Diabetes structured self-management education programmes: a narrative review and current innovations

Both type 1 and type 2 diabetes are associated with long-term complications that can be prevented or delayed by intensive glycaemic management. People who are empowered and skilled to self-manage their diabetes have improved health outcomes. Over the past 20 years, diabetes self-management education programmes have been shown to be efficacious and cost-effective in promotion and facilitation of self-management, with improvements in patients' knowledge, skills, and motivation leading to improved biomedical, behavioural, and psychosocial outcomes. Diabetes self-management education programmes, developed robustly with an evidence-based structured curriculum, vary in their method of delivery, content, and use of technology, person-centred philosophy, and specific aims. They are delivered by trained educators, and monitored for quality by independent assessors and routine audit. Self-management education should be tailored to specific populations, taking into consideration the type of diabetes, and ethnic, social, cognitive, literacy, and cultural factors. Ways to improve access to and uptake of diabetes self-management programmes are needed globally. Both type 1 and type 2 diabetes are associated with long-term complications that can be prevented or delayed by intensive glycaemic management. People who are empowered and skilled to self-manage their diabetes have improved health outcomes. Over the past 20 years, diabetes self-management education programmes have been shown to be efficacious and cost-effective in promotion and facilitation of self-management, with improvements in patients' knowledge, skills, and motivation leading to improved biomedical, behavioural, and psychosocial outcomes. Diabetes self-management education programmes, developed robustly with an evidence-based structured curriculum, vary in their method of delivery, content, and use of technology, person-centred philosophy, and specific aims. They are delivered by trained educators, and monitored for quality by independent assessors and routine audit. Self-management education should be tailored to specific populations, taking into consideration the type of diabetes, and ethnic, social, cognitive, literacy, and cultural factors. Ways to improve access to and uptake of diabetes self-management programmes are needed globally. Jane Speight: tackling diabetes and its stigma Down UnderJane Speight is not fond of the label “diabetic”—she feels that calling people by their medical condition contributes to stigma. Australia has a growing number of people who, to her chagrin, might be labelled as diabetics. Out of a total population of about 24·5 million, Australia has more than 1·25 million people with diagnosed diabetes, including about 1·1 million with type 2 diabetes (about 500 000 more are estimated to have undiagnosed type 2 diabetes). Speight has called for increased research investment—particularly regarding behavioural and psychological research—from the Government. Full-Text PDF Correction to Lancet Diabetes Endocrinol 2018; 6: 130–42Chatterjee S, Davies MJ, Heller S, Speight J, Snoek FJ, Khunti K. Diabetes structured self-management education programmes: a narrative review and current innovations. Lancet Diabetes Endocrinol 2017; published online Sept 29. http://dx.doi.org/10.1016/S2213-8587(17)30239-5—In table 2 of this Review, the short-term biomedical outcomes for the Dose Adjustment for Normal Eating (OzDafne) study should read “12 months: HbA1c 0·2% reduction in people above the target at baseline (p<0·001), severe hypoglycaemia reduction (p<0·001), weight 0·7 kg decrease (p=0·01), and reduction in hospital admission for diabetic ketoacidosis (non-significant trend)”. Full-Text PDF Technology and chronic disease management – Authors' replyWe thank Dinesh Visva Gunasekeran for his comments on our Review1 regarding the use of web-based platforms and technology in chronic disease management. We agree that clinical outcomes vary depending on study design when testing digital health interventions. However, in a systematic review2 of 25 studies assessing mobile phones, secure messaging, social media, and video conferencing for the enhancement of diabetes self-management education and support, the investigators reported reductions in HbA1c (mean difference intervention vs control 0·3–0·9%) in 18 studies. Full-Text PDF Technology and chronic disease managementIn their Review1 on structured self-management education for people with diabetes, Sudesna Chatterjee and colleagues discuss the promise of web-based platforms and new technologies in enhancing the management of chronic diseases. However, not all digital health interventions have similar success when robust study designs are used,2 even in the context of chronic diseases such as type 2 diabetes.3 Full-Text PDF