title: Effects of the Diabetes Manual 1:1 structured education in primary care.
abstract: OBJECTIVE
  To determine the effects of the Diabetes Manual on glycaemic control, diabetes-related distress and confidence to self-care of patients with Type 2 diabetes.
  
  
  METHODS
  A cluster randomized, controlled trial of an intervention group vs. a 6-month delayed-intervention control group with a nested qualitative study. Participants were 48 urban general practices in the West Midlands, UK, with high population deprivation levels and 245 adults with Type 2 diabetes with a mean age of 62 years recruited pre-randomization. The Diabetes Manual is 1:1 structured education designed for delivery by practice nurses. Measured outcomes were HbA(1c), cardiovascular risk factors, diabetes-related distress measured by the Problem Areas in Diabetes Scale and confidence to self-care measured by the Diabetes Management Self-Efficacy Scale. Outcomes were assessed at baseline and 26 weeks.
  
  
  RESULTS
  There was no significant difference in HbA(1c) between the intervention group and the control group [difference -0.08%, 95% confidence interval (CI) -0.28, 0.11]. Diabetes-related distress scores were lower in the intervention group compared with the control group (difference -4.5, 95% CI -8.1, -1.0). Confidence to self-care Scores were 11.2 points higher (95% CI 4.4, 18.0) in the intervention group compared with the control group. The patient response rate was 18.5%.
  
  
  CONCLUSIONS
  In this population, the Diabetes Manual achieved a small improvement in patient diabetes-related distress and confidence to self-care over 26 weeks, without a change in glycaemic control. Further study is needed to optimize the intervention and characterize those for whom it is more clinically and psychologically effective to support its use in primary care.
authors.affiliation: Warwick Medical School, University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK. jackie.sturt@warwick.ac.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Sturt
authors.forename: S
authors.initials: S
authors.lastname: Whitlock
authors.forename: C
authors.initials: C
authors.lastname: Fox
authors.forename: H
authors.initials: H
authors.lastname: Hearnshaw
authors.forename: A J
authors.initials: AJ
authors.lastname: Farmer
authors.forename: M
authors.initials: M
authors.lastname: Wakelin
authors.forename: S
authors.initials: S
authors.lastname: Eldridge
authors.forename: F
authors.initials: F
authors.lastname: Griffiths
authors.forename: J
authors.initials: J
authors.lastname: Dale
mesh_terms: D000368:Aged; D016000:Cluster Analysis; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008370:Manuals as Topic; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000592:standards*; D012648:Self Care / Q000523:psychology