Lasting impact of an implemented self‐management programme for people with type 2 diabetes referred from primary care: a one‐group, before–after design

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The number of persons with type 2 diabetes has increased rapidly in recent years. In 1995, an estimated 135 million people worldwide had type 2 diabetes. The increase is associated with a parallel increase in obesity and increasing lack of physical activity in general 1. In 2013, the World Health Organization 1 estimated diabetes to be ranked as the seventh leading cause of death. Reducing death risk and preventing or delaying diabetes complications are vital in diabetes care. Diabetes care is to a great extent concerned with providing people with knowledge and skills, developing and maintaining attitudes and motivation required to self‐manage their diabetes effectively 2. Diabetes care is hence a complex educational challenge as it aims to adjust behaviour into enhanced self‐care. Diabetes self‐management education is the ongoing process to facilitate the necessary knowledge, skill and ability to self‐care behaviour 5. As knowledge achievement insufficiently promotes change, self‐management interventions have shifted from traditional teaching to incorporate a span of behavioural processes 6. The processes aims to support informed decision‐making, self‐care behaviours, problem‐solving and active collaboration with the healthcare team to improve clinical outcomes, health status and quality of life 5. Some patients with type 2 diabetes require insulin to reach their goal of HbA1c and need specified self‐management skills to be able to maintain a healthy lifestyle 7.
Systematic reviews and meta‐analyses show that group‐based educational research interventions for people with type 2 diabetes improve knowledge of diabetes in the short and long term, improve diabetes control (fasting blood glucose and glycated haemoglobin), and increase empowerment and self‐management skills 3. However, research interventions in uniform clinical settings and in patients fulfilling well‐defined inclusion criteria might show a more pronounced effect than implementing the same intervention in existing practice. The effectiveness of existing, locally adapted Diabetes Self‐Management Educations (DSMEs) in terms of diabetes knowledge, skills, and confidence in self‐managing diabetes and self‐efficacy needs to be assessed in unselected groups of patients. Hence, the aim of this study was to examine the short‐term impact and sustainability of an established DSME programme on diabetes knowledge in people with type 2 diabetes, implemented in a sample of unselected patients referred from primary care. We also determined how this programme affected the secondary outcomes, patient activation and self‐efficacy.

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