title: Increasing capacity to deliver diabetes self-management education: results of the DESMOND lay educator non-randomized controlled equivalence trial.
abstract: OBJECTIVE
  To develop and test a format of delivery of diabetes self-management education by paired professional and lay educators.
  
  
  METHODS
  We conducted an equivalence trial with non-randomized participant allocation to a Diabetes Education and Self Management for Ongoing and Newly Diagnosed Type 2 diabetes (DESMOND) course, delivered in the standard format by two trained healthcare professional educators (to the control group) or by one trained lay educator and one professional educator (to the intervention group). A total of 260 people with Type 2 diabetes diagnosed within the previous 12 months were referred for self-management education as part of routine care and attended either a control or intervention format DESMOND course. The primary outcome measure was change in illness coherence score (derived from the Diabetes Illness Perception Questionnaire-Revised) between baseline and 4 months after attending education sessions. Secondary outcome measures included change in HbA1c level. The trial was conducted in four primary care organizations across England and Scotland.
  
  
  RESULTS
  The 95% CI for the between-group difference in positive change in coherence scores was within the pre-set limits of equivalence (difference = 0.22, 95% CI 1.07 to 1.52). Equivalent changes related to secondary outcome measures were also observed, including equivalent reductions in HbA1c levels.
  
  
  CONCLUSIONS
  Diabetes education delivered jointly by a trained lay person and a healthcare professional educator with the same educator role can provide equivalent patient benefits. This could provide a method that increases capacity, maintains quality and is cost-effective, while increasing access to self-management education.
authors.affiliation: Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.
authors.forename: M E
authors.initials: ME
authors.lastname: Carey
authors.forename: P K
authors.initials: PK
authors.lastname: Mandalia
authors.forename: H
authors.initials: H
authors.lastname: Daly
authors.forename: L J
authors.initials: LJ
authors.lastname: Gray
authors.forename: R
authors.initials: R
authors.lastname: Hale
authors.forename: L
authors.initials: L
authors.lastname: Martin Stacey
authors.forename: N
authors.initials: N
authors.lastname: Taub
authors.forename: T C
authors.initials: TC
authors.lastname: Skinner
authors.forename: M
authors.initials: M
authors.lastname: Stone
authors.forename: S
authors.initials: S
authors.lastname: Heller
authors.forename: K
authors.initials: K
authors.lastname: Khunti
authors.forename: M J
authors.initials: MJ
authors.lastname: Davies
mesh_terms: D000368:Aged; D057191:Capacity Building; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006126:Group Processes; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D008297:Male; D008611:Mentors; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D010865:Pilot Projects; D012606:Scotland; D012648:Self Care; D000078329:Workforce
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human