Carey M E, Mandalia P K, Daly H, Gray L J, Hale R, Martin Stacey L, Taub N, Skinner T C, Stone M, Heller S, Khunti K, Davies M J
Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.
Diabet Med. 2014 Nov;31(11):1431-8. doi: 10.1111/dme.12483. Epub 2014 May 26.
To develop and test a format of delivery of diabetes self-management education by paired professional and lay educators.
We conducted an equivalence trial with non-randomized participant allocation to a Diabetes Education and Self Management for Ongoing and Newly Diagnosed Type 2 diabetes (DESMOND) course, delivered in the standard format by two trained healthcare professional educators (to the control group) or by one trained lay educator and one professional educator (to the intervention group). A total of 260 people with Type 2 diabetes diagnosed within the previous 12 months were referred for self-management education as part of routine care and attended either a control or intervention format DESMOND course. The primary outcome measure was change in illness coherence score (derived from the Diabetes Illness Perception Questionnaire-Revised) between baseline and 4 months after attending education sessions. Secondary outcome measures included change in HbA1c level. The trial was conducted in four primary care organizations across England and Scotland.
The 95% CI for the between-group difference in positive change in coherence scores was within the pre-set limits of equivalence (difference = 0.22, 95% CI 1.07 to 1.52). Equivalent changes related to secondary outcome measures were also observed, including equivalent reductions in HbA1c levels.
Diabetes education delivered jointly by a trained lay person and a healthcare professional educator with the same educator role can provide equivalent patient benefits. This could provide a method that increases capacity, maintains quality and is cost-effective, while increasing access to self-management education.
开发并测试由专业教育工作者和非专业教育工作者配对进行糖尿病自我管理教育的授课形式。
我们进行了一项等效性试验，将参与者非随机分配至2型糖尿病持续及新诊断患者糖尿病教育与自我管理（DESMOND）课程，对照组由两名经过培训的专业医护教育工作者以标准形式授课，干预组由一名经过培训的非专业教育工作者和一名专业教育工作者授课。共有260名在过去12个月内确诊的2型糖尿病患者作为常规护理的一部分被转介接受自我管理教育，并参加了对照组或干预组形式的DESMOND课程。主要结局指标是参加教育课程后基线至4个月期间疾病连贯得分（源自修订后的糖尿病疾病认知问卷）的变化。次要结局指标包括糖化血红蛋白（HbA1c）水平的变化。该试验在英格兰和苏格兰的四个初级保健机构进行。
连贯得分正向变化的组间差异的95%置信区间在预先设定的等效性范围内（差异 = 0.22，95%置信区间为1.07至1.52）。在次要结局指标方面也观察到了等效变化，包括HbA1c水平的等效降低。
由一名经过培训的非专业人员和一名担任相同教育者角色的专业医护教育工作者联合开展的糖尿病教育可给患者带来同等益处。这可以提供一种增加服务能力、维持质量且具有成本效益的方法，同时增加自我管理教育的可及性。
