£1000: The cost of delivering a type 2 diabetes remission programme in the NHS

University of Glasgow | December 2018 | £1000: The cost of delivering a type 2 diabetes remission programme in the NHS

A new study that involved researchers from the universities of Glasgow and Newcastle suggests rolling out a Type 2 diabetes remission programme in the NHS could cost around £1,067 per participant in its first year – or, factoring in the likelihood of success, £2,564 for each case of remission. Researchers say findings ‘make the case for shifting resources to offer remission’ in the future.

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Calculating the cost of the the 12-month programme, accounting for savings for reduced drug and medical needs, was £1,067. The researchers compared the treatment costs of the two groups in DiRECT: those on the weight loss programme (the intervention group), and those receiving current standard NHS care (the control group).

Mike Lean, Professor of Human Nutrition at the University of Glasgow and consultant physician at Glasgow Royal Infirmary, said: “The cost of a year’s programme to achieve remission of Type 2 diabetes is less than the annual cost of continuing to treat this progressive and often debilitating condition – particularly at its later stages. It is becoming hard to see why, ethically, people with Type 2 diabetes should not be offered the chance, and supported, to achieve remission if they can. This is no quick fix, but instead a promising medical treatment with potentially huge benefits.”

DiRECT is testing a low-calorie weight management programme in over 300 people across Glasgow and Tyneside. The programme, which involves an 800 calorie liquid diet and structured, long-term support from a healthcare professional to reintroduce healthy food and maintain the weight loss, is aiming to establish if the approach could put people with Type 2 diabetes into remission and keep them there in the longer term.

The programme is delivered within NHS primary care, it is relatively inexpensive compared to serious and expensive complications of Type 2 diabetes

A new study suggests rolling out a Type 2 diabetes remission programme in the NHS could cost around £1,067 per participant in its first year – or, factoring in the likelihood of success, £2,564 for each case of remission. Researchers say findings ‘make the case for shifting resources to offer remission’ in the future (Source: University of Glasgow).

Read more about the research in this press release University of Glasgow 

The article is available to read from the Lancet Diabetes & Endocrinology

Follow-Up Support for Effective type 1 Diabetes self-management (The FUSED Model)

Full reference: Campbell, F., et al. |2018| Follow-Up Support for Effective type 1 Diabetes self-management (The FUSED Model): A systematic review and meta-ethnography of the barriers, facilitators and recommendations for sustaining self-management skills after attending a structured education programme| BMC health services research| 18|1| 898|https://doi.org/10.1186/s12913-018-3655-z

Researchers from ScHARR (School of Health and Related Research) are part of a research team that has looked at a series of qualitative studies that identify factors that inform and influence people’s self management behaviours following attendance of strucutred education sessions. It is anticipated that their findings will be used to inform the design of more effective support; with the reserachers presenting ten recommendations abstracted from the papers reviewed to provide a model for a programme of individualised and responsive follow-up support.

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Abstract 

Background

People with type 1 diabetes who attend structured education training in self-management using flexible intensive therapy achieve improved blood glucose control and experience fewer episodes of severe hypoglycaemia. However, many struggle to sustain these improvements over time. To inform the design of more effective follow-up support we undertook a review of qualitative studies which have identified factors that influence and inform participants’ self-management behaviours after attending structured education and their need for support to sustain improvements in glycaemic control.

 

Methods

We undertook a meta-ethnography of relevant qualitative studies, identified using systematic search methods. Studies were included which focused on participants’ experiences of self-managing type 1 diabetes after attending structured education which incorporated training in flexible intensive insulin therapy. A line of argument approach was used to synthesise the findings.

 

Results

The search identified 18 papers from six studies. The studies included were judged to be of high methodological quality. The line of argument synthesis developed the Follow-USupport for Effective type 1 Diabetes self-management (FUSED) model. This model outlines the challenges participants encounter in maintaining diabetes self-management practices after attending structured education, and describes how participants try to address these barriers by adapting, simplifying or personalising the self-management approaches they have learned. To help participants maintain the skills taught during courses, the FUSED model presents ten recommendations abstracted from the included papers to provide a logic model for a programme of individualised and responsive follow-up support.

 

Conclusions

This meta-ethnography highlights how providing skills training using structured education to people with type 1 diabetes does not necessarily result in participants adopting and sustaining recommended changes in behaviour. To help people sustain diabetes self-management skills after attending structured education, it is recommended that support be provided over the longer-term by appropriately trained healthcare professionals which is responsive to individuals’ needs. Although developed to inform support for people with type 1 diabetes, the FUSED model provides a framework that could also be applied to support individuals with other long term conditions which require complex self-management skills to be learned and sustained over time.

The full article is available to read from BMC Health Services Research

Leicester professors urge NHS to tackle diabetes “before it’s too late”

Two professors from the University of Leicester are calling on the NHS to address the ticking time bomb that is type 2 diabetes, by implementing a a structured diabetes programme for those at risk of developing the condition and also patients with diabetes.

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Professor Melanie Davies CBE, a professor of Diabetes Medicine at the University of Leicester and Co-Director of the Leicester Diabetes Centre, explained:

“In the last two years there has been a number of high-quality research publications that have consolidated the evidence for the effectiveness of structured self-management education and has even shown that good evidence based programmes can save lives.”

Her colleague Professor Kasmlesh Khunti, who is also Co-Director of the Leicester Diabetes Centre, added: “We already know that type 2 figures is a ticking time health bomb, with figures significantly rising year on year.

“Not only is the condition a health issue, but it’s also a financial drain on the NHS. As all the research indicates structured education can significantly make a difference, I urge all NHS decision makers to start incorporating it among their treatment pathways before it’s too late.

Both professors are part of a team that is currently rolling out the Embedding study, which involves developing and testing an ‘embedding package’ of practical advice and solutions to facilitate an increase in uptake to structured education for self-management of type 2 diabetes.

There are several different structured education programmes available for people to follow. One, which has had much success with people, is the Diabetes Education and Self-Management for Ongoing and Diagnosed (Desmond) programme.

The programme has been supporting patients with type 2 diabetes and equipping them with the skills necessary to manage their condition since 2003.

It was developed by researchers based at the Leicester Diabetes Centre, recently named an ‘International Centre of Excellence’ and an ‘International Centre of Education’ by the International Diabetes Federation (IDF) (Source University of Leicester).

The full press release  is available from the University of Leicester