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D6 shows scant effect in diabetes care

D6 training for nurses treating patients with type 2 diabetes showed little effect in improving glycaemic control

D6 training for nurses treating patients with type 2 diabetes showed little effect in improving glycaemic control


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Sub-optimal glycaemic control is common in patients with type 2 diabetes, often associated with psychological factors such as depression. This randomised controlled trial investigated whether practice nurses specifically trained in psychological skills, motivational interviewing and basic cognitive behaviour therapy (known as the D6 intervention) could integrate this with diabetes care and improve glycaemic control.

Twenty-four inner city practices were randomised to provide usual care or usual care plus the D6 intervention to 334 patients recruited for the study. All patients were invited for 12 usual care or usual care plus D6 appointments over 12 months. The mean number of appointments attended was seven for the usual care group and eight for the intervention group.

Hard to engage with patients

At an 18-month follow-up there was no significant difference in measurements of glycaemic control (HbA1c), body mass index, blood pressure, fasting triglyceride, or psychological distress between the usual care and intervention group patients.

On reviewing audiotapes of the nurse-patient sessions, the researchers found little difference in the approach and level of psychological skills displayed between the usual care and the intervention nurses. Explanations included the practice nurses seeing this psychological approach as within their remit or preferred style of working, and difficulties of engaging this group of patients.


Ismail K, Winkley K, de Zoysa N et al (2018) Nurse-led psychological intervention for type 2 diabetes: a cluster randomised controlled trial (Diabetes-6 study) in primary care. British Journal of General Practice. 68, 673, e531-e540.  doi: 10.3399/bjgp18X696185

Compiled by Vari Drennan, professor of healthcare and policy research at Kingston and St. George’s, University of London

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