This study aims to evaluate a different approach to diabetes patient education. It begins with an overview of the epidemiology of Type 2 diabetes in recognition that although there have been major developments over the years in identifying and treating diabetes, people with diabetes are still dying prematurely and their quality of their life is still poor when compared to those without the condition.
Chapter 2 reviews definitions of health, health behaviour models, relevant international literature and its impact on national policy. Most countries are currently at the
experimental stage of developing therapeutic and self-management education programmes. However, routine patient education in Europe and the United States is still based largely on biomedical models.
A systematic review of group-based, therapeutic and self-management education programmes for adults with Type 2 diabetes is presented in Chapter 3. This reveals that
these approaches to diabetes education improve diabetes control, enhance patient knowledge of diabetes and reduce the requirement for diabetes medication. There is also
some evidence to suggest there is increased self-management skills, self-empowerment, quality of life and treatment satisfaction, although further research is recommended to
confirm those findings.
The tutor's manual for the expert patient programme "X-PERT" is presented in Chapter 4. This was written to encourage the delivery of the X-PERT programme to adults
living with Type 2 diabetes. It is designed to illustrate the theories of empowerment and patient activation. Delivery and content of this six-session, group-based, health professional-led diabetes expert patient programme is described in detail.
The research proposal for the randomised controlled trial is presented in Chapter 5. A brief background summary is followed by a full description of development of the
X-PERT trial, demographic aspects of Burnley, Pendle and Rossendale and the research design. The intervention group was invited to attend the X-PERT programme whilst the
control group received routine diabetes treatment.
The X-PERT trial tests the hypothesis that delivery of a professional-led, community based, diabetes-specific expert patient programme for adults with Type 2 diabetes based
on the theories of patient empowerment and patient activation would: (1) develop the skills and confidence needed for patients to be able to make informed decisions
regarding their diabetes self-management; (2) improve biomedical, lifestyle and psychosocial outcomes both in the short term (four months) and longer-term (14 months); (3) meet the International Diabetes Federation (IDF) structure and process standards regarding diabetes education.
The results, presented in Chapter 6, support each of the three aspects of the hypothesis stated above. The expert patients, compared with the control group, improved their
diabetes control, became more knowledgeable about their diabetes, had a greater sense of empowerment, increased their self-management skills and food related quality of life. Many of the IDF diabetes education standards were also addressed.
Chapter 7 considers the strengths and limitations of the trial. It then concludes that a structured, group-based approach to patient education, using models of patient
empowerment and activation, offers an improved approach to the treatment of Type 2 diabetes, a serious, expensive and increasing international problem. Pressures on NHS
resources from diabetes and its complications are large. Offering people living with diabetes the skills and confidence to self-manage their condition could bring immense benefits, both to those with the condition and to the NHS.