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NCT Number: NCT03360058

Obesity and Type 2 Diabetes - Raising the Issue of Weight Management in Primary Care

To ensure that patients who are overweight or obese and have type 2 diabetes are identified, receive personalised diabetes care, have the issue of weight raised and explained in a non-judgemental manner by staff in primary care, and are referred on to weight management services as appropriate ensuring equity of access across NHS Greater Glasgow and Clyde.

Specific aims of the whole project:

1. To improve GP/ primary care staff knowledge of the evidence base for the management of diabetes when there is co-existing obesity and local care pathways 2. To increase GP/ primary care staff knowledge of and confidence in their role in raising the issue of weight management, 3. To improve primary care referral rates of appropriate patients who are overweight or obese and have type 2 diabetes, and are "ready to change" to NHS funded weight management services 4. To improve patient uptake of and attendance at NHS funded weight management services NB This is a service evaluation of a training programme being delivered by NHS Greater Glasgow and Clyde Health Improvement. Full ethical approvals are being sought due to the randomised design and so that results can be generalised and published.

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Key information

Conditions

Weight Management Diabetes Mellitus Diabetes Mellitus, Type 2 Endocrine System Diseases Glucose Metabolism Disorders Metabolic Diseases Nutritional and Metabolic Diseases

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Glasgow Cardiovascular Research Centre

Glasgow, Scotland, G12 8TA, United Kingdom

About this study

The Glasgow and Clyde weight management service (GCWMS) delivers a specialist multi-disciplinary, multi-component weight management programme throughout the Glasgow and Clyde area. In a recent evaluation of the service, the authors highlighted that 27% of the patients who are referred to the programme do not opt into the service. This describes patients who are referred via their GP practice and do not contact the service to opt into an initial assessment.

Similarly, Brook et al described initial uptake and engagement of a small weight management programme of 502 patients. In addition to completing an extensive questionnaire, patients were requested to call to make an appointment with the service personally. Of those referred to the programme, 46% did not opt in.

Engaging patients in a weight management programme is especially difficult, even when the intervention is provided via the primary care route. For example, The Counterweight Project, a weight management programme delivered via the GP surgery, has been taken up by a number of surgeries in Scotland, however after 2 years, one fifth of enlisted practices failed to enrol patients onto the programme.

Even when GP's do address matters of weight related behaviour, there is often disagreement from the patient that the topic has been raised. In a sample of 456 patients, 39% of patients disagreed with GP reporting about the content of the discussion during consultations regarding weight, diet and physical activity. In particular, GP's reported more occasions of discussing weight than patients in 12.5% of consultations. Patients' likeliness to engage in a weight management programme is also influenced by practice endorsement and opinion of the GP of the intervention available in addition to other factors: clear understanding of the programme, clear understanding of the programme goals, structured pro-active follow-up and perception of positive outcomes.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • GP practices in NHS Greater Glasgow and Clyde which:
  • Have a contract for local enhanced services for long term conditions (Diabetes)
  • Have a unique clinical database (i.e. not shared with another practice)

Exclusion criteria

  • "17c" practices (those with a separate contract for long term conditions)
  • Those practices with a database shared with another practice (8 practices in area)

Treatment and study plan

Small Talk Big Difference Immediate access training

Behavioral

Immediate access to 1 hour online training and supporting print materials for implementation in primary care practice

Small Talk Big Difference delayed access training

Behavioral

Delayed access (by 4 months) to 1 hour online training and supporting print materials for implementation in primary care practice

Primary outcomes

  1. Measure the effectiveness of an online training programme, practice implementation toolkit and face to face training for primary care staff

    Time frame: 12 months

    which will be measured as number of patient referrals and patient attendance at NHS funded weight management services

Secondary outcomes

  1. Implementation/ Normalization

    Time frame: 12 months

    NOMAD questionnaire will be used to ascertain how STBD impacts on primary care clinicians work

  2. Percentage of diabetes reviews with recorded weight management discussion in LES template

    Time frame: 12 months

    percentage of diabetes review in primary care

  3. Training uptake

    Time frame: 12 months

    Training uptake - online, face to face and experiential

    • By practice
    • By GP and practice Nurse By diabetes lead

Sponsors and collaborators

Lead sponsor

NHS Greater Glasgow and Clyde

Other

Collaborators

  • University of Glasgow

Registry information

Official study title

Obesity and Type 2 Diabetes - Raising the Issue of Weight Management in Primary Care (Small Talk Big Difference)

Acronym: STBD

Important dates

Study start
2017
Primary completion
2018
Study completion
2018
First posted
Dec 2, 2017
Registry last updated
Nov 23, 2018

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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