In terms of HbA1c, looking at the unadjusted HbA1c, there is a significant fall in both groups with HbA1c but a 0.5% difference in HbA1c at three years between the two groups; however, once you adjust for the baseline HbA1c and for cluster, the statistical significance is lost. The intervention group continue to have a lower body mass index; the other changes, whilst in the right direction, were not significant once adjusted

for baseline and cluster. These data are encouraging based on the fact that this is a one-off selleck screening library intervention shortly after diagnosis, and to see significant changes in illness beliefs and weight three years down the line is an unexpected and actually quite unique finding.11 There has been some concern regarding the lack of difference in HbA1c with the newly diagnosed DESMOND programme, but this is not unexpected if we consider data in those with newly diagnosed diabetes in the UKPDS which show that, after diagnosis, A1c generally improves.12 PLX4032 In patients with established diabetes, both the XPERT and the Turin studies did see significant differences in HbA1c but showed either modest or, in fact, maintenance of HbA1c in the intervention group compared

to an increase of HbA1c in the control groups.13,14 Since 2003, the momentum of DESMOND has been maintained; 2009 saw the beginning of a five-year research programme to finalise development and begin a trial of the DESMOND Ongoing model – integrating Fenbendazole life-long learning, care planning and treatment optimisation. The training and quality development for health care professionals is a key component of the programme’s success; very briefly, it integrates professional development with objective assessment, develops reflective practitioners, monitors

reliability and ensures that the programme is of a consistently high quality wherever it is delivered.15 This programme of work has fundamentally influenced national guidelines and standards for structured education and has highlighted the importance of health care professionals’ training.16,17 It is important that research leads to change in practice and now 104 primary care organisations are delivering DESMOND across the UK and Ireland with 747 trained educators and 77 training courses since 2005.18 The black and minority ethnic (BME) DESMOND programme is now up and running with 16 PCTs delivering it. A commonly held myth is that exercise prevents diabetes. In fact, if you look on Google, you will find over 1 600 000 hits for exercise and diabetes prevention. This is not unexpected as we know that exercise and increase in physical activity are strongly and adversely associated with the incidence of T2DM, and this association is independent of body weight and other lifestyle behaviours.