A brief structured education programme enhances self-care practices and improves glycaemic control in Malaysians with poorly controlled diabetes. Integrating medical management with diabetes self-management training: a randomized control trial of the Diabetes Outpatient Intensive Treatment program. Type 2 diabetes patients educated by other patients perform at least as well as patients trained by professionals. Adherence to self-care behavior and glycemic effects using structured education Therapeutic education among adults with type 2 diabetes: effects of a three-day intervention on perceived competence, self-management behaviours and glycaemic control The effect of the Talking Diabetes consulting skills intervention on glycaemic control and quality of life in children with type 1 diabetes: cluster randomised controlled trial (DEPICTED study) A trial of empowerment-based education in type 2 diabetes--global rather than glycaemic benefits. The impact of structured blood glucose testing on attitudes toward self-management among poorly controlled, insulin-naïve patients with type 2 diabetes. Empowering diabetes out-patients with structured education: short-term and long-term effects of functional insulin treatment on perceived control over diabetes. Approaches to integrating paediatric diabetes care and structured education: experiences from the Families, Adolescents, and Children's Teamwork Study (FACTS). A nurse‐led interdisciplinary approach to promote self‐management of type 2 diabetes: a process evaluation of post‐intervention experiences The effect of a structured behavioral intervention on poorly controlled diabetes: a randomized controlled trial. Effect of a Nurse-Led Diabetes Self-Management Education Program on Glycosylated Hemoglobin among Adults with Type 2 Diabetes Improving diabetes self-management through acceptance, mindfulness, and values: a randomized controlled trial. The Effect of Diabetes Self-Management Education With Frequent Follow-Up on the Health Outcomes of African American Men Effect of structured group education on glycemic control and hypoglycemia in insulin-treated patients. Flexible eating and flexible insulin dosing in patients with diabetes: Results of an intensive self-management course.
We assessed the effectiveness of a brief structured diabetes education programme based on the concept of self-efficacy on self-care and glycaemic control using single-blind study design . One hundred and sixty-four participants with poorly controlled diabetes from two setting s were r and omized using computer-generated list into control ( n = 82 ) and intervention ( n = 82 ) groups , of which 151 completed the study . Monthly interventions over 12 weeks addressed the self-care practice s of diet , physical activity , medication adherence and self-monitoring of blood glucose ( SMBG ) . These self-care practice s were assessed at Weeks 0 and 12 using pre- and post- question naires in both groups together with glycated haemoglobin A1c ( HbA1c ) and diabetes knowledge . In the intention-to-treat analysis ( n = 164 ) , the intervention group improved their SMBG ( P = < 0.001 ) , physical activity ( P = 0.001 ) , HbA1c ( P = 0.03 ) , diabetes knowledge ( P = < 0.001 ) and medication adherence . At Week 12 , HbA1c difference adjusted for SMBG frequency , medication adherence and weight change remained significant ( P = 0.03 ) compared with control group . For within group comparisons , diabetes knowledge ( P = < 0.001 ) , HbA1c level ( P = < 0.001 ) , SMBG ( P = < 0.001 ) and medication adherence ( P = 0.008 ) improved from baseline in the intervention group . In the control group , only diabetes knowledge improved ( P = < 0.001 ) . These findings can contribute to the development of self-management diabetes education in Malaysia OBJECTIVE This study evaluated the Diabetes Outpatient Intensive Treatment ( DOIT ) program , a multiday group education and skills training experience combined with daily medical management , followed by case management over 6 months . Using a r and omized control design , the study explored how DOIT affected glycemic control and self-care behaviors over a short term . The impact of two additional factors on clinical outcomes were also examined ( frequency of case management contacts and whether or not insulin was started during the program ) . RESEARCH DESIGN AND METHODS Patients with type 1 and type 2 diabetes in poor glycemic control ( A1c > 8.5 % ) were r and omly assigned to DOIT or a second condition , entitled EDUPOST , which was st and ard diabetes care with the addition of quarterly educational mailings . A total of 167 patients ( 78 EDUPOST , 89 DOIT ) completed all baseline measures , including A1c and a question naire assessing diabetes-related self-care behaviors . At 6 months , 117 patients ( 52 EDUPOST , 65 DOIT ) returned to complete a follow-up A1c and the identical self-care question naire . RESULTS At follow-up , DOIT evidence d a significantly greater drop in A1c than EDUPOST . DOIT patients also reported significantly more frequent blood glucose monitoring and greater attention to carbohydrate and fat contents ( ACFC ) of food compared with EDUPOST patients . An increase in ACFC over the 6-month period was associated with improved glycemic control among DOIT patients . Also , the frequency of nurse case manager follow-up contacts was positively linked to better A1c outcomes . The addition of insulin did not appear to be a significant contributor to glycemic change . CONCLUSIONS DOIT appears to be effective in promoting better diabetes care and positively influencing glycemia and diabetes-related self-care behaviors . However , it dem and s significant time , commitment , and careful coordination with many health care professionals . The role of the nurse case manager in providing ongoing follow-up contact seems important BACKGROUND Diabetes education can improve the quality of care of people with diabetes , but many organizations are not equipped to manage its implementation . Involving people with diabetes in the education process can overcome the problem . Thus , we compared clinical , metabolic and psychological outcomes in people with type 2 diabetes 1 year after attending a structured diabetes education programme implemented by professional educators versus the same programme implemented by trained peers with diabetes  that also provided ongoing peer support . METHODS People with type 2 diabetes ( 25 - 75 years ) were r and omly assigned to attend a 4-week structured diabetes education course delivered by professional educators ( control ) or previously trained peers ( peer ) . Peers also received continuing psychological support , including examples on how to apply diabetes knowledge in daily life via weekly peer cellular phone calls and bimonthly face-to-face interviews in small groups ( ten patients ) , using a structured question naire related to the patient 's clinical , metabolic and psychological progress . Identical outcome data from both groups were used for follow-up . RESULTS Both groups had a comparable positive effect on clinical , metabolic and psychological indicators immediately following the programme . Over the following year , peer-educated subjects had lower A(1C ) and systolic blood pressure and showed higher adherence to physical activity and better control of hypoglycaemic episodes . CONCLUSION The non-inferiority of the peer outcomes and the mentioned improvements in this group suggest that volunteer trained peer educators and ongoing support can be successful . This approach provides an effective alternative method of education , especially in areas with limited availability of professionals and economic re sources Aims / Introduction The purpose of the present study was to examine glycemic control in suboptimally controlled type 2 diabetes provided by a structured education group using the Diabetes Conversation Map ™ ( CM ™ ) vs usual care in a university-based hospital primary care clinic . Material s and Methods This was a r and omized , pragmatic clinical trial . Patients with type 2 diabetes were r and omly assigned to structured education or usual care groups . The primary outcome was the difference in the mean change of glycated hemoglobin ( HbA1c ) from baseline to 12 months . Secondary outcomes included the percentage achieving therapeutic HbA1c goal and self-behavioral changes . Results A total of 245 patients were r and omly assigned to two groups ( CM ™ group n = 121 ; usual care group , n = 116 ) . The absolute reduction of HbA1c was significantly greater in the CM ™ group at 3 and 6 months ( Δ = −0.59 % and Δ = −1.13 % , P < 0.01 ) , but the difference was no longer statistically significant at 9 and 12 months ( Δ = −0.43 % and Δ = −0.49 % ) , based on an intention-to-treat analysis . A per- protocol analysis showed the significant change was maintained at 12 months ( Δ = −0.67 % ) . In the intervention group , greater percentages of patients achieved their American Association of Diabetes Educators Self-Care Behaviours ™ framework ( AADE7 ) behavioral goals at 3 months , in particular being active , problem-solving , reducing risk and health coping . Conclusions In type 2 diabetic patients with suboptimally controlled glucose , there were greater improvements in glucose control and self-care behavioral goals in those who underwent the CM ™ education program compared with outcomes achieved in patients receiving usual care The purpose of this study was to evaluate the impact of a three-day therapeutic education programme on perceived competence , self-management behaviours ( i.e. physical activity , diet and medication ) and glycaemic control among adults with type 2 diabetes . A total of 120 participants were included in this r and omized , wait list control group trial . The results confirm that therapeutic education may be a powerful healthcare intervention to improve lifestyle and health status of people with type 2 diabetes . We observed that the education programme used in this study generated positive changes in glycaemic control and adherence to physical activity and diet after three months follow-up . Furthermore , the intervention positively impacted participants ’ perceived competence towards physical activity and diet . The latter finding is of particular importance , given that perceived competence has been found to