Specifying a patient education programme for people with type 2 diabetes
The key components of a patient education programme for people with type 2 diabetes are:
- identifying, and ensuring appropriate referral of, people with diabetes
- developing a high-quality patient education programme for people with type 2 diabetes that meets the criteria set in NICE clinical guideline CG66 on type 2 diabetes (update).
Identifying, and ensuring appropriate referral of, people with diabetes
The diagnosis and general management of type 2 diabetes is described in detail in NICE clinical guideline CG66 on type 2 diabetes (update). It is clearly important to identify people with diabetes needing or wanting education to ensure delivery of care based on the best available evidence. NICE recommends that structured education should be offered to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review as an integral part of diabetes care.
Ensuring that people with diabetes are referred for structured education is important both in terms of reducing the risk of complications, and also in managing service demand. These programmes are additional to the routine advice, education and support provided by the usual care team on an ongoing basis.
A Healthcare Commission report highlighted that some groups report poorer access to education than others. This includes some black and minority ethnic populations and people who have been diagnosed for some time or who are managed in primary care. NICE clinical guideline CG63 on diabetes in pregnancy also recommends a structured education programme for women who are, or who are planning to become, pregnant.
Developing a high-quality patient education programme for people with type 2 diabetes
NICE clinical guideline CG66 on type 2 diabetes (update) recommends that a patient education programme is selected that meets the criteria laid down by the Department of Health and Diabetes UK report on structured patient education in diabetes.
The programme should:
- have a person-centred, structured curriculum that is theory-driven and evidence-based, resource-effective, has supporting materials, and is written down
- be delivered by trained educators who have an understanding of education theory appropriate to the age and needs of the programme learners, and are trained and competent in the delivery of the principles and content of the programme they are offering, including the use of different teaching media
- provide the necessary resources to support the educators, and that the educators are properly trained and given time to develop and maintain their skills
- have specific aims and learning objectives and should support development of self-management attitudes, beliefs, knowledge and skills for the learner, their family and carers
- be reliable, valid, relevant and comprehensive
- be flexible enough to suit the needs of the individual (for example including the assessment of individual learning needs) and to cope with diversity, for example meeting the cultural, linguistic, cognitive and literacy needs in the locality
- offer group education as the preferred option, but with an alternative of equal standard for a person unable or unwilling to participate in group education
- be familiar to all members of the diabetes healthcare team and integrated with the rest of the care pathway, and that people with diabetes and their carers have the opportunity to contribute to the design and provision of local programmes
- be quality assured and be reviewed by trained, competent, independent assessors who assess it against key criteria to ensure sustained consistency
- have its outcomes regularly audited.
The way that education programmes are advertised and explained to people with diabetes influences their uptake. It should be emphasised that education programmes are an important and routine part of good patient care. The range of benefits for patients described in Commissioning a patient education programme for people with type 2 diabetes section in this guide should also be made clear. The programmes aim to improve people's health and confidence so that they can care for themselves, rather than simply increasing their knowledge. Commissioners may wish to consider delivering a patient education programme for people with type 2 diabetes in a number of different ways, and mixed models of provision may be appropriate across a local health economy.
Commissioners may also want to review the accessibility of the existing programmes, as well as planned new programmes, in terms of timing, location, premises and other barriers.
Local stakeholders, including service users and their carers, should be involved in determining what is needed from a patient education programme for people with type 2 diabetes in order to meet local needs. The service should be patient-centred and integrated with other elements of care for people with type 2 diabetes. When developing, commissioning or providing a patient education programme in diabetes, there are opportunities to explore relationships and potential collaboration with the voluntary and charitable sectors and other organisations.
- DESMOND was developed by a collaborative group seeking to improve opportunities for learning and support for people newly diagnosed with diabetes and the healthcare professionals working with them.
- The X-PERT programme provides a structured approach to patient education in diabetes and is aimed at people with established diabetes.
- The Warwick diabetes manual is aimed at people with a new diagnosis of type 2 diabetes, to improve their self-management. It can be delivered by healthcare professionals from primary or secondary care who are experienced in diabetes management.
- Other local programmes, such as those described by the Diabetes Education Network, can be reviewed against the criteria laid out above using the self-assessment toolkit.
The service specification needs to consider:
- how it will meet the requirements set out above and in the Department of Health and Diabetes UK report on structured patient education in diabetes
- other NICE guidance relevant to structured education, including PH1 Brief interventions and referral for smoking cessation; PH2 Four commonly used methods to increase physical activity; PH6 Behaviour change; PH8 Physical activity and the environment; PH10 Smoking cessation services and CG43 Obesity
- the required competencies of, and training for, staff responsible for providing the service
- the expected number of patients (this should take into account how quickly any changes in service provision are likely to take place) and how to engage hard-to-reach groups
- ease of access and service location; commissioners should engage with service users and other relevant individuals and organisations locally
- care and referral pathways
- information and audit requirements, including IT support and infrastructure
- planned service improvement, including redesign, quality, equitable access
- service monitoring criteria.
Useful sources of information may include:
- The NICE Pathway for diabetes care provides an information resource which visually organises NICE recommendations about diabetes management.
- The NICE Quality Standard for Diabetes in adults is a set of specific, concise statements which sets out high quality, cost-effective diabetes care.
- The NICE shared learning database offers examples of how organisations have implemented NICE guidance locally.
- The Department of Health and Diabetes UK Patient Education Working Group report sets out the requirements for developing a high-quality patient education programme.
- The Department of Health, in conjunction with Diabetes UK and the National Diabetes Support Team, has published an improvement toolkit on how to assess structured diabetes education and improve services and the number of educators.
- The Diabetes commissioning toolkit describes how to ‘carry out a health needs assessment for a local diabetes population and provides a generic specification for diabetes care, signposting recognised quality markers and suggesting key outcomes for the service'.
- The Diabetes Education Network provides resources to help diabetes teams across the UK provide high quality self-management education for their patients.
- A 2008 health technology assessment provided a systematic review of the clinical and cost-effectiveness of models for educating adults with type 2 diabetes in diabetes self-management
This page was last updated: 03 April 2012
- Commissioning a patient education programme for people with type 2 diabetes
- Specifying a patient education programme for people with type 2 diabetes
- Determining local service levels for a patient education programme for people with type 2 diabetes
- Assumptions used in estimating a population benchmark
- The commissioning tool
- Ensuring corporate quality assurance