Participant outcomes evaluation of the DWELL (Diabetes and WELLbeing) type 2 diabetes 12-week psychoeducational self-management programme across four European countries

Introduction Type 2 diabetes mellitus (T2DM) is a lifelong condition that has large societal, economic and clinical implications, and treatment should be supported by healthy lifestyle factors. Interventions for effective self-management are essential to the sustainability of treatment, however there is no standard approach. Research Design and Methods Six hundred and five participants diagnosed with Type 2 Diabetes Mellitus were recruited from four countries (UK, France, Netherlands, Belgium) to complete the 12-week DWELL (Diabetes and WELLbeing) psychoeducational intervention. The programme was delivered at community and hospital-based settings and comprised of four key areas: education, nutrition, physical activity and wellbeing. Metabolic health (weight, waist size, BMI and HbA1c) and self-reported psychological measures were taken at four points: pre- and post-intervention, and two follow up points (at 6 and 12 months) to assess the impact of the programme.

Participants showed a significant reduction in all metabolic health measures, with improvements in both weight and BMI being maintained at 6-month follow-up. Participation in the programme also led to enhanced levels of participant empowerment, with significant improvements also seen in perceptions of diabetes, eating behaviours, mental and physical health, and self-care behaviours.

The study results demonstrated that an empowerment-based, holistic and flexible approach to diabetes self-management education programmes has a wider impact in improving longer term coping behaviours which help in achieving and sustaining positive metabolic and psychological changes. What is already known on this topic Diabetes education has evolved from a compliance and knowledge-oriented approach to an empowerment and self-management-oriented approach. Yet, type 2 diabetes self-management education (DSME) programmes are mainly evaluated in relation to impact on metabolic (glycaemic) outcomes than on wider psychosocial outcomes. What this study adds Participation in the DWELL programme led to significant improvements in metabolic health measures and produced significant positive changes across a range of psychological measures such as patient empowerment, illness perceptions, eating behaviours and self-care behaviours. How this study might affect research, practice or policy The DWELL DSME programme which was co-designed with patients, healthcare professionals and family carers, focussed on patient empowerment and self-control, by offering flexibility and choice of options as well as peer support. Programme outcomes indicated that this approach led to positive changes in empowering and enabling health behaviour changes and improvements in metabolic health. The study adds to the body of knowledge of patient-led DSME practice with a holistic approach. Further research could shed light on the cultural and intersectional aspects of such approach that can inform more targeted programmes supporting T2DM patients with multiple co-morbidities such as serious mental health conditions. Competing Interest Statement The authors have declared no competing interest. Funding Statement The DWELL study was funded by the EU Interreg 2 Seas Mers Zeeen Programme 2014-2020 (co-funded by the European Regional Development Fund). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Health Research Authority/London Bridge Research Ethics Committee gave ethical approval for this work (REC reference: 17/LO/1480) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes s.manship{at}kent.ac.uk, Rachael.Morris{at}eefoundation.org.uk, tet1{at}hotmail.co.uk, julia.moore{at}uca.ac.uk, S.Hulbert{at}kent.ac.uk, david.vernon{at}canterbury.ac.uk Data Availability All data produced in the present work are contained in the manuscript.