Randomised Controlled Feasibility Trial of Face-To-Face Diabetes Self-Management Education Shows High Completion Rates Are Needed to Improve Patient-Reported Outcomes

Published Date: 27th May 2026

Publication Authors: Lewis. G, Hardy. K

Aims
To examine the dose–response relationship between diabetes self-management education (DSME) attendance and psychological outcomes in type 2 diabetes, assessing whether minimal attendance (10%) produces clinically meaningful improvements and comparing outcomes at the internationally adopted 60% completion benchmark with full (100%) completion.

Materials and Methods
This randomised feasibility trial enrolled 120 adults (≥ 18 years) due to attend a UK DSME programme. Participants were randomised to receive 100% (routine DSME), 60%, 10% or 0% (delayed DSME). Primary outcomes were changes in self-management skills; secondary outcomes included health-related quality of life (HRQoL) and diabetes distress.

Results
Participants had a mean age of 61 years, mean HbA1c of 8.4% (68 mmol/mol) and median diabetes duration of 8 years. Significant between-group differences were observed in change scores for self-management skills (F[3,109] = 6.914, p < 0.001) and diabetes distress (F[3,108] = 7.369, p < 0.001). Education dose explained 16%–17% of the variance demonstrating a dose–response relationship (ηp2 = 0.16–0.17) with a moderate effect size (n2 = 0.16, 95% CI [0.04, 0.27]). Within-group statistical improvements were observed for both 100% and 60% completion, but clinically meaningful improvements across all psychological domains occurred only with full (100%) completion. No significant between-group differences were observed for HRQoL.

Conclusions
In this randomised feasibility trial, clinically significant psychological benefits from DSME required full (100%) programme completion. Attendance thresholds of ≤ 10% or partial completion (≥ 60%) did not yield meaningful improvements in diabetes distress or HRQoL. These findings suggest that existing performance indicators based on partial attendance may not reflect meaningful benefits and support 100% DSME attendance as the gold standard.

Lewis, G.A.; Hardy, K.J. et al. (2026). Randomised Controlled Feasibility Trial of Face-To-Face Diabetes Self-Management Education Shows High Completion Rates Are Needed to Improve Patient-Reported Outcomes,”. Diabetes, Obesity and Metabolism. Early View, pp.1-9. [Online]. Available at: https://doi.org/10.1111/dom.70917 [Accessed 4 June 2026].