Diabetes Mellitus, Type 2 Clinical Trial
Official title:
Obesity and Type 2 Diabetes - Raising the Issue of Weight Management in Primary Care (Small Talk Big Difference)
To ensure that patients who are overweight or obese and have type 2 diabetes are identified,
receive personalised diabetes care, have the issue of weight raised and explained in a
non-judgemental manner by staff in primary care, and are referred on to weight management
services as appropriate ensuring equity of access across NHS Greater Glasgow and Clyde.
Specific aims of the whole project:
1. To improve GP/ primary care staff knowledge of the evidence base for the management of
diabetes when there is co-existing obesity and local care pathways
2. To increase GP/ primary care staff knowledge of and confidence in their role in raising
the issue of weight management,
3. To improve primary care referral rates of appropriate patients who are overweight or
obese and have type 2 diabetes, and are "ready to change" to NHS funded weight
management services
4. To improve patient uptake of and attendance at NHS funded weight management services NB
This is a service evaluation of a training programme being delivered by NHS Greater
Glasgow and Clyde Health Improvement. Full ethical approvals are being sought due to the
randomised design and so that results can be generalised and published.
The Glasgow and Clyde weight management service (GCWMS) delivers a specialist
multi-disciplinary, multi-component weight management programme throughout the Glasgow and
Clyde area. In a recent evaluation of the service, the authors highlighted that 27% of the
patients who are referred to the programme do not opt into the service. This describes
patients who are referred via their GP practice and do not contact the service to opt into an
initial assessment.
Similarly, Brook et al described initial uptake and engagement of a small weight management
programme of 502 patients. In addition to completing an extensive questionnaire, patients
were requested to call to make an appointment with the service personally. Of those referred
to the programme, 46% did not opt in.
Engaging patients in a weight management programme is especially difficult, even when the
intervention is provided via the primary care route. For example, The Counterweight Project,
a weight management programme delivered via the GP surgery, has been taken up by a number of
surgeries in Scotland, however after 2 years, one fifth of enlisted practices failed to enrol
patients onto the programme.
Even when GP's do address matters of weight related behaviour, there is often disagreement
from the patient that the topic has been raised. In a sample of 456 patients, 39% of patients
disagreed with GP reporting about the content of the discussion during consultations
regarding weight, diet and physical activity. In particular, GP's reported more occasions of
discussing weight than patients in 12.5% of consultations. Patients' likeliness to engage in
a weight management programme is also influenced by practice endorsement and opinion of the
GP of the intervention available in addition to other factors: clear understanding of the
programme, clear understanding of the programme goals, structured pro-active follow-up and
perception of positive outcomes.
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