Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Policy Innovation Research Unit, London School of Hygiene and Tropical Medicine, London, UK.
Diabet Med. 2022 Mar;39(3):e14752. doi: 10.1111/dme.14752. Epub 2021 Dec 15.
The Diabetes Remission Clinical Trial (DiRECT) used a formula total diet replacement programme followed by structured weight loss maintenance to induce and sustain weight loss and remission of type 2 diabetes (T2D) in 36% of participants after 2 years. Nurses and dietitians delivering DiRECT in 22 primary care practices in Tyneside and Scotland provided behavioural support to participants. Participant experiences with DiRECT highlighted the key role of support by healthcare professionals (HCPs). We evaluated HCPs' experiences with DiRECT.
Healthcare professionals delivering DiRECT were interviewed at 12 months, while general practices (GPs) were sent an implementation questionnaire. The interviews were analysed thematically. The questionnaires were analysed using frequencies and a narrative synthesis.
Healthcare professionals representing 11 of 22 intervention practices were interviewed and 10 of 22 GPs completed questionnaires. HCPs' initial concerns over perceived potential negative intervention effects, particularly withdrawing anti-diabetes and anti-hypertensive medications, were barriers to engagement. Trust of HCPs towards the research team and perceived credibility of the study facilitated engagement and adoption. Ongoing support by research dietitians was key to the management of participants. Involvement in DiRECT inspired more focus on behaviour modification in the treatment of other people living with T2D in routine practice.
Diabetes Remission Clinical Trial was considered highly appropriate for the management of T2D in primary care when supported by trained dietitians. Addressing limitations, including varying training needs of HCPs may improve intervention scale-up and tailoring to clinical contexts.
糖尿病缓解临床试验（DiRECT）使用了一种总膳食替代方案的公式，随后进行结构化的体重维持，以在 2 年后诱导并维持 2 型糖尿病（T2D）患者的体重减轻和缓解，有 36%的参与者达到了这一效果。在泰恩赛德和苏格兰的 22 个初级保健诊所中，护士和营养师为参与者提供行为支持，以实施 DiRECT。参与者对 DiRECT 的体验突出了医疗保健专业人员（HCPs）支持的关键作用。我们评估了 HCPs 对 DiRECT 的体验。
在 12 个月时对实施 DiRECT 的医疗保健专业人员进行了访谈，同时向一般实践（GPs）发送了实施问卷。访谈采用主题分析方法进行分析。问卷分析采用频率和叙述性综合方法进行分析。
代表 22 个干预实践中的 11 个的医疗保健专业人员接受了访谈，22 个 GPs 中的 10 个完成了问卷。HCPs 最初对潜在的负面干预效果的担忧，特别是停止抗糖尿病和抗高血压药物的使用，是参与的障碍。HCPs 对研究团队的信任和对研究的可信度感知促进了参与和采用。研究营养师提供的持续支持是管理参与者的关键。参与 DiRECT 激发了更多关注行为改变，以在常规实践中治疗其他患有 T2D 的人。
当得到经过培训的营养师的支持时，糖尿病缓解临床试验被认为非常适合在初级保健中管理 T2D。解决包括 HCPs 培训需求不同在内的限制因素，可能会改善干预措施的推广和针对临床环境的调整。
