National University of Ireland, wrote: ‘Healthcare professionals need to appreciate that structured education represents one element of a patients-centred approach to diabetes care and not just another box to tick at the time of annual review.'

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