Branney, J

Branney, P

Fenton, G

McArthur, K

Mowat, E

English

Leeds Beckett Repository 

Leeds Community Healthcare
© NHS Leeds Community Healthcare (Leeds PCT) Nov 2010 • LCH ref: 0170/A
NHS Leeds Community Healthcare is responsible for providing healthcare services in the Leeds area and is hosted by Leeds Primary Care Trust (NHS Leeds)
Background
Diabetes is a complex , lifelong condition requiring skilfull self-
management to reduce the risks of physical illness and complications 
(Diabetes UK and Peyrot et al 2005).
• An estimated  41% of people with the condition have poor 
psychological wellbeing (Diabetes UK and Diabetes UK 2008).
• Recognising, assessing and treating psychological and mental health 
problems of an individual with diabetes is important and integral in 
improving their glycaemic control thereby reducing the risks to their 
health (Diabetes UK 2008).
In 2008, Leeds Community Diabetes Service was launched by NHS Leeds 
primarily for people with Type 2 Diabetes. An integral Psychological 
Support Service was established from the outset. The aim of the 
psychological arm is to provide support in the community setting 
to poorly controlled individual Type 2 diabetes patients, where a 
likely psychological problem has been highlighted using a screening 
questionnaire by the MDT. There is no direct GP access to this service.
The psychological support is provided by 2 mental health practitioners who:
• assess individual patient  psychological needs and offer various 
interventions.
• provide professional training for the Community Diabetes Team.
Authors:
Branney, Jane - Senior Mental Health Practitioner 
Fenton, Grania - Clinical Psychologist 
McArthur, Kirsty - Senior Mental Health Practitioner 
Branney, Peter - Senior Research Fellow
Mowat, Elizabeth - GPSI
Leeds Community Diabetes Service, Leeds LS9 6DE
elizabeth.mowat@nhs.net
Aim
To determine the impact of the Community Diabetes Psychological 
Support Service in facilitating individuals to improve outcomes regarding:
• global distress and wellbeing 
• overall diabetes control.
Method
1005 patients referred to Community Diabetes Service: 
Recorded outcome measures for 19 patients including:
• pre and post *CORE, **DDS, and Hba1c were reviewed for the 19 
patients who had completed psychological treatment by the time of 
the study.
*  Clinical Outcomes in Routine Evaluation (CORE) measures global 
distress through 34 questions including well being, commonly 
experienced symptoms/problems and life/social functioning. 
**Diabetes Distress Scale (DDS) through 17 questions measures diabetes 
related emotional distress.
Results
Number of Patients referred for Psychological Support:  153 (15%)
Number of Patients: 12 female   7 male   (Age range: 27 – 70 yrs)
Conclusions
The availability of a Community Psychological Support Service 
does have evidence of benefi t, in relation to:
• Improved psychological wellbeing
 - including a reduction in the overall range of psychological wellbeing
• Reduction in diabetes distress
 - the overall range remained the same but is skewed towards lower 
scores
• Only 15% of patients accessed the service in comparison to the 
41% estimated to have poor psychological wellbeing.
But there is limited evidence of improvement in HbA1c as a 
consequence of improved psychological wellbeing. In cases with 
no improvement in HbA1c, patients can demonstrate benefi cial 
improvement in wellbeing.
“Was it worth it?”
• Yes! The numbers are small but results positive for psychological 
and clinical outcomes. 
• Conclusions are limited though worthy of discussion.
References:
Diabetes UK Emotional and Psychological Support and care in Diabetes. Report 
from the emotional and psychological support working group of NHS Diabetes 
and Diabetes UK. www.diabetes.nhs.uk
Diabetes UK (2008) Diabetes UK 2008 A Report from Diabetes UK.
Peyrot M.T., Rubin R.R., Lauritzen T., Snoeks F. J., Mathews D.R, and Skovlund 
S.E. On behalf of the International DAWN Advisory Panel. (2005) Psychological 
Problems and Barriers to Improved Diabetes Management: Results of the Cross-
National Diabetes Attitudes, wishes and Needs (DAWN) Study. Diabetes UK. 
Diabetic Medicine.22 p1379-1385
Labels Pre-CORE Post-CORE PRE-DDS Post-DDS
Min 12 7 31 21
Q1 35 12.5 42 26.5
Median 47 21 57 30
Q3 68.5 32 62.5 45
Max 91 81 79 64
IQR 33.5 19.5 20.5 18.5
Upper 
Outliers 0 1 0 0
Lower 
Outliers 0 0 0 0
No. with Improved CORE score post intervention: 17
No. with Improved DDS Score post intervention:  18
Number with Improved CORE and DDS score:     16 
Number with improved HbA1c:       6/8
Was it worth it?
Psychological Support and Leeds Community Diabetes Service


Was it worth it? Psychological support and the Leeds Community Diabetes Service.

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