The diabetes mentorship programme in type 2 diabetes

The diabetes mentorship programme has been in place since June 2008. The service is delivered by two specially trained diabetes support workers (DSWs) who speak Urdu and Bengali, and who are supported by DSNs. The aim is to provide structured diabetes education time and one-to-one support to people with type 2 diabetes who do not speak English. 

Rationale
In 2005, the diabetes education programme for people with type 2 diabetes in Luton was changed to DESMOND (Diabetes Education and Self-management for Ongoing and Newly Diagnosed). At the same time, to meet the needs of people who could not access DESMOND due to a language barrier, a local education course called Living with Diabetes in Urdu and Bengali was developed. This was delivered in Urdu and Bengali with the assistance of a link worker who worked for half a day, once a week. 

It was identified that the education course Living with Diabetes in Urdu and Bengali was not enough to change the behaviour of many south Asian people who often had very poorly controlled diabetes. The author felt that if these people had regular support from someone who was specially trained in diabetes, understood their culture and could speak their language, diabetes control in this population could well be improved.

A business case was written, and accepted, and in May 2008 two band 4 DSWs who speak Urdu and Bengali were employed to work in the recently expanded nurse-led Community Diabetes Services.

How is the programme delivered?
People must first be referred to Living with Diabetes in Urdu or Bengali from their GP or practice nurse. If, after attending the course, they meet the mentorship inclusion criteria (type 2 diabetes duration >1 year; HbA_1c level >8.5% [>69 mmol/mol]) they are offered a place on the programme. This consists of regular one-to-one support from a DSW, encouraging and reinforcing the message of maintaining a healthy diet, regular exercise and medicines adherence. Contact is through a combination of home visits, meetings at the Luton Treatment Centre and telephone support. The whole family are encouraged to be involved, as very often they also have diabetes or are at risk of developing it. 

Each DSW has a maximum of 20 people on their caseload. Both work 30 hours per week, and they have now completed an accredited diabetes course and DESMOND BME training.

At the beginning of mentorship a full diabetes assessment is carried out, including a quality of life (QOL) assessment. HbA_1c measurements are repeated at 3 months, and if at this time individuals’ HbA_1c levels are ≤7% (≤53 mmol/mol) they are discharged back to GP; if not, they are kept in the programme for a further 3 months, assessed again and discharged, with a full report sent to the person’s GP. 

Results to-date
An average HbA_1c reduction of 2.6 percentage points (28 mmol/mol; range, 0.9–5.4 percentage points [10–34 mmol/mol]) has been observed, and QOL measures have improved, possibly as a result of improved diabetes control and the associated increase in energy and motivation to self-care. 

An independent telephone patient satisfaction questionnaire was recently carried out, which received excellent feedback. 

Conclusion
Although one-to-one intensive support is expensive, this cost may well be offset by improved medications adherence and the appropriate use of self-monitoring of blood glucose due to improved understanding of how to interpret and act on results. Participants learn the importance of taking an active part in self-management and the prevention of vascular complications, and as a result, QOL is improved. As a long-term intervention this has the potential to reduce the burden of this debilitating and costly condition both to the individual with type 2 diabetes and healthcare providers.