The impact of an online self-management programme for type 2 diabetes. The BEATdiabetes prospective service evaluation.

Abstract

To deliver and evaluate online, supported self-management interventions (BEATdiabetes) designed to promote lifestyle change and reduce psychological distress in type 2 diabetes (T2D). 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. 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/m²; 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). 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.