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Tytuł pozycji:

Delivering the Diabetes Remission Clinical Trial (DiRECT) in primary care: Experiences of healthcare professionals.

Tytuł:
Delivering the Diabetes Remission Clinical Trial (DiRECT) in primary care: Experiences of healthcare professionals.
Autorzy:
Rehackova L; Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.; Policy Innovation Research Unit, London School of Hygiene and Tropical Medicine, London, UK.
Taylor R; Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
Lean M; Human Nutrition, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK.
Barnes A; Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
McCombie L; Human Nutrition, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK.
Thom G; Human Nutrition, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK.
Brosnahan N; Human Nutrition, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK.
Leslie WS; Human Nutrition, School of Medicine Dentistry and Nursing, University of Glasgow, Glasgow, UK.
Sniehotta FF; Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.; Faculty of Behavioural, Management and Social Sciences (BMS), Twente University, Enschede, The Netherlands.
Źródło:
Diabetic medicine : a journal of the British Diabetic Association [Diabet Med] 2022 Mar; Vol. 39 (3), pp. e14752. Date of Electronic Publication: 2021 Dec 15.
Typ publikacji:
Journal Article; Research Support, Non-U.S. Gov't
Język:
English
Imprint Name(s):
Publication: Oxford : Blackwell Science
Original Publication: Chichester [Sussex, England] ; New York : Wiley, [c1984-
MeSH Terms:
Primary Health Care*
Randomized Controlled Trials as Topic*
Diabetes Mellitus, Type 2/*therapy
Health Personnel/*psychology
General Practice ; Health Personnel/education ; Humans ; Interviews as Topic ; Professional Role ; Qualitative Research ; Surveys and Questionnaires ; United Kingdom
References:
Lean MEJ, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391:541-551.
Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol. 2019;7:344-355.
Taheri S, Zaghloul H, Chagoury O, et al. Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol. 2020;8:477-489.
Leslie WS, Ford I, Sattar N, et al. The Diabetes Remission Clinical Trial (DiRECT): protocol for a cluster randomised trial. BMC Fam Pract. 2016;17:20.
NHS Choices. Very low calorie diets part of NHS action to tackle growing obesity and type 2 diabetes epidemic. Accessed March 26, 2021. https://www.england.nhs.uk/2018/11/very-low-calorie-diets-part-of-nhs-action-to-tackle-growing-obesity-and-type-2-diabetes-epidemic/.
Scottish Government. Scottish Indices of Multiple Deprivation. 2015.
Hopkins M, Andrews R, Salem V, et al. Improving understanding of type 2 diabetes remission: research recommendations from Diabetes UK’s 2019 remission workshop. Diabet Med. 2020;37:1944-1950.
Rehackova L, Rodrigues AM, Thom G, et al. Participant experiences in the Diabetes Remission Clinical Trial (DiRECT). Diabet Med. 2021. doi:10.1111/dme.14689.
Taylor R, Leslie WS, Barnes AC, et al. Clinical and metabolic features of the randomised controlled Diabetes Remission Clinical Trial (DiRECT) cohort. Diabetologia. 2018;61:589-598.
NICE. Obesity: identification, assessment and management. 2014. Accessed February 20, 2021. https://www.nice.org.uk/guidance/CG189.
SIGN. Management of obesity No 115. 2010. Accessed February 20, 2021. https://www.sign.ac.uk/assets/qrg115.pdf.
QSR International Pty Ltd. NVivo Qualitative Data Analysis Software 12. Pro Ed; 2020.
Sealed Envelope. Randomisation and online databases for clinical trials; 2017. Accessed December 10, 2021. https://www.sealedenvelope.com/.
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McSharry J, McGowan L, Farmer AJ, et al. Perceptions and experiences of taking oral medications for the treatment of type 2 diabetes mellitus: a systematic review and meta-synthesis of qualitative studies. Diabet Med. 2016;33:1330-1338.
Rehackova L, Araújo-Soares V, Adamson AJ, et al. Acceptability of a very-low-energy diet in type 2 diabetes: patient experiences and behaviour regulation. Diabet Med. 2017;34:1554-1567.
Brundisini F, Vanstone M, Hulan D, et al. Type 2 diabetes patients’ and providers’ differing perspectives on medication nonadherence: a qualitative meta-synthesis. BMC Health Serv Res. 2015;15:516.
Astbury NM, Albury C, Nourse R, et al. Participant experiences of a low-energy total diet replacement programme: a descriptive qualitative study. PLoS One. 2020;15:e0238645.
Kempf K, Röhling M, Niedermeier K, et al. Individualized meal replacement therapy improves clinically relevant long-term glycemic control in poorly controlled type 2 diabetes patients. Nutrients. 2018;10:1022.
Rehackova L, Arnott B, Araujo-Soares V, et al. Efficacy and acceptability of very low energy diets in overweight and obese people with type 2 diabetes mellitus: a systematic review with meta-analyses. Diabet Med. 2016;33:580-591.
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Stokes J, Gellatly J, Bower P, et al. Implementing a national diabetes prevention programme in England: lessons learned. BMC Health Serv Res. 2019;19:991.
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Halley M, Peterse J, Nasrallah C, Szwerinski NK, Romanelli R, Azar KMJ. Barriers and facilitators to real-world implementation of the diabetes prevention program in large healthcare systems: lifestyle coach perspectives. J Gen Intern Med. 2020;35(6):1684-1692. doi: 10.1007/s11606-020-05744-y.
Contributed Indexing:
Keywords: diabetes remission; evaluation; general practitioners; healthcare professionals; implementation; mixed methods
Entry Date(s):
Date Created: 20211127 Date Completed: 20220322 Latest Revision: 20220322
Update Code:
20240104
DOI:
10.1111/dme.14752
PMID:
34837259
Czasopismo naukowe
Objective: The Diabetes Remission Clinical Trial (DiRECT) used a formula total diet replacement programme followed by structured weight loss maintenance to induce and sustain weight loss and remission of type 2 diabetes (T2D) in 36% of participants after 2 years. Nurses and dietitians delivering DiRECT in 22 primary care practices in Tyneside and Scotland provided behavioural support to participants. Participant experiences with DiRECT highlighted the key role of support by healthcare professionals (HCPs). We evaluated HCPs' experiences with DiRECT.
Research Design and Methods: Healthcare professionals delivering DiRECT were interviewed at 12 months, while general practices (GPs) were sent an implementation questionnaire. The interviews were analysed thematically. The questionnaires were analysed using frequencies and a narrative synthesis.
Results: Healthcare professionals representing 11 of 22 intervention practices were interviewed and 10 of 22 GPs completed questionnaires. HCPs' initial concerns over perceived potential negative intervention effects, particularly withdrawing anti-diabetes and anti-hypertensive medications, were barriers to engagement. Trust of HCPs towards the research team and perceived credibility of the study facilitated engagement and adoption. Ongoing support by research dietitians was key to the management of participants. Involvement in DiRECT inspired more focus on behaviour modification in the treatment of other people living with T2D in routine practice.
Conclusions: Diabetes Remission Clinical Trial was considered highly appropriate for the management of T2D in primary care when supported by trained dietitians. Addressing limitations, including varying training needs of HCPs may improve intervention scale-up and tailoring to clinical contexts.
(© 2021 Diabetes UK.)

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