Abstract
Aims
To deliver and evaluate online, supported self-management interventions (BEATdiabetes) designed to promote lifestyle change and reduce psychological distress in type 2 diabetes (T2D).
Design & methods
A prospective service evaluation of BEATdiabetes, delivered within primary care in the National Health Service (NHS), 2019–2021. Primary outcome was absolute change in HbA1c and secondary outcomes were BMI, blood pressure (BP) and total cholesterol (TC) analysed using adjusted regression models. Pre- and post-analysis of the Diabetes Distress Scale (DDS) in the BEATdiabetes group only. The comparator population was The Salford Integrated Record (SIR, Salford, UK) diabetes cohort (no access to BEATdiabetes); matched by age, sex, ethnicity and BMI. Odds ratios (OR) evaluated achievement of clinical targets according to national guidelines.
Results
BEATdiabetes (n = 574) followed for median 217 days (interquartile range [IQR] 158–328); comparator group 241 days (IQR 187–328). BEATdiabetes had greater change in mean HbA1c (0.3 % DCCT; −3.3 mmol/mol; 95 % confidence interval [CI] −4.7 to −1.9 mmol/mol), BMI (-0.81 kg/m
; 95 % CI −1.07 to −0.54), systolic BP (-2.8 mmHg; 95 % CI −4.3 to −1.3; all P ' 0.001), and diastolic BP (-1.3 mmHg; 95 % CI −2.3 to −0.3; P ' 0.01). At baseline, n = 58 had DDS of ≥ 2 and n = 39 at follow-up (P = 0.023). BEATdiabetes had greater achievement target BP (OR 1.69 [95 % CI 1.28–2.24]), HbA1c (OR 1.79 [95 % CI 1.33–2.42]) and TC (OR 0.71 [95 % CI 0.50–0.99]). Estimated average cost per intervention was £ 149; 2021/2).
Conclusions
Combined online nutritional, psychological and behavioural intervention was more effective for weight and glycaemic reduction among adults with T2D, compared with usual care, with associated reduction in DDS.