key: cord-0781785-urrnr3oo authors: Quinn, Lauren M; Davies, Melanie J; Northern, A; Brough, C; Schreder, S; Stribling, B; Khunti, K; Hadjiconstantinou, Michelle title: Use of MyDesmond digital education programme to support self‐management in people with type 2 diabetes during the COVID‐19 pandemic date: 2020-12-04 journal: Diabet Med DOI: 10.1111/dme.14469 sha: c6762264e2bc52a4bcf526711c5043efd7424e99 doc_id: 781785 cord_uid: urrnr3oo The pandemic has presented unique challenges for people with diabetes, who comprise a high risk group for severe COVID‐19 infection(1–3). There has been increased emphasis on the importance of self‐care activities for people with diabetes to optimise their diabetes management; however, this has proven difficult because of restrictions due to lockdown and reduced face‐to‐face diabetes education (4). Nevertheless, the pandemic has also presented people with diabetes and their healthcare teams with an opportunity to innovate and move quickly towards increasingly digitalised care, to continue supporting people with diabetes from their own homes. The pandemic has presented unique challenges for people with diabetes, who comprise a high risk group for severe COVID-19 infection(1-3). There has been increased emphasis on the importance of self-care activities for people with diabetes to optimise their diabetes management; however, this has proven difficult because of restrictions due to lockdown and reduced face-to-face diabetes education (4) . Nevertheless, the pandemic has also presented people with diabetes and their healthcare teams with an opportunity to innovate and move quickly towards increasingly digitalised care, to continue supporting people with diabetes from their own homes. MyDesmond, is an online programme to support people with diabetes with their selfmanagement (5) . It is accessible on the NHS Apps Library and incorporates content from the NICE endorsed face-to-face DESMOND programme (6, 7) . MyDesmond is due to be rolled out in Australia end of 2020, based on a recent pilot evaluation, which showed a significant improvement in health outcomes, including diabetes empowerment and diabetes-related distress (5, 7, 8) . This theory-based digital programme adopts evidence-based strategies to optimise learning and engagement, whilst allowing people with diabetes to progress through the educational content at their own pace. Other features of MyDesmond include discussion forums, booster sessions, goal setting features, monitoring steps, 'Ask the Expert', step challenges, health trackers and a buddy system to tailor selfmanagement strategies and promote behaviour change. This article is protected by copyright. All rights reserved During the pandemic, MyDesmond was made freely available across the UK and uptake increased by 400% in a month with a current total of 10,000 registered users. We therefore undertook an online survey in August with registered users to ascertain satisfaction and usefulness of the MyDesmond programme, and to understand what aspects of self-care activities the COVID-19 pandemic had impacted. This survey was available for one week. Of those who responded (n=803), the majority had been diagnosed with type 2 diabetes in the last year (55%), 28% had been living with type 2 diabetes for 1-5 years, and 17% for more than 10 years. Experience of MyDesmond also varied with 21% having used the programme for <1 month, 51% for 1-6 months and 28% for >6 months. Users accessed MyDesmond on computers and smartphones, and the majority found the content sufficiently detailed (83%), providing clear and concise information (92%). A further 85% agreed the programme was easy to use, 83% enjoyed using the programme and 83% would recommend the programme to others. In addition, 81% reported that the programme helped them to better understand their condition, and the educational material were considered the most helpful aspect of the programme. The interactivity incorporated was considered to be engaging by 79% of the respondents. Sixty-seven per cent said they had improved their diet, 59% became more active because of the programme, and 39% felt the programme helped them to better manage stress. In terms of how the pandemic and lockdown period affected self-management behaviours, compared to pre-lockdown, 24% reported eating more than usual, 37% were less active than usual, and 35% felt more anxious or depressed, with 30% sleeping less than usual. Overall, 19% felt less confident in self-managing their diabetes during the lockdown period, which further highlights the added burden of stress impacting diabetes management during the pandemic ]. Users continued to access diabetes care services during the lockdown period, with 24% having attended a face-to-face appointment or received face-to-face treatment (12%), 8% had a video consultation whereas 50% had a telephone consultation with a healthcare professional. Overall, 58% embraced a digital consultation and 81% were satisfied with the care received, demonstrating high accessibility and satisfaction. However, for a minority, 20% reported reducing prescription orders and medication intake, and a further 15% had avoided seeking expert advice or medical care during the pandemic. This highlights the added fear and anxiety experienced due to local restrictions, and emphasises the strong need to consider and address these negative emotions in digital self-management programmes. This article is protected by copyright. All rights reserved Overall, these findings suggest that MyDesmond provided a positive experience for people with diabetes to encourage lifestyle and self-care activities. Self-management was an increased challenge during the pandemic, and reported changes in lifestyle behaviours were concerning, given the increased risk of COVID-19 infection with sub-optimally controlled diabetes. The decline of wellness and self-care activities however, is likely anticipated given the restrictions on access to facilities and public spaces (4, 9) . This high satisfaction and uptake for a digital self-management programme further supports NHS England's aim to enhance digitalisation of care, and combines the added benefits including efficiency and increased convenience to use by people with diabetes (10) with the overall aim of improving diabetes care. We anticipate that even after the lockdown period, people with diabetes will continue to use digital platforms to support their self-management activities in the long-term and this is an essential focus to reduce the risk not only from diabetes-related complications but from COVID-19 infection also. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations Diabetes and covid-19 : a global health challenge Diabetes self-management amid COVID-19 pandemic Using Intervention Mapping to Develop a Digital Self-Management Program for People With Type 2 Accepted Article This article is protected by copyright Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial National Diabetes Services Scheme Improving behavioural health indicators in people with type 2 diabetes: outcomes from MyDESMOND Australia Clinical considerations for patients with diabetes in times of COVID-19 epidemic The NHS Long Term Plan