Skip to main content Skip to navigation

Theme 8: Implementation of effective community care for diabetes

This theme was concerned with type 2 diabetes, which currently affects 2.3 million people in England and Wales.

We evaluated the comprehensive programme of care put in place by, what was then South Birmingham PCT and measured uptake of services (such as screening for retinopathy and consultation with a nutritionalist), effects on diet and exercise, attendance for necessary check-ups and glucose control achieved. We will also measured quality of life over time and conducted qualitative research to identify barriers to care and glean a deep understanding of what the disease and its treatment mean to different groups of people.

The results of the research will be used to adapt the care package in ways that are sensitive to different sectors of the local population.

Our projects

DESMOND Foundation Programme

In collaboration with Leicester General Hospital; the DESMOND Foundation Study was a randomised control trial for patients with type 2 diabetes in Birmingham targeted at a mutli-ethnic population. The study aimed to improve biomedical, lifestyle and psychological outcomes of a multi-ethnic population with established diabetes (more than 12 months, with less than 10 years duration). The study utilised an adapted version of the DESMOND Foundation programme, a patient-centred education programme to help adults assess their risk of diabetes related complications and manage their routine care. A total of 640 patients with type 2 diabetes were recruited and split across the control and intervention arms. The intervention arm was invited to attend the education programme at study entry whereas the control arm was invited to the education programme at the end of the study. The primary outcome was a reduction in HbA1c levels of greater than or equal to 0.5 per cent which represents a clinically significant change.

Primary care Research Into Diabetes Evolution (PRIDE)

A study of the long-term outcomes of diabetes and its complications. It aimed to study a population of patients with diabetes within a discrete primary care trust area. PRIDE included several phases. The larger PRIDE cohort (PRIDE 1), aimed to capture the majority of patients with diabetes in South Birmingham Primary Care Trust (SBPCT), including a detailed collection of data to provide a well-characterised patient population for future studies into diabetes. Subsequently, the project aimed to conduct a more detailed study of patients with type 2 diabetes, using more specific validated measures and instruments, in a subset of the cohort population to assess important factors that contribute to diabetes and its macro- and micro-vascular complications (PRIDE 2). Additionally, in a longitudinal qualitative sub-study (PRIDE 3), an in-depth interview was used to explore patients’ experiences of living with type 2 diabetes. This study provided important information to the NHS and health professionals aiming to develop effective interventions to prevent and treat diabetes.

Steps Programme Evaluation

A randomised controlled trial to evaluate a newly designed type 2 diabetes self-management programme, focused on lifestyle rather than diabetes specifically. The aim was to assess whether the self-management programme ‘Steps to your healthy future’ can yield improvements in glucose control, psychosocial measures, lifestyle measures and other biomedical measures including body mass index (BMI), waist, hip, neck circumference, blood pressure and cholesterol. There was also be a qualitative component to the evaluation, whereby participants were interviewed to gain insight into the patient experience.

Rangoli Arts

Researchers from Theme 8 and a local artist worked together to find out more about what South Asian communities think about Diabetes and how it affects them and their communities. Whilst talking, the participants took part in a Rangoli art workshop using beans and pulses to prompt discussion on food and diabetes. A total of six sessions were arranged with a number of different community organisations.

Raising the issue

The aim of this project is to determine whether health professionals are deterred from raising the issue of obesity with their patients. The research will explore whether there are any barriers of communication for patients and health professionals; what level of health professional is best placed to raise the issue; what resources do the health professionals need to be equipped with and how the issue should be raised in a culturally sensitive way. The research involved PPI consultation with White, South Asian and African Caribbean groups. With the support of the PPIs we designed an appropriate process for health professionals to raise the issue of obesity.

Chat mat

The chat mats are an interactive education tool for overweight and obese people using the content of the SLIM programme. They are based on a patient centred model and narrative principles. With a patient-centred model the patient defines the need, is active and is independent. The tools are essentially large, pictorial mats aided by an information manual and visual props and are used to educate people about overweight/ obesity and healthy living. The sessions were interactive and engaging with participants sharing stories and learning about weight management. The tools can be used by health professionals as well as by lay people on a community level.


CEDAR: Exploring the Co-morbidities and Epidemiology of Diabetes using A primary care Research database. This used The Health Improvement Network (THIN) database which is an anonymous medical record of over nine-million patients registered among 479 general practices in the UK since 1991.

The Guangzhou Biobank Cohort

Sleep loss has been associated with a wide variety of problems including cognitive function decline, mental health, and a host of other functional deficits. We sought to identify factors that are associated with short sleep and memory impairment.

