Key findings | Increasing uptake of self-management education programmes for type 2 diabetes in primary care: the Embedding research programme including an RCT

Increasing uptake of self-management education programmes for type 2 diabetes in primary care: the Embedding research programme including an RCT · Key findings

Key findings

CC BY 4.0 · National Institute for Health and Care Research · approximately 3 min read

Workstream 1

An iterative, mixed-methods approach enabled design of an intervention for primary care. NPT usefully informed the design process (assimilating literature and qualitative data; conducting stakeholder consultations). Key intervention components for embedding SSME into primary care were:

clear marketing strategy for SSME
user-friendly and effective referral pathway
new/amended professional roles
toolkit of resources.

Workstream 2

We found that the RCT was feasible with design improvements, HbA1c (RCT primary outcome) was over 90% complete in primary care data, and 91% of patient questionnaire respondents consented to linking their questionnaire and primary care data. Most practices had limited intervention engagement, so it was planned that the RCT intervention implementation would focus on SSME providers.

Workstream 3

Baseline SSME attendance was higher than expected in wait-list (64%) and immediate (38%) practices. Most embedding activities remained at practice-level due to study-related logistical reasons. Practices interacted minimally with the intervention.

Overall, the Embedding Package did not affect HbA1c, SSME referrals and attendance, or most other secondary outcomes. HbA1c was statistically, but not clinically, significantly lower among ethnic minority individuals in intervention than control conditions; SSME attendance did not improve.

Practice, self-report and provider data were 39–66% complete for SSME referral and attendance. Each source used a different SSME definition.

Ethnography data showed that the intervention’s attractiveness and usefulness were not self-evident to practices and providers, despite efforts to ensure this during development. Most activity was embedder-led, with much less active work (sometimes none) by local stakeholders, who were better integrated with greater local knowledge than embedders, and thus may have been better placed to integrate the package into local practice. Finally, adapting the intervention to (often divergent) local contexts was important, and an embedder covering multiple localities was not necessarily best placed to undertake this.

Workstream 4

Intervention costs were calculated, with sensitivity analyses accounting for uncertainties around real-world implementation. The intervention cost per patient was £0.52 (£0.36 for sensitivity analysis).

Longer-term analyses (RCT and 12-month observational follow-up data) showed that HbA1c was lower and SSME attendance higher during intervention than control conditions. These results require caution, as ethnographic and implementation data suggest limited intervention implementation in most settings. Furthermore, the observational follow-up occurred during the COVID-19 pandemic when there was a substantial shift to online SSME and global messaging about the negative impact of COVID-19 in people with diabetes. However, these results suggest that the package could be effective with a longer period over which to realise its impact, perhaps reflecting that system-wide change may take longer than allowed for within the RCT design, and that the intervention was not patient facing so the indirect effect could take longer to materialise.

The qualitative substudy suggests acceptability of virtual SSME programmes. Despite IT challenges, feedback on virtual programme delivery was highly positive, particularly regarding financial and logistical benefits. Attendees and staff noted the lack of interaction and informal conversations with fellow attendees, and the inability to read body language and visual cues, were negative compared with face-to-face sessions. There was a strong indication that virtual SSME programmes have a place in future education delivery. The vision for SSME delivery is to progress with a blended approach, providing people with T2DM with a choice of format where virtual SSME complements face-to-face SSME.

Public involvement

Patient Participant Groups showed promise as a starting point for recruiting public involvement participants in new localities; however, they may lack diversity and rely on practices for initial engagement.

Attribution. Melanie J Davies; Shona Agarwal; Danielle H Bodicoat; Alan Brennan; Simon Dixon; Helen Eborall et al. (2025). Increasing uptake of self-management education programmes for type 2 diabetes in primary care: the Embedding research programme including an RCT. National Institute for Health and Care Research. Copyright © 2025 Davies et al. Licensed under CC BY 4.0. NCBI Bookshelf NBK612496. CC BY 4.0. Original source ↗. Text reproduced from the Bookshelf XML without changing wording; figures, images and supplements are not reproduced.