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GPs and nurses could slash diabetes patients waiting times for psychological care

GPs and nurses should be trained to deliver psychological therapies shown to help people struggling to cope with type 2 diabetes, according to researchers at the University of Warwick.

Interventions such as counselling and cognitive behavioural therapy have been shown to help people with type 2 diabetes to control their blood glucose. However, a shortage of psychological therapists in the NHS means that access to these services are severely limited.

In a paper published in the journal Patient Education and Counselling, a team at the University’s Warwick Medical School reviewed 35 trials exploring the clinical and psychological effects of offering type 2 diabetes patients psychological interventions.

In half of the trials the therapies were delivered by psychological therapists and the other half were delivered by general health professionals, such as GPs and nurses, who had been given specialist training.

The review revealed that blood glucose levels were reduced to the same degree irrespective of whether it was a psychological therapist or a general health care professional who delivered the therapy. The team concluded psychological therapies could be successfully delivered by general health professionals to allow greater access to services.

Dr Jackie Sturt, Associate Professor in Behavioural and Social Sciences at Warwick Medical School, said psychological therapies had been shown to reduce HbA1c, a measure which shows the average amount of sugar in the blood over the last two to three months, by between half and one percent which can equal a 14-37% reduction in serious diabetes-related complications such as heart disease, blindness and kidney disease.

Dr Sturt said psychological therapies were vitally important for people with type 2 diabetes and a regulated training course was needed for general health professionals.

She said: “The behavioural changes facilitated by close attention to diet, medication regimens including insulin injections, exercise, weight management, self-monitoring of daily blood glucose levels and foot care are burdensome and have social and emotional consequences.

“In addition to this, specific psychological problems including depressive disorders and eating disorders can manifest themselves through poor glycaemic control, this gives rise to further complications.”

Coventry GP Kumkum Misra underwent training to pilot offering psychological therapies at her surgery in Queen Mary’s Road, Coventry.

She said: ”Patients with chronic disease need more time from the clinicians so that a better care plan can be devised for their management. It generally not only improves the doctor patient relationship but also helps the doctor to build the confidence of the patient to take more responsibility for caring for their problem.”

“Every patient is an individual with their own individual problems and with this study it has given me the confidence to make my consultations more patient centred.”

Notes to editors

The review, An updated meta-analysis to assess the effectiveness of psychological interventions delivered by psychological specialists and generalist clinicians on glycaemic control and on psychological status, has been published in Patient Education and Counselling, doi: 10.1016/j.pec.2008.08.026

Dr Sturt is available for interview, call 02476 573753 and Coventry GP Dr Misra is also happy to be contacted through the University’s Communications Office. For more information please contact Kelly Parkes-Harrison, Communications Officer, University of Warwick,, 02476 150483, 07824 540863.