Education and support for people living with diabetes

Module 2: Structured education for people living with type 2 diabetes: the UK experience

Welcome to this EASD e-Learning module on Structured education for the self-management of people living with type 2 diabetes: the UK experience co-authored by Prof. Melanie Davies, Dr. Michelle Hadjiconstantinou and Alison Northern, Msc.  

Throughout this module, the co-authors use the UK’s DESMOND and MyDESMOND programmes as examples to show how evidence, educational theory, and practical delivery tools come together to create impactful structured education.

What is structured education?
According to the 2022 ADA/EASD consensus report on the management of hyperglycaemia in type 2 diabetes, diabetes self-management education and support (DSMES) is “delivered through structured educational programmes provided by trained diabetes care and education specialists… that focus particularly on… lifestyle behaviours (healthy eating, physical activity and weight management), medication-taking behaviour, self-monitoring when needed, self-efficacy, coping and problem-solving.”

About the authors and their chapters

Chapters 1 & 2

Melanie Davies is Professor of Diabetes Medicine at the University of Leicester and an Honorary Consultant Diabetologist at the University Hospitals of Leicester NHS Trust. As one of the founding leads of the Leicester Diabetes Centre, she has been at the forefront of developing and evaluating structured education programmes for people living with type 2 diabetes.

1. In this module, Professor Davies introduces the rationale for structured education and tells the story of how the DESMOND programme was established.
2. Drawing on the largest randomised controlled trial of its kind, she demonstrates that structured education can deliver improvements not only in glycaemic control and cardiovascular risk factors, but also in key psychosocial outcomes such as treatment satisfaction, depression, well-being, quality of life and health behaviours such as smoking.
3. She also reviews the evidence from systematic reviews and meta-analyses, and outlines the criteria that define structured education: a clear evidence base, delivery by trained educators, grounding in theory, cost-effectiveness, and ongoing quality assurance.

Chapters 3 & 4

Michelle Hadjiconstantinou is a Behavioural Scientist and a Chartered Psychologist at the University of Leicester and the Leicester Diabetes Centre with expertise in behaviour change and the development and evaluation of diabetes self-management education programmes. Her contribution to this module focuses on the theoretical underpinnings and frameworks that shape effective programmes.

1. She introduces the Medical Research Council (MRC) Framework for complex interventions, which emphasises the importance of context, stakeholder engagement, feasibility testing, evaluation and implementation.
2. She also explores behaviour change models such as the behaviour change wheel, intervention mapping and the person-based approach, which provide practical tools for intervention design.
3. Finally, she outlines the psychological and learning theories that underpin DESMOND — Social Learning Theory, Self-Regulation Theory, and Dual-Process Theory — showing how concepts such as self-efficacy, illness representations and modes of information processing explain the mechanisms of behaviour change in structured education.

Chapters 6 to 9

Alison Northern is an Implementation Lead at the Leicester Diabetes Centre with extensive experience in rolling out structured education programmes across the NHS and beyond. Her chapters of the module are highly practical, showing how evidence-based interventions can be delivered and sustained at scale.

1. She describes the evolution of DESMOND from face-to-face delivery to virtual formats, including the digital platform MyDESMOND, which has been shown to reduce emotional distress and increase self-efficacy in people living with type 2 diabetes.
2. She explains how quality is maintained through structured educator training, competency assessment, governance processes and referral pathway support.
3. Alison also addresses real-world barriers to uptake, such as work and family commitments, transport, cultural or language challenges, and the perception among some patients that they already know enough.
4. Finally, she shares tactics to overcome these barriers, ensuring that structured education reaches as many people as possible.

References

Davies MJ, Aroda VR, Collins BS, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45(11):2753-2786. doi:10.2337/dci22-0034

This module includes self-marked assessments, such as knowledge checks and/or case studies, as well as a marked final assessment, which you can attempt up to five times. To complete the module, you must review all chapters, pass the final assessment (80% pass mark), and fill in our feedback form.