Quality standard

Quality statement 1: Structured education programmes

Quality statement 1: Structured education programmes

Quality statement

Adults with type 1 diabetes are offered a structured education programme. [2011, updated 2023]

Rationale

Adults with type 1 diabetes need to acquire a large range of new skills and knowledge, such as how to manage their insulin therapy and diet. Structured education enables self-management, which is important in diabetes management. It allows adults with type 1 diabetes to adapt their diabetes management to changes in their daily lives and to maintain a good quality of life. The first few months after diagnosis involve considerable adjustment, so although information should be given from diagnosis, a more intensive structured education programme, of proven benefit, should be offered when appropriate.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly. Services may want to use these measures to focus on dimensions of health inequality, for example by reporting data grouped by age, ethnicity or indices of deprivation.

Process

a) Proportion of adults with type 1 diabetes who are offered a structured education programme 6 to 12 months after diagnosis.

Numerator – the number in the denominator who are offered a structured education programme 6 to 12 months after diagnosis.

Denominator – the number of adults diagnosed with type 1 diabetes in the last 12 months.

Data source: The National Diabetes Audit's care processes and treatment targets report collects and reports data on the number of adults with type 1 diabetes who have been offered structured education within 1 and 2 years of diagnosis and with no time limit from diagnosis. NHS Digital's Quality and Outcomes Framework indicator DM014 reports data on the percentage of patients newly diagnosed with diabetes who have a record of being referred to a structured education programme within 9 months of entry on to the diabetes register. While referral can be made at any time, for measurement purposes a time scale of 6 to 12 months following diagnosis can be used.

b) Proportion of adults with a new diagnosis of type 1 diabetes who attend a structured education programme.

Numerator – the number in the denominator who attend a structured education programme.

Denominator – the number of adults with a new diagnosis of type 1 diabetes.

Data source: The National Diabetes Audit's care processes and treatment targets report collects and reports data on the number of adults with type 1 diabetes who have attended structured education within 1 and 2 years of diagnosis and with no time limit from diagnosis.

c) Proportion of adults with type 1 diabetes who complete a structured education programme.

Numerator – the number in the denominator who complete a structured education programme.

Denominator – the number of adults with type 1 diabetes who attend a structured education programme.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

Outcome

Patient confidence to self-manage their type 1 diabetes after attending a structured education programme.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient surveys and confidence scaling.

What the quality statement means for different audiences

Service providers (such as GP practices, community healthcare providers and secondary care providers) ensure that systems are in place for adults with type 1 diabetes to be offered a structured education programme. The services providing the education programme should ensure that it is available in a format suitable for the person, such as in-person or online, and at times suitable for them, including outside standard working hours.

Healthcare professionals (such as GPs, practice nurses, community healthcare providers, dietitians, consultant diabetologists and diabetes specialist nurses) ensure that they offer a structured education programme to adults with type 1 diabetes. Healthcare professionals ensure they highlight the importance of attending the structured education programme to encourage attendance. They should ensure adults with type 1 diabetes are given clear information on the structured education programme and help to access it.

Integrated care systems ensure that structured education programmes of proven benefit are available for adults with type 1 diabetes. They ensure that programmes are available in a format suitable for the person, such as in-person or online, and at times suitable for them, including outside standard working hours.

Adults with type 1 diabetes are offered a course to help them improve their understanding of type 1 diabetes and how to manage it in their everyday life. This should cover checking their glucose levels, using insulin and choosing a healthy lifestyle.

Source guidance

Type 1 diabetes in adults: diagnosis and management. NICE guideline NG17 (2015, updated 2022), recommendations 1.3.1 and 1.3.2

Definitions of terms used in this quality statement

Structured education programme

Adults with type 1 diabetes should be offered group education programmes as the preferred option. Any structured education programme for adults with type 1 diabetes should:

  • be evidence-based, of proven benefit, and suit the needs of the person

  • have specific aims and learning objectives, and should support the person and their family members and carers to develop attitudes, beliefs, knowledge and skills to self-manage diabetes

  • have a structured curriculum that is theory-driven, evidence-based and resource-effective, has supporting materials and is written down

  • have outcomes that are audited regularly

  • be quality assured and reviewed by trained, competent, independent assessors who measure it against criteria that ensure consistency

  • be delivered by trained educators who:

    • understand educational theory appropriate to the age and needs of the person

    • are trained and competent to deliver the principles and content of the programme.

An example of a structured education programme of proven benefit is the Dose Adjustment for Normal Eating (DAFNE) programme. [Adapted from NICE's guideline on type 1 diabetes in adults: diagnosis and management, recommendations 1.3.1, 1.3.3 and 1.3.4]

Equality and diversity considerations

Structured education programmes should meet the cultural, linguistic, cognitive and literacy needs in the local area and consider the characteristics of the target population, including socioeconomic status and social context.

Structured education programmes should be adapted to ensure they are accessible to adults with type 1 diabetes and a learning disability, such as accommodating views of those with a learning disability, short sessions and the programme rolled out over longer periods in community settings.

Group education programmes are the preferred option, but an alternative of equal standard should be provided for adults who are unable or prefer not to take part in group education. Adults with type 1 diabetes should be given information that they can easily read and understand themselves, or with support, so they can communicate effectively with educators. Information should be in a format that suits their needs and preferences. It should be accessible to adults who do not speak or read English, and it should be culturally appropriate and age appropriate. Adults should have access to an interpreter or advocate if needed. 

For adults with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.