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Case study: Fighting diabetes with information

The NHS spends around 10% of its budget on treating type 2 diabetes every year. An online tool that helps patients self-manage their condition could help millions of people with type 2 diabetes across the UK and save money for the NHS at the same time.

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Making diabetes support more accessible

Many of us know someone who’s affected by diabetes - there are more than 2.8 million people living with type 2 diabetes in England and a further 750,000 people are believed to be undiagnosed.

But what’s less well-known is that the NHS spends around 10% of its budget on treating the disease every year. That’s around £10 billion - enough to keep one of the UK’s largest hospitals running for 10 years.

Much of this money is poured into treating preventable complications of the disease, such as heart disease, eye problems, and lower limb amputations. The NHS could make huge savings by finding better ways to help control diabetes.

That’s where Professor Elizabeth Murray comes in. Prof Murray is the director of University College London’s e-Health Unit, where she works to help people improve their health through digital health promotion and disease management programmes.

Type 2 diabetes is a daunting condition to be diagnosed with - 4 in 10 people with the condition report feelings of guilt and depression. When they first started working on this research project, Prof Murray and her team knew that despite UK guidelines recommending that newly diagnosed patients be given personalised support to help them manage their disease, this often wasn’t available or was difficult for them to access.

So they approached NIHR for funding to develop HeLP-Diabetes (Healthy Living for People with Type 2 Diabetes), an online toolkit designed to help patients and carers affected by diabetes learn more about the condition and find the best ways to manage their own symptoms and blood sugar levels, at their own pace.

After securing funding from NIHR Programme Grants for Applied Research, Prof Murray and her team started working on their online portal, with the aim of creating a tool that could provide diabetes education for anyone, as well as making it more cost effective and efficient for the NHS to deliver this vital support.

How does the tool work?

The team’s experience in e-health meant they knew it was crucial to involve people with diabetes, carers, and health professionals to find out what they wanted from an online education tool. They ran focus groups with 6-8 people with type 2 diabetes, asking them what they would want and need from an online tool. The researchers also involved health professionals to find out how the tool could help them in consultations with patients, and what potential problems might need to be overcome.

Using all of this feedback, the team then developed a draft version of the online tool that was tested by patients and healthcare professionals. This also helped the researchers to understand the best ways to make the tool available to people who don’t have access to computers at home - for example, by using text messages or phone calls alongside consultations with doctors and nurses who could use the tool with the patient.

This research programme is a great example of how NIHR funds research that can make a real difference to patient’s lives and to the NHS
Professor Elizabeth Murray

“Having a five year programme grant meant the work could progress without the delays caused by having to repeatedly seek additional funding for the next stage of a complex programme of work, and that made a big difference,” Prof Murray adds. 

All the content in the HeLP-Diabetes platform was designed to be accessible to people with different levels of literacy, with essential content provided as video and text. The tool includes information sections on diabetes, how diabetes is treated, and possible complications of diabetes. Other areas cover the possible impacts of diabetes on relationships at home and at work, dealing with unusual situations like parties, holidays, travelling or shift work and what lifestyle changes can help improve users’ health.

The tool also features modules on how to change behaviour in areas such as eating healthily, losing weight, being more physically active, stopping smoking, moderating alcohol consumption, managing medicines, glycaemic control and blood pressure control. Users can use the tool to send themselves reminder text messages or emails, and can specify the content and how often they receive the reminders.

The third strand of the programme focuses on emotional wellbeing, with self-help tools based on cognitive behavioural therapy and mindfulness. There are several personal stories and a moderated forum.

“Online programmes offer individuals the flexibility to access support that fits around their lifestyle,” said Prof Murray. “All the content in our programme was evidence based, drawing on a range of diabetes management research including behavioural change, accessibility and usability, and promoting emotional wellbeing by drawing on principles of cognitive behavioural therapy and mindfulness.”

Testing and rolling out the tool

The final stage of the research was to find out what benefits the tool could bring - and the results were exciting. The researchers tested the tool by recruiting 374 people with the help of the NIHR Clinical Research Network. The participants were split into two groups - one group used the tool, while people in the other group had normal care through their GP and other healthcare staff.

The team found that the online tool improved people’s physical health, helping them to take control and manage their own condition. The group of patients using the tool had better control over their blood sugar levels after 12 months.

And not only did their physical health improve - the group using the online support tool also showed improvements in their mental wellbeing. 

Alan, 71, from Sunderland, has been living with type 2 diabetes for 18 years. “When I was diagnosed it was a shock to the system and I didn’t know anything about type 2 diabetes,” he said. “I wish that a website such as HeLP would have been available for me back then.

“My first piece of advice to anyone diagnosed with any form of diabetes is to learn as much as possible about it. HeLP is a great way to do that – the more you know, the better you can manage your condition.”

The benefits could have far-reaching consequences – potentially helping millions of people with type 2 diabetes across the UK and helping to save money for the NHS at the same time. NHS England has piloted the tool at a number of NHS sites and is looking into making it available nationally to people with diabetes.

Prof Murray commented: “It is great to see the advantages of online interventions - scalability and cost effectiveness - being realised in the NHS. 

“I’m very excited at the thought of HeLP-Diabetes being available to help patients across the NHS"

My research is all about using digital technology to improve health and health care for patients, and it’s wonderful to see it come to fruition like this.

Further reading