EXTending availability of self-management structured EducatioN programmes for people with type 2 Diabetes in low-to-middle income countries (EXTEND)

2型糖尿病（T2 D）是一种长期的疾病，身体无法正确管理血糖（葡萄糖）。这可能导致血液中的葡萄糖水平相当高。如果身体长时间暴露在血液中高水平的葡萄糖中，它会伤害血管系统-身体中的大血管和脆弱的血管。这可能导致一些并发症，如失明，肾损伤，神经损伤和心脏病发作。当有人被诊断患有T2 D时，他们得到支持并被教导如何管理他们的病情以预防这些并发症是非常重要的。在全球范围内，患有T2 D的人数正在增加，目前约有4.15亿人患有这种疾病。80%的T2 D患者生活在中低收入国家。中低收入国家没有财政资源或基础设施来有效管理这一不断增加的患者群体，特别是因为它们已经不堪重负，无法应对这些国家常见的传染病，即艾滋病毒、结核病。因此，非常需要为患者提供廉价但有效的治疗选择。糖尿病患者每天都自己管理自己的病情。国际专家指出，糖尿病患者应该被教导如何做到这一点;结构化教育计划（SEP）使糖尿病患者具备自我管理技能。SEP已被证明可以改善患者的糖尿病相关结果，如血糖和健康。一个受过教育和授权的病人可以更有效地与他们的医生合作，以改善和保持更好地控制他们的病情。SEP通常由受过训练的非医学教育者提供给社区中的患者群体，因此是一种相对便宜的“治疗”。在英国，研究人员已经开发并测试了一种名为DESMOND的SEP，该SEP已被证明可以改善健康状况，坚持服药，减肥以及其他积极的结果。目前在英国的100多个地点交付，也在南爱尔兰、澳大利亚和卡塔尔使用。到目前为止，还没有在中低收入国家中测试过糖尿病的SEP。因此，这提供了一个很好的机会，采取糖尿病SEP被证明是有效的，并在一个国家广泛参加，并将其转移到另一个国家。英国研究小组与来自南非、莫桑比克和马拉维的临床医生和学者合作，建议在文化上适应和翻译（语言适应）DESMOND方案，以供两个中低收入国家-莫桑比克和马拉维使用。然后，该合作将在这两个地点测试经过调整的SEP的可行性。将收集以下数据：受邀人数、对邀请做出回应的人数、参加该计划的人数、糖尿病控制（使用即时检测）、血压以及他们对该计划的看法和经验。这些信息将共同用于帮助我们设计本工作方案结束后的正式研究。将开发一个可持续就业方案适应工具包（详细说明），以便其他组织能够采用在一个国家工作的可持续就业方案，并对其进行调整。还将再次制定一个实施模式，允许其他组织/卫生服务机构实施-即大规模和可持续地提供SEPs。这两个都将免费提供给公众。为了确保这项工作的成功，我们将与当地糖尿病协会密切合作，我们将培训当地医疗保健专业人员和当地社区的人员提供教育，这意味着他们可以在本研究结束后继续做得很好。

Type 2 diabetes (T2D) is a long term condition where the body doesn't manage its blood sugars (glucose) properly. This can result in the levels of glucose in the blood being quite high. If the body is exposed to high levels of glucose in the blood for long periods of time it can injure the vascular system - both the large and the delicate blood vessels in the body. This can lead to a number of complications such as blindness, kidney damage, damage to the nerves and heart attacks. It is really important when someone is diagnosed with T2D they are supported and taught how to manage their condition to prevent these complications. Globally, the number of people with T2D is increasing with approximately 415 million people currently living with this condition. Eighty percent of people who have T2D live in low-to-middle income countries. LMICs do not have the financial resources, or infrastructure to effectively manage this increasing patient population specifically as they are already stretched dealing with the infectious diseases that are common in these countries i.e. HIV, TB. Therefore, there is great need for inexpensive but effective treatment options for patients. Patients with diabetes manage their condition on a daily basis themselves. International experts state that patients with diabetes should be taught how to do this; structured education programmes (SEPs) equip people with diabetes with self-management skills. SEPs have been shown to improve diabetes related outcomes in patients, such as blood glucose and wellbeing. An educated and empowered patient can work more effectively with their doctor to improve and maintain better control of their condition. SEPs are usually delivered to groups of patients in the community by trained non-medical educators and thus are a relatively inexpensive 'therapy'. In the UK researchers have developed and tested a SEP called DESMOND which has been shown to improve well-being, adherence to medication, and weight loss amongst other positive outcomes. DESMOND and is currently delivered in over 100 sites in the UK and is also used in in Southern Ireland, Australia and Qatar. To date no SEPs for diabetes have been tested in LMICs. Therefore, this provides a great opportunity to take a diabetes SEP that is proven to be effective and is widely attended in one country and transfer it to another. The UK research team in collaboration with clinicians and academics from South Africa, Mozambique and Malawi propose to culturally adapt and translate (linguistic adaptation) the DESMOND programme for use in two LMICs - Mozambique and Malawi. The collaborative will then test the feasibility of the adapted SEP in both locations. Data will be collected on the number of people that are invited, respond to invitation, the number that attended the programme, their diabetes control (using point-of-care-testing), blood pressure and their opinion and experience of the programme. Collectively, this information will be used to help us design a formal study after the end of this programme of work. An SEP adaptation tool-kit (detailed instructions) will be developed so that other organisations can take SEPs that work in one country and adapt it for themselves. An implementation model will also be developed again allowing other organisations/health services to implement - that is make SEPs available on a large and sustainable scale. Both of these will be freely available for the public. To ensure the success of this work we will work closely with the local diabetes associations, we will train local healthcare professionals and people from the local community to deliver the education which means that they can continue to do so well after the end of this study.