Indian Men’s Health Beliefs & Perceptions of Type 2 Diabetes

Through narrative interview, we aimed to explore:

  • Specific cultural and social practices which influence health behaviours
  • How lay beliefs about health influence perceptions of type 2 diabetes and/or its risk
  • Attitudes and beliefs of health and illness across two generations of Indian Punjabi men


Assessing the Impact of the Combination of the GLP-1 Analogue Liraglutide (Victoza) and Laparoscopic Adjustable Gastric Banding (LAGB) on Diabetes Control; GLIDE: Gastric band and Liraglutide Intervention in Diabetes Evolution.

The extra impact on weight loss and metabolism achieved by other surgical procedures is suspected to be due to post-operative hormonal changes, including increased glucagon-like-peptide-1 (GLP-1) secretion, not observed following LAGB. Liraglutide (Victosa, Novo Nordisk) is a GLP-1 analogue associated with significant reductions in weight and fasting glucose levels, with good safety and tolerability. The combination of liraglutide and LAGB is likely to offer extremely obese patients with diabetes the opportunity of achieving significant weight loss and diabetes resolution with minimal surgical risk.

Evaluation of LES in BEN PCT

Birmingham East and North Primary Care Trust (BENPCT) invested in a diabetes Local Enhanced Service (LES). Participating GP Practices provided all essential and additional services for diabetic patients- including management of patients with type 2 diabetes on diet and/or tablets, patients with type 1 diabetes, and more complex type 2 patients. We explored the difference between LES and Non-LES practices for Quality and Outcomes Framework (QOF) indicator outcomes for DM12 (percentage with diabetes in whom the last blood pressure is 145/85 or less), DM17 (percentage whose last measured total cholesterol within the previous 15 months is 5mmol/l or less) and DM23 (percentage with diabetes in whom the last HbA1c is 7 or less).

Unobtrusive research into patients experiences of bariatric surgery

Collecting patient data from online discussion forum to analyse concerns post surgery (specifically constipation).


What is social media feeding you? A study of diet and weight loss information available on YouTube. Exploring a novel method of identifying videos a user if most likely to access for further qualitative analysis

Other Academic Work

Analysis of cohort data to assess the prevalence of metabolic syndrome, examine associated factors and compare screening tools in a West Midlands HIV population; systematic review on the effectiveness of dietary intervention in HIV dyslipidaemia.

A systematic review on the effectiveness of dietary intervention in HIV dyslipidaemia. Protocol has been registered with PROSPERO.

Analysis of cohort data to assess the prevalence of metabolic syndrome, examine associated factors and compare screening tools in a West Midlands HIV population.

Author(s) Title Journal Publication date
Araghi, MH; Jagielski, A; Neira, I; Brown, A; Higgs, S; Thomas, GN; Taheri, S The complex associations among sleep quality, anxiety-depression, and quality of life in patients with extreme obesity Sleep, 2013 Dec 1;36(12):1859-65. doi: 10.5665/sleep.3216
1 Dec 2013
Banerjee, D; Leong, WB; Arora, T; Nolen, M; Punamiya, V; Grustein, R; Taheri, S The Potential Association between Obstructive Sleep Apnea and Diabetic Retinopathy in Severe Obesity—The Role of Hypoxemia PLoS One
doi: 10.1371/journal.pone.0079521
18 November 2013
Araghi, MH; Chen YF; Jagielski, A; Choudhury, S; Banerjee, D; Thomas, N; Taheri, S Effectiveness of Lifestyle Interventions on Obstructive Sleep Apnea (OSA): Systematic Review and Meta-Analysis Sleep
2013; 36(10):1553-1562
1 October 2013
Leong WB, Arora T, Jenkinson D, Thomas A, Punamiya V, Banerjee D, Taheri S The prevalence and severity of obstructive sleep apnea in severe obesity: the impact of ethnicity Journal of Clinical Sleep Medicine. 2013;9(9):853-8.
doi: 10.5664/jcsm.2978
4 September 2013
Arora, T; Broglia, E; Pushpakumar, D; Lodhi, T; Taheri, S An investigation into the strength of the association and agreement levels between subjective and objective sleep duration in adolescents PLoS One
doi: 10.1371/journal.pone.0072406
9 August 2013

Theme lead

Dr Shahrad Taheri

  • Former South Birmingham Primary Care Trust
  • Heart of England NHS Foundation Trust
  • University of Birmingham