X-PERT Health provides high quality and enjoyable structured education that allows people with diabetes to develop the knowledge, understanding, and confidence to take charge of their condition and improve overall health. Four structured education programmes are available; X-PERT Prevention of Diabetes, X-PERT Diabetes, X-PERT Weight and X-PERT Insulin. The X-PERT Insulin programme required updating with the new theme of ‘Reduce or Omit’, the focus being to prioritise healthy lifestyles and patient choice, helping people to reduce or omit their insulin requirements to manage blood glucose levels.
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Traditionally, education and advice for people taking insulin focuses on how much insulin is needed to match the food they are eating and physical activity levels. Being able to match insulin to lifestyle is important for diabetes management, but this approach often results in the perception that the quality and quantity of food consumed is not important as long as insulin is adjusted accordingly. Over time this can lead to worsening health and the need for more insulin, which increases risk of hypos, (further) insulin resistance, weight gain and health complications, and can negatively affect quality of life. The relaunched X-PERT Insulin programme helps people make personalised, appropriate lifestyle changes to reduce insulin requirements and thus improve long-term health. All X-PERT programmes are based on the theories of discovery learning (Brunner), facilitative learning (Rogers) and experimental learning (Kolb) to support empowerment and patient activation. They use a non-didactic approach, visual aids, and constructive learning to help attendees make their own informed decisions. The X-PERT Insulin programme is novel because it is the only national structured education programme that is suitable for people with Type 1 and Type 2 diabetes, and it is delivered over a longer period of time (six consecutive weekly sessions of 2.5 hours each), enabling messages to be introduced gradually and reiterated as necessary. The programme is facilitated by trained and quality-assured X-PERT educators, supporting NICE guidance for diabetes management in adults. The new programme is a creative solution centred on current evidence. It bridges gaps in existing care, and in the knowledge of many people with diabetes, by covering a range of lifestyle aspects that may impact on diabetes self-care, such as diet, physical activity, stress, sleep, carb counting, types of insulin, using insulin safely and living with diabetes. The programme offers dietary flexibility, providing an individualised, person-centred approach. In addition to the group sessions, each participant receives an X-PERT Insulin handbook. This includes information on each session and goal-setting exercises to help people make the right lifestyle changes. After the programme, participants are invited to attend update sessions to recap and to keep up to date with new information. A free online forum provides additional ongoing support, information and useful resources for both participants and educators.
The X-PERT Insulin programme needed updating to help people to make lifestyle changes to help them reduce the amount of insulin they needed to take to manage their blood glucose levels. A literature search and critical appraisal of the research relating to diabetes and insulin treatment was undertaken to inform the new programme structure and content. The content was designed and written with specific learning outcomes assigned to each session. These included: understanding diabetes; nutrition; exploring insulin; carbohydrate and fat awareness; troubleshooting and physical activity. New resources (a patient handbook, an educator manual, labels and digital resources) were developed and an educator training programme was organised. The new programme was launched at a three-day educator training programme in Bexley (for Bexley Health Neighbourhood Care), in July 2017. All educators were required to sign a licence agreement which ensured data was uploaded to the audit database and a quality assurance assessment was completed within the first year of delivery. Educators were also required to attend a one-day training course every two years, to ensure they were up to date with new information, guidance and programme developments. X-PERT programmes are continuously audited, and a summary review is produced annually.
Results from the original X-PERT Insulin programme were compared to those of the relaunched version. Data collected over an 18-month period (1 January 2016-31 June 2017 for the old programme and 1 July 2017-1 January 2019 for the relaunched programme) were used for this comparison. Since the relaunch, there has been a 14% increase in programmes delivered, a 45% increase in participants registered and an increase in those completing the programme (currently 81%). Wellbeing, captured via a validated empowerment questionnaire, demonstrated an 18.2% increase from baseline. Clinical markers, such as HbA1c, blood pressure and lipid results, also saw improvements. HbA1c reduced on average by 9.6mmol/mol (n=112) which was an improvement of 43% compared to the previous X-PERT Insulin audit results. Reductions of 2 mmHg systolic blood pressure and 2 mmHg diastolic (n=44) were also seen. Reductions in triglycerides and in triglyceride to HDL-C ratio, a strong indicator of an increased risk of cardiovascular disease, were seen (0.3 mmol/l and 0.5, respectively). These were both improvements on the previous X-PERT Insulin audit results. Additionally, 56% of patients had completely omitted or reduced their insulin requirements and 22% had reduced or omitted other diabetes medications. These results demonstrate that patients who attend the X-PERT Insulin programme improve glycaemic control, reduce or omit insulin (and other diabetes medication), and reduce cardiovascular risk factors through lifestyle change.
Sustainability and Spread
The relaunched X-PERT Insulin programme has led to substantial health improvements in course attendees. There has been a 50% increase in the number of organisations offering the programme since the relaunch (n=15), with more areas being commissioned. X-PERT Health holds a conference and awards ceremony annually, which is free for commissioners, managers, healthcare professionals and educators. The annual audit report is published at the conference and is also available on the X-PERT website, distributed widely through leaflets at conferences and included in X-PERT newsletters. The free online forums are available for continuous feedback, evaluation, support and information.
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