Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND)

See also: Dose adjustment for normal eating and exercise (DAFNE); Diabetes and Intercurrent Illness.

The National Service Framework (NSF) for diabetes¹ and NICE's technology appraisals of diabetes education models² explicitly state that all PCTs must commit to offering structured education programmes to people with type 2 diabetes from the point of diagnosis and as an ongoing part of their therapy in the long-term. The requirement for primary-care services to provide high-quality, structured education programmes to all people with diabetes was first identified in the planning and priorities framework and targets of the document Improvement, Expansion & Reform: The Next Three Years, published in 2003.³

DESMOND is such a structured education programme designed for patients with type 2 diabetes, and is the first one to meet the criteria set down by NICE for suitable education programmes; it has been developed as a collaborative project between service users, workers, Diabetes UK and the Department of Health.⁴

It is currently available to newly diagnosed type 2 diabetes patients (defined as those diagnosed in the last 2–3 months, increasing to 6–9 months where appropriate).⁴ It was piloted in 15 English PCTs between January and May 2004 and revised following feedback from all involved parties. The course provides 6 hours of structured group education based on a formal curriculum. It is offered either as a 1-day or 2-half-day sessions of teaching, for 6–10 patients at a time. Attendees may be accompanied by a person of their choice. Written material is provided to accompany the programme and allow later reference by graduates of the course. The course is delivered by two healthcare professionals trained as DESMOND educators. There is an ongoing quality assurance assessment for those who teach the course. The course aims to provide patients with a good foundation and practical skills to begin self-management of their diabetes. It empowers them to self-manage by providing a working understanding of their illness and through addressing issues around the initiation and sustaining of motivation.⁴ The curriculum provides the structured education under the broad topics outlined below.⁵

Initial abstracts of preliminary research findings were presented at the Diabetes UK annual conference in 2005.⁶ The main points were as follows:

• Illness beliefs do not match the medical model for many newly diagnosed type 2 patients, and beliefs about the impact, and the future prognosis of diabetes, are correlated with depressive symptomatology at diagnosis⁷
• Pilot data indicated the DESMOND course for newly diagnosed individuals changed important illness beliefs.⁸ At three month follow-up there was a reported improvement in quality of life and metabolic control.⁹

A larger randomised controlled trial was conducted involving 824 adult patients in 207 general practices in 13 primary care sites in the United Kingdom. The results showed that compared to patients who did not undergo the DESMOND programme there were greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but there were no differences in haemoglobin A1_c levels up to 12 months after diagnosis.¹⁰

• It hopes to promote understanding of type 2 diabetes, allowing patients to be more knowledgeable about what will positively benefit their long-term health as they live with the condition.
• The course aims to dispel any myths about the condition, and any illness beliefs that are false or potentially damaging.
• It should help patients to see their illness in a biomedical model, as well as the personal functional and social model that most use as their initial conceptual framework for understanding the impact of the illness.
• It should enable patients to effectively monitor their type 2 diabetes, realise when their control is inadequate, and enable them to self-manage their lifestyle, nutrition and medication to bring about improvement in diabetic control, or know when to seek professional help.
• It should enable them to be an active partner in the management of their type 2 diabetes, along with healthcare professionals.

All newly diagnosed type 2 diabetes patients should have access to a DESMOND programme. 69 areas now offer the programme. The DESMONDweb link in the internet section below is a good source of information and resources on what is happening nationally and in your locale, and on how you or your PCT can become part of the DESMOND programme.