Clinical FeaturesEndocrine/Metabolic

Structured Education for People living with Type 2 Diabetes (T2DM)

Clair Naughton, Regional Development Officer, Diabetes Ireland

Type 2 diabetes (T2DM) is a condition that can be complex to manage, with most of the management decided on daily by the person living with diabetes. Effective self-management of diabetes requires knowledge, skills and confidence as many decisions and healthy lifestyle choices need to be made by each individual day to day. Equipping a person with self-management skills and promoting empowerment in selfcare is challenging for healthcare professionals in a clinical setting, given the limited time for consultation and everything that needs to be discussed in a routine diabetes review. Self-management support interventions such as structured patient education (SPE) programmes are widely accepted to be an integral part of the management of T2DM.

The HIQA Health Technology Assessment of Chronic Disease Self-Management Support Interventions published in December 2015 showed there is very good evidence that SPE, can improve blood glucose control in patients with T2DM. This report also suggests that diabetes self-management education programmes are cost effective relative to usual care.

One of the recommendations from the HSE Model of Integrated care for the patients with Type 2 diabetes is that “within three months of being newly diagnosed with Type 2 diabetes people should receive a structured type 2 diabetes education package. This package will give the patient appropriate dietetic input and advice regarding their clinical care”.

Currently in Ireland there are three structured education programmes for people with T2DM: CODE – Community Orientated Diabetes Education, DESMOND – Diabetes Education and Self-Management for On-going and Newly Diagnosed diabetes and DISCOVER DIABETES – Diabetes Insights and self-care options via education and reflection. All three programmes are supported by the HSE and are free to attend.

CODE (Community Orientated Diabetes Education) is Diabetes Ireland’s structured education programme for people living with T2DM. Running since 2008, the programme shows positive results for people who attend in biomedical markers, knowledge, empowerment, and quality of life. CODE is philosophically based on empowerment, empathy, and self-efficacy. The structured curriculum is delivered by diabetes healthcare professionals with accredited facilitation training, using the theories of adult learning to ensure that learning is needs based, structured, developmental, and participatory.

The delivery of the programme is such that most of the learning takes places through group discussion and shared experiences. The format of the programme makes diabetes information more accessible and ensures that knowledge is imparted based on the unique needs of each group. CODE allows people to speak about their diabetes, in a supportive setting for the benefit of all in the group. Time is allocated for feedback on self-management behaviours, healthy eating and physical activity planning, management targets and goal setting.

Currently being delivered online CODE supports and supplements care from the individual’s own diabetes team so that knowledge and skills are reinforced placing emphasis on the personal responsibility each individual has to manage their diabetes. CODE empowers individuals to take an active role in their diabetes care, to live healthily and to maintain and improve their quality of life through informed decision making.

Delivered over four 2-hour sessions (the first 3 sessions are held over 3 consecutive weeks, a 10 week phone call and a final session held at six months), CODE has the flexibility to meet the needs of each individual group. Topics covered include:

Week 1

  • Personal story, what are the collective needs of the group
  • Explanation of types of diabetes, risk factors, signs and symptoms
  • What are normal glucose levels and understanding hypo and hyperglycaemia
  • Treatments for diabetes

Week 2

  • Physical activity – benefits, barriers and recommendations
  • Understanding healthy eating guidelines for T2DM,
  • Understanding carbohydrates and how portions affect glucose levels
  • Individual goal setting

Week 3

  • Potential complications of diabetes and the importance of screening at annual review
  • Understanding routine blood results
  • Behaviour change and individual goal setting
  • Entitlements
  • Miscellaneous topics that are relevant to the group e.g driving, planning pregnancy

Week 10 phone call with facilitator and each individual to give support, discuss personal goal setting and answer any queries the person may have.

Final sessions at 6 months

  • Feedback on personal progress
  • Recap of topics healthy eating, physical activity and annual review checklist
  • Review of blood results and measurements
  • Entitlements, employment, travel insurance and any outstanding queries
  • Sign posting to additional resources HSE living well programme, Diabetes Ireland additional supports and membership

Anyone wishing to do CODE can register their interest via the Diabetes Ireland website on or telephone 01 842 8118

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