Desmond course

DESMOND is a basic course for newly diagnosed diabetics and serves it purpose well. However the newly diagnosed diabetic rarely has the experience to provide much useful input to DESMOND, which naturally reduces the usefulness of this course. Having initially attended DESMOND many participants want to know more! Where do they get this information from? I doubt if DESMOND ever answer that question.

DESMOND clearly state in its own documentation “The curriculums were developed acknowledging that not all nutrition messages could be covered in this first course, and that other food ‘messages’ would be covered (if relevant) in future educational courses, as part of a care pathway, either in group education, and/or in 1:1 consultations.” (section 3.2, page 3). Thus the designers of DESMOND admit it does not cover nutritional education adequately and that other interventions are required.

The very best course is the X-PERT Diabetes course, which I strongly recommend. Unfortunately this course is not run in all areas. But there is really no comparison between the DESMOND one day course and the X-PERT course spread over six weeks.

You will sometimes hear that Audits have shown DESMOND to be a cost effective programme in reducing diabetes outcomes. However, DESMOND has not been shown to improve clinical outcomes other than a small amount of body weight at 1 or 3 years when implemented as a randomised controlled trial and they do not collect audit results on standard implementation therefore any evidence outside a research climate is not known. In comparison, all X-PERT licensed organisations enter attendance, clinical, medication, evaluation and empowerment outcomes into an audit database and can demonstrate that all clinical and psychosocial improvements shown in the clinical trial are replicated through routine implementation.

One would assume that as a one day course DESMOND is cheaper than the X-PERT course but I have seen comparison figures that show the cost per patient for DESMOND is £87 versus £48 for X-PERT. This, I believe, is because the licence fee is more expensive and Educator’s deliver in pairs to groups of only 8 to 10 patients whereas X-PERT evidence base lies in one Educator delivering to group sizes of 15-18 patients.

I have taken some figures from the National Diabetes Audit 2010-2011 Report 2: Complications and Mortality), showing below a comparison between Medway (who run the X-PERT Course) and West Kent (who do not but run DESMOND) of the percentage risk of diabetic complications. Draw your own conclusions from the figures below.

Percentage Diabetic Complications Risk Medway West Kent

Angina 54.9 71.2
Myocardial Infarction 53.4 61.6
Heart Failure 43.4 65.5
Stroke 13.4 32.8
Renal Replacement Therapy 154 177
Minor Amputations 298 398
Major Amputations 127 270

My apologies if the columns do not come out as they should but I fear that is the system. Hopefully you can work out where the figures belong.

So why are you all being so negative. Its free info and relevant. Its foe new people who are lost and it helps. Take the info from all sources and then use it as you feel appropriate. They will tell you there are no rules and that a balance is needed. Sounds about right to me.

I am far from negative about it. It is a good start.

Some people will be negative for the sake of being negative.

There is a follow on course, foundation I think. Not done in this half of the trust yet though.

Someone above stated X-Pert is "the very vest course", I cannot comment. I have only done Desmond.

Hi, the DESMOND I did was broken up over two consecutive Saturdays. There is a lot of information to absorb and breaking it up certainly helped. We were also given a good set of notes in a folder which you can read at your leisure, which is what I have done.

Nik

I attended a Desmond course when I was first diagnosed in Febraury 2011 and took my husband along with me, I found the day beneficial and would recommend for people to attend but I found it was similar if not mostly the same advice given that you are given in the documents when you are diagnosed. I know that they were looking to change it but they seemed to be trying to make this more hands on and to make you look at the foods you should be eating more of and less of.