be involved in long-term adherence to self-management behaviours Objective To evaluate the effectiveness on glycaemic control of a training programme in consultation skills for paediatric diabetes teams . Design Pragmatic cluster r and omised controlled trial . Setting 26 UK secondary and tertiary care paediatric diabetes services . Participants 79 healthcare practitioners ( 13 teams ) trained in the intervention ( 359 young people with type 1 diabetes aged 4 - 15 years and their main carers ) and 13 teams allocated to the control group ( 334 children and their main carers ) . Intervention Talking Diabetes programme , which promotes shared agenda setting and guiding communication style , through flexible menu of consultation strategies to support patient led behaviour change . Main outcome measures The primary outcome was glycated haemoglobin ( HbA1c ) level one year after training . Secondary outcomes were clinical measures ( hypoglycaemic episodes , body mass index , insulin regimen ) , general and diabetes specific quality of life , self reported and proxy reported self care and enablement , perceptions of the diabetes team , self reported and carer reported importance of , and confidence in , undertaking diabetes self management measured over one year . Analysis was by intention to treat . An integrated process evaluation included audio recording a sample of 86 routine consultations to assess skills shortly after training ( intervention group ) and at one year follow-up ( intervention and control group ) . Two key domains of skill assessment were use of the guiding communication style and shared agenda setting . Results 660/693 patients ( 95.2 % ) provided blood sample s at follow-up . Training diabetes care teams had no effect on HbA1c levels ( intervention effect 0.01 , 95 % confidence interval −0.02 to 0.04 , P=0.5 ) , even after adjusting for age and sex of the participants . At follow-up , trained staff ( n=29 ) were more capable than controls ( n=29 ) in guiding ( difference in means 1.14 , P<0.001 ) and agenda setting ( difference in proportions 0.45 , 95 % confidence interval 0.22 to 0.62 ) . Although skills waned over time for the trained practitioners , the reduction was not significant for either guiding ( difference in means −0.33 , P=0.128 ) or use of agenda setting ( difference in proportions −0.20 , −0.42 to 0.05 ) . 390 patients ( 56 % ) and 441 carers ( 64 % ) completed follow-up question naires . Some aspects of diabetes specific quality of life improved in controls : reduced problems with treatment barriers ( mean difference −4.6 , 95 % confidence interval −8.5 to −0.6 , P=0.03 ) and with treatment adherence ( −3.1 , −6.3 to −0.01 , P=0.05 ) . Short term ability to cope with diabetes increased in patients in intervention clinics ( 10.4 , 0.5 to 20.4 , P=0.04 ) . Carers in the intervention arm reported greater excitement about clinic visits ( 1.9 , 1.05 to 3.43 , P=0.03 ) and improved continuity of care ( 0.2 , 0.1 to 0.3 , P=0.01 ) . Conclusions Improving glycaemic control in children attending specialist diabetes clinics may not be possible through brief , team-wide training in consultation skills . Trial registration Current Controlled Trials IS RCT N61568050 We have assessed the effect of a structured , empowerment-based educational system ( " LAY or " Look After Yourself " ) for patients with type 2 diabetes . A r and omised controlled trial ( RCT ) was conducted , testing the system against st and ard support . Using 3 centres , 89 patients participated in the study . Outcome measures included glycated haemoglobin ( HbA(1c ) ) , body mass index ( BMI ) and a variety of quantitative psychological and educational measures . Assessment was made at 6 months ( " short-term " ) and 12 months ( " long-term " ) post-intervention . The educational programme was associated with benefits in HbA(1c ) levels ( p=0.005 ) , illness attitudes ( p=0.04 ) , and perceived treatment effectiveness ( p=0.03 ) at 6 months follow-up compared to controls . At 12 months however , only illness attitudes ( p=0.01 ) , and self-monitoring ( p=0.002 ) showed benefit . A combined outcome measure showed positive benefit for the educational programme both at 6 months ( p=0.001 ) and 12 months ( p=0.002 ) . This structured educational programme , aim ed at encouraging self-help , was associated with only limited benefits in glycaemic control , but there were significant educational and psychological benefits . Diabetes education should be regarded as having broad patient-based positive outcomes , and should not be expected to have lasting benefits on glycaemic control INTRODUCTION Patients with T2DM often view self-monitoring of blood glucose ( SMBG ) as burdensome and pointless , which may affect their broader attitudes toward diabetes management . We examined how a structured SMBG protocol influenced diabetes self-efficacy and autonomous motivation over time , and linked these to changes in glycemic control . MATERIAL S AND METHODS The Structured Testing Program ( STeP ) is a 12-month , two-arm , cluster-r and omized trial that assessed the efficacy of structured SMBG in 483 insulin-naïve T2DM patients . Measures included : Confidence in Diabetes Self-Care for Type 2 patients ( CIDS-T2 ) , Diabetes-related Autonomous Motivation ( DRAM ) , self-management behaviors and HbA1c . RESULTS Intent-to-treat ( ITT ) and per- protocol ( PP ) analyses showed significant increases in CIDS-T2 scores over time ( main effects p<0.0001 ) . PP analysis showed significant between-group differences ( p<0.05 ) , with adherent STG patients displaying greater CIDS-T2 improvement than ACG patients . PP analyses showed main and between-group effects in DRAM with similar findings . Changes in CIDS-T2 were related to HbA1c changes over time ; no self-management variable mediated this relationship . CIDS-T2 and HbA1c displayed a significant time-concordant relationship . DISCUSSION Structured SMBG leads to significant increases in self-confidence and autonomous motivation associated with diabetes self-management . Changes in self-confidence are linked to changes in glycemic control and share a time-concordant relationship OBJECTIVE To investigate short-term and long-term effects of structured outpatient education for Functional Insulin Treatment  ( FIT : selective insulin dosages for eating , fasting or correcting hyperglycaemia ) on perceived control over diabetes and related health beliefs . FIT was thought to influence the perception of self-efficacy in diabetes , in contrast to conventional treatment , based on scheduled , rigid food intake and insulin delivery -- it allows flexible eating , provided independent control of glycemia . METHODS Structured , comprehensive , outpatient group training in FIT for selective use of insulin either for eating , fasting or correction included practical " insulin games . " The FIT program focused on everyday criteria for choices of insulin dosages and thus on the patient 's ability to execute his/her newly gained flexible treatment to his/her everyday life while preventing acute and late complications . To evaluate effects of FIT on " Perceived Control over Diabetes " and related " Health Beliefs Concerning Diabetes " ( Bradley 's question naires , 1984 ) , a fully r and omized short-term controlled Study 1 ( four weeks , 32 patients ) , and long-term uncontrolled pilot Study 2 ( three years , 68 patients ) were performed . RESULTS The short-term study revealed that FIT induced the feeling of independence from situational control while self-managing diabetes . In the long-term study , the patients were increasingly freed from the feeling of being under the control of physician and treatment-related restrictions , which -- together with higher perceived self-efficacy -- contributed to the feeling of " empowerment . " This was associated with high treatment satisfaction and significant improvement of glycemic control . CONCLUSION Structured out-patient group training for FIT results in measurable improvement of patients ' perceived control over diabetes and self-efficacy AIMS The Families , Adolescents and Children 's Teamwork Study ( FACTS ) is a family-centred structured education programme for children and adolescents with Type 1 diabetes . It aims to integrate group-based diabetes education into routine care , enhance parental responsibility for self management and improve glycaemic control . METHODS A r and omized wait-list control group study allocated participants to either the immediate ( four educational sessions during year 1 ) or delayed intervention ( four educational sessions during year 2 ) . In both groups , glycated haemoglobin ( HbA1c ) was measured 3-monthly and participants completed the  Paediatric Quality of Life Inventory ( PedsQL ) , Problem Areas in Diabetes Scale ( PAID ) and Diabetes Family Responsibility Question naire ( DFRQ ) before and after the intervention . RESULTS Intention-to-treat analysis showed no significant difference in HbA1c or parental responsibility between participants r and omized to the immediate or delayed programme . However , during 12 months ' follow-up , families who attended > or = 2 sessions reported increased parental involvement ( P = 0.01 ) , and in children/adolescents who attended > or = 2 sessions HbA1c fell by 0.29 % compared with an increase of 0.11 % in non-attenders ( P = 0.04 ) . CONCLUSION This family-centred education programme has been integrated into paediatric diabetes care with potential benefits on parental involvement and glycaemic control , but further study is warranted before routine application into clinical care RATIONALE , AIMS AND OBJECTIVES Self-management of type 2 diabetes through diet , exercise and for many medications , are vital in achieving and maintaining glycaemic control in type 2 diabetes . A number of interventions have been design ed to improve self-management , but the outcomes of these are rarely explored from a qualitative angle and even fewer through a process evaluation . METHOD A process evaluation was conducted using a qualitative design with participants r and omized to an intervention . Seventy-three people living with type 2 diabetes and hyperglycaemia for a minimum of 1 year , r and omized to one of two interventions ( n = 34 to an education intervention and n = 39 to an education and acceptance and commitment therapy