This model outlines the challenges participants encounter in maintaining diabetes self-management practice s after attending structured education , and describes how participants try to address these barriers by adapting , simplifying or personalising the self-management approaches they have learned .
Conclusions This meta-ethnography highlights how providing skills training using structured education to people with type 1 diabetes does not necessarily result in participants adopting and sustaining recommended changes in behaviour .
Background People with type 1 diabetes who attend structured education training in self-management using flexible intensive therapy achieve improved blood glucose control and experience fewer episodes of severe hypoglycaemia .
However , many struggle to sustain these improvements over time .
To inform the design of more effective follow-up support we undertook a review of qualitative studies which have identified factors that influence and inform participants ’ self-management behaviours after attending structured education  and their need for support to sustain improvements in glycaemic control .
Flexible eating and flexible insulin dosing in patients with diabetes: Results of an intensive self-management course.
AIMS To evaluate the outcomes of an established programme to teach patients to match their insulin dose to their carbohydrate intake . RESEARCH DESIGN AND METHODS A prospect i ve observational study in Australia ( Newcastle , NSW ) of 137 consecutive patients with type 1 ( n=82 ) or type 2 diabetes ( n=55 ) over two successive years . Four educational principles were used to teach intensive insulin management and diabetes self-care skills including : carbohydrate counting and insulin dose adjustment , exercise , appropriate treatment of hypoglycaemia and hyperglycaemia , managing sickness , problem solving , communication with health professionals , goal setting , and the importance of support . Outcomes included changes at 4 and 12 months in HbA1c , self-efficacy measured by a diabetes empowerment scale ( DES ) , diabetes specific quality of life ( ADDQoL ) , and problem solving . Both intention to treat and efficacy analyses were performed . RESULTS Diabetes-related quality of life and diabetes problem solving skills improved significantly . Excluding 16 people who failed to adopt intensive insulin management and 24 who started with an HbA1c less than 7 % , intention to treat analysis showed the average HbA1c fell from 8.7 % initially to 8.1 % at 12 months and the number of people with an HbA1c of less than 8 % rose from 67 ( 48.9 % ) before the program to 86 ( 62.8 % ) afterwards . CONCLUSIONS An intensive diabetes self-management program led to improvements in HbA1c , empowerment , and quality of life that were largely sustained at 1 year . This is all the more remarkable given that the intervention was once only , entailed no long-term follow-up , and took place in normal clinical operations
This model outlines the challenges participants encounter in maintaining diabetes self-management practice s after attending structured education , and describes how participants try to address these barriers by adapting , simplifying or personalising the self-management approaches they have learned .
Conclusions This meta-ethnography highlights how providing skills training using structured education to people with type 1 diabetes does not necessarily result in participants adopting and sustaining recommended changes in behaviour .
Background People with type 1 diabetes who attend structured education training in self-management using flexible intensive therapy achieve improved blood glucose control and experience fewer episodes of severe hypoglycaemia .
However , many struggle to sustain these improvements over time .
To inform the design of more effective follow-up support we undertook a review of qualitative studies which have identified factors that influence and inform participants ’ self-management behaviours after attending structured education  and their need for support to sustain improvements in glycaemic control .