Pilot study of an online diabetes education program

Problem

The number of people in England with T2DM is set to rise from 3.9 million in 2015 to 5 million in 2025. Structured education reduces the risk of complications and improves outcomes, and it is NHS policy that newly diagnosed patients are referred to structured education. But uptake remains low. Of the 183,098 people newly diagnosed with T2DM in 2012 – 13, only 16.7% were offered structured education and 3.6% attended.One reason for this is that almost all diabetes self-management education (DSME) is group-based. Studies suggest that barriers to face-to-face education include geographical isolation, transport difficulties, disability, work or carer commitments, and perceived stigma. The internet could help surmount many of these barriers, particularly now that 86% of the British population has home internet access.

Approach

HeLP-Diabetes: Starting Out is an online-self management education programme for T2DM developed by our team at UCL. It is informed by the Corbin and Strauss model of self-care for long term conditions (including medical, emotional and role management), and was developed with significant input from patients, healthcare professionals, academics and IT specialists. We have funding from an NIHR School for Primary Care Research (NSPCR) to carry out a 12 month pilot study in primary care, with the aim of determining acceptability and effectiveness, and to use the results to optimize the program and inform the design of a feasibility trial. The pilot study uses mixed methods, combining quantitative (referral rates, uptake, completion, self-reported outcomes) and qualitative (interview) data.

Findings

We have undergone one cycle of optimization, which recruited to target and led to a more stream-lined course structure, improved referral system and facilitation package. An iterative approach to testing digital interventions is common in computer science, and is recommended in the MRC guidance on the development of complex interventions. Qualitative data confirms that patients find the program useful, and improvements in Diabetes Self-Management Self-Efficacy Scale (DSMSES) scores show that patients become more confident about being able to manage their condition.

Consequences

Once we complete this research, and if we can prove the feasibility of a phase 3 randomised controlled trial (RCT), the likelihood of gaining further competitive funding for such an RCT and future implementation of the intervention in practice is high. This is because T2DM is such a priority, because structured education is NHS policy and because online education is likely to be more cost effective. The intervention is likely to appeal to commissioners due to the need for alternatives to face to face education, the potential for rapid implementation and the benefit to patients.