intervention )  completed stage one of the process evaluation , immediately following the intervention through written feedback guided by open-ended questions . A purposive sample of 27 participants completed semi-structured interviews at 3 and 6 months post intervention . Interview data were transcribed and data analysed using a thematic analysis . RESULTS The majority of participants described an increase in knowledge around diabetes self-management and an increased sense of personal responsibility . Participants also described changes in self-management activities and reflected on the challenges in instigating and maintaining change to improve diabetes management . CONCLUSION The complexities of implementing change in daily life to improve glycaemic control indicate the need for ongoing support post intervention , which may increase and maintain the effectiveness of the intervention BACKGROUND Although maintaining nearly normal glycemia delays onset and slows progression of diabetes complications , many patients with diabetes and their physicians struggle to achieve glycemic targets . The best methods to support patients as they follow diabetes prescriptions and recommendations are unclear . METHODS To test the efficacy of a behavioral diabetes intervention in improving glycemia in long- duration , poorly controlled diabetes , we r and omized 222 adults with diabetes ( 49 % type 1 ) ( mean [ SD ] age , 53 [ 12 ] years ; mean [ SD ] disease duration 18 [ 12 ] years ; mean [ SD ] hemoglobin A(1c ) [ HbA(1c ) ] concentration , 9.0 % [ 1.1 % ] ) to attend ( 1 ) a 5-session manual-based , educator-led structured group intervention with cognitive behavioral strategies ( structured behavioral arm ) ; ( 2 ) an educator-led attention control group education program ( group attention control ) ; or ( 3 ) unlimited individual nurse and dietitian education sessions for 6 months ( individual control ) . Outcomes were baseline and 3- , 6- , and 12-month postintervention HbA(1c ) levels ( primary ) and frequency of diabetes self-care , 3-day pedometer readings , 24-hour diet recalls , average number of glucose checks , physical fitness , depression , coping style , self-efficacy , and quality of life ( secondary ) . RESULTS Linear mixed modeling found that all groups showed improved HbA(1c ) levels ( P < .001 ) . However , the structured behavioral arm showed greater improvements than the group and individual control arms ( 3-month HbA(1c ) concentration changes : -0.8 % vs -0.4 % and -0.4 % , respectively ( P = .04 for group × time interaction ) . Furthermore , participants with type 2 disease showed greater improvement than those with type 1 ( P = .04 for type of diabetes × time interaction ) . Quality of life , glucose monitoring , and frequency of diabetes self-care did not differ by intervention over time . CONCLUSIONS A structured , cognitive behavioral program is more effective than 2 control interventions in improving glycemia in adults with long- duration diabetes . Educators can successfully use modified psychological and behavioral strategies . TRIAL REGISTRATION clinical trials.gov Identifier : NCT000142922 In recent years , great emphasis has been placed on the role of nonpharmacological self-management in the care of patients with diabetes . Studies have reported that nurses , compared to other healthcare professionals , are more likely to promote preventive healthcare seeking behaviors . The aim of this study was to investigate the effectiveness of a nurse-led diabetes self-management education on glycosylated hemoglobin . A two-arm parallel-group r and omized controlled trial with the blinded outcome assessors was design ed . One hundred forty-two adults with type 2 diabetes were r and omized to receive either usual diabetes care ( control group ) or usual care plus a nurse-led diabetes self-management education ( intervention group ) . Duration of the intervention was 12 weeks . The primary outcome was glycosylated hemoglobin ( HbA1c values ) . Secondary outcomes were changes in blood pressure , body weight , lipid profiles , self-efficacy ( efficacy expectation and outcome expectation ) , self-management behaviors , quality of life , social support , and depression . Outcome measures were assessed at baseline and at 12-week and 24-week postr and omizations . Patients in the intervention group showed significant improvement in HbA1c , blood pressure , body weight , efficacy expectation , outcome expectation , and diabetes self-management behaviors . The beneficial effect of a nurse-led intervention continued to accrue beyond the end of the trial result ing in sustained improvements in clinical , lifestyle , and psychosocial outcomes . This trial is registered with I RCT 2016062528627N1 Patients in a low-income community health center with Type 2 diabetes ( N = 81 ) taking a one-day education workshop  as part of their diabetes medical management were r and omly assigned either to education alone or to a combination of education and acceptance and commitment therapy ( ACT ) . Both groups were taught how to manage their diabetes , but those in the ACT condition also learned to apply acceptance and mindfulness skills