Summary
The Homewell Diabetes Injectable Groups Project aimed to enhance care for patients with T2DM on injectable therapies in a deprived Hampshire area. Monthly group sessions encouraged peer learning and covered topics like insulin use, diet, and complication management. Attendance was modest (15 participants), but feedback showed high satisfaction and improved understanding. Those attending more frequently saw greater reductions in HbA1c levels. However, challenges included low turnout and barriers linked to mental health and social care needs. The project suggests a hybrid approach, combining group and individual sessions, may better support this high-need population. Further research into engagement strategies is recommended.
Innovation/Novel approach to an existing problem
The Homewell Practice is situated in Havant, Hampshire. The patient population includes the Leigh Park Estate and features a high level of socioeconomic deprivation and health inequality. A significant cohort of patients on injectable therapies was identified for treatment of their type 2 diabetes. It was felt that group education might allow participants to connect with others facing similar struggles, and peer support might reduce stigma or social overwhelm, while being cost-effective. Previous local trials had suggested anecdotally that group dynamics would foster interactive learning where participants could ask questions, share experiences, and learn from each other’s successes and setbacks. Different perspectives and problem-solving approaches could be encouraged, enriching the learning experience beyond individual education. Each monthly group session was person-centred and informal, using personal experiential learning in a flexible curriculum allowing participants to choose the education topics and generate peer discussion. Specific objectives were: to improve patient confidence in titrating insulin doses; to improve understanding of insulin time peak and action; to increase understanding and awareness of factors that can affect blood glucose levels; to increase understanding on how to recognise and treat hypoglycaemia; to increase understanding of the impact of weight gain and weight loss on medication and glycaemia; to improve awareness of glycaemic targets and to empower patients to set their own targets. Using EMIS software to search the diabetic population on insulin/GLP-1 therapy, patients were stratified according to highest risk/biggest perceived benefit. Three initial target groups were: patients identified as moderately or severely frail using mixed insulin products; patients using injectable diabetes therapy (insulin or GLP-1 agents) with a most recent HBA1C result of 75mmol/mol or higher; patients with a QAdmissions score of 20% or greater. These groups were then stratified into patients fitting all three criteria, patients fitting two criteria, and patients fitting one. Invites were sent to patients fitting two criteria, as only seven met all three criteria. In June 2022 this expanded to include patients fitting any one of the criteria, and then in August 2022 to all those with type 2 diabetes on injectable therapy.
Equality, Diversity and Variation
It was important to hold the group in a non-clinical environment close to the surgery and for it to be easily accessible by public transport/have adequate car parking. A church hall with a large room and suitable facilities was hired. The sessions were held at no cost to the patient population, other than local travel costs. As the sessions progressed, weekend and evenings were offered to make the meetings as accessible as possible. There were no physical barriers and interpretation in British Sign Language and non-English languages was available. Variation in technological and digital literacy was considered and patients were contacted via a variety of methods (replyable text, email, telephone, letter).
Impact to Patient Care
The project showed a clear dose-response relationship between attendance frequency and glycaemic control improvements (see Results). The peer-support element proved central to the programme’s appeal. Patients reported significant improvements in diabetes self-management knowledge. Additional benefits included reduced hypoglycemia frequency and enhanced understanding of diabetic complications. The qualitative feedback revealed high satisfaction with the educational content and delivery. Patients appreciated the knowledgeable staff, regular medication adjustments, and particularly valued hearing about others' experiences and problem-solving approaches. Despite positive outcomes for attendees, overall attendance was lower than anticipated, with only 15 patients participating over the 12-month period. The project revealed that patients with the highest need preferred individual consultations.
Results
The sessions ran monthly from May 2022 to April 2023, with attendance ranging from four to 12 participants per session. Over the 12-month period, 15 unique patients attended at least one session, comprising 8 female and 7 male patients. The highest attendance occurred in the final session (April 2023) with 12 participants, while the lowest was in August 2022 with only four attendees. Most sessions averaged four-to-six participants, with supporters (carers or spouses) occasionally attending. The majority of patients attended infrequently, with five attending only once and one attending twice. However, six patients attended four or more sessions, and three attended three sessions. Notably, no patient attended every session. Patients attending four or more sessions achieved the most significant HbA1c reduction of 12.4% from baseline. Those attending three sessions showed a 5.6% improvement, while patients attending twice had a 2.4% reduction. Patients who attended only once showed a slight increase of 1.8% in HbA1c levels. The project was funded by an education and development grant provided equally by: Eli Lilly UK, Embecta UK and Novo Nordisk UK.
User Feedback
Nine out of 15 attendees completed anonymous paper evaluation questionnaires, revealing overwhelmingly positive feedback. All respondents found the sessions useful, with four rating them ‘very useful’ and five ‘somewhat useful’. The most valued educational theme was sharing experiences with other people living with type 2 diabetes, identified by eight out of nine respondents. Other highly appreciated topics included understanding HBA1C and blood sugar levels (6 responses), treating hypoglycaemia (6 responses), injection techniques (5 responses), and the effect of different foods on blood glucose levels (5 responses). All respondents reported improved understanding of their condition, while seven noted better understanding of how food and drink impact blood sugar control. Six reported blood sugar improvements, and smaller numbers reported reduced hypoglycaemia frequency and improved understanding of diabetic complications. Eight out of nine patients would recommend the group sessions. The qualitative feedback emphasised the value of peer support, knowledgeable staff, and practical diabetes management advice.