to difficult diabetes-related thoughts and feelings . Compared with patients who received education alone , after 3 months those in the ACT condition were more likely to use these coping strategies , to report better diabetes self-care , and to have glycated hemoglobin ( HbA-sub(1C ) ) values in the target range . Mediational analyses indicated that changes in acceptance coping and self-management behavior mediated the impact of treatment on changes in HbA-sub(1C ) PURPOSE This study was conducted to determine whether objective clinical , patient performance , quality -of-life , and subjective outcomes are significantly different among African American men with type 2 diabetes who received follow-up at either monthly or 3-month intervals after participating in a structured diabetes self-management education program . METHODS Prior to the diabetes self-management education program , 30 African American men with type 2 diabetes were r and omly assigned to 2 groups to receive telephone follow-up at either monthly or 3-month intervals over a 6-month period . Information obtained at follow-up contact included HbA1c level , perception of general health , and present diabetes knowledge . In addition , daily foot care , dietary , exercise , and medication compliance measures were assessed postprogram . RESULTS There were no significant differences between the participants who received follow-up at monthly and 3-month intervals on any measures of the selected clinical , patient performance , quality -of-life , and subjective outcomes . CONCLUSIONS This cross-sectional study showed that telephone follow-up at 3 month intervals following a structured program of diabetes self-management education may be just as effective in contributing to favorable diabetes health outcomes as monthly follow-up We investigated the effect of a structured group diabetes education program ( 1 ) on insulin-treated patients who had received individual counseling ( at the time of diagnosis and insulin initiation ) . A total of 1,369 type 1 and insulin-treated type 2 diabetic patients with mean disease duration of 11.7 and 13.7 years , respectively , were allocated to receive or not receive structured group education , which was delivered in 10 45-min sessions over 3–5 days . Baseline GHb levels of type 1 diabetic patients were 9.3 % for AIMS To evaluate the outcomes of an established programme to teach patients to match their insulin dose to their carbohydrate intake . RESEARCH DESIGN AND METHODS A prospect i ve observational study in Australia ( Newcastle , NSW ) of 137 consecutive patients with type 1 ( n=82 ) or type 2 diabetes ( n=55 ) over two successive years . Four educational principles were used to teach intensive insulin management and diabetes self-care skills including : carbohydrate counting and insulin dose adjustment , exercise , appropriate treatment of hypoglycaemia and hyperglycaemia , managing sickness , problem solving , communication with health professionals , goal setting , and the importance of support . Outcomes included changes at 4 and 12 months in HbA1c , self-efficacy measured by a diabetes empowerment scale ( DES ) , diabetes specific quality of life ( ADDQoL ) , and problem solving . Both intention to treat and efficacy analyses were performed . RESULTS Diabetes-related quality of life and diabetes problem solving skills improved significantly . Excluding 16 people who failed to adopt intensive insulin management and 24 who started with an HbA1c less than 7 % , intention to treat analysis showed the average HbA1c fell from 8.7 % initially to 8.1 % at 12 months and the number of people with an HbA1c of less than 8 % rose from 67 ( 48.9 % ) before the program to 86 ( 62.8 % ) afterwards . CONCLUSIONS An intensive diabetes self-management program led to improvements in HbA1c , empowerment , and quality of life that were largely sustained at 1 year . This is all the more remarkable given that the intervention was once only , entailed no long-term follow-up , and took place in normal clinical operations
This model outlines the challenges participants encounter in maintaining diabetes self-management practice s after attending structured education , and describes how participants try to address these barriers by adapting , simplifying or personalising the self-management approaches they have learned .
Conclusions This meta-ethnography highlights how providing skills training using structured education to people with type 1 diabetes does not necessarily result in participants adopting and sustaining recommended changes in behaviour .
Background People with type 1 diabetes who attend structured education training in self-management using flexible intensive therapy achieve improved blood glucose control and experience fewer episodes of severe hypoglycaemia .
However , many struggle to sustain these improvements over time .
To inform the design of more effective follow-up support we undertook a review of qualitative studies which have identified factors that influence and inform participants ’ self-management behaviours after attending structured education  and their need for support to sustain improvements in glycaemic control .