Association between diabetes self‐management education attendance, hospital admissions and mortality in type 2 diabetes: A cohort analysis protocol

Introduction: Type 2 diabetes is associated with excess hospital admissions and increased mortality. Structured diabetes self‐management education (DSME) is recommended internationally and is associated with improved self‐management skills, well‐being and minor improvements in glycated haemoglobin (HBA1c), but does it reduce hospital admissions or prevent premature mortality? Our aim is to examine the relationship between DSME attendance, hospitalisations, mortality and 3‐point major adverse cardiovascular events (MACE) in people with type 2 diabetes to inform future healthcare policy and diabetes care. Methods and Analysis: This protocol details a 10‐year retrospective open cohort study of patients aged over 18 years old who have a clinical diagnosis of type 2 diabetes and were registered to an English GP practice from 29 March 2011 to 29 March 2021 and have attended DSME. Patients in the 'ever' cohort will be matched at baseline for age, sex, age at diagnosis and diabetes duration, to those who have 'never' attended DSME. Data will be identified via the UK Clinical Practice Research Datalink and linked to Hospital Episode Statistics Admitted Patient Care data, Office for National Statistics death registrations and patient Index of Multiple Deprivation deciles. Patients will be followed‐up through serial cross‐sections. Multiple imputation will be considered to manage covariates where data are >12‐months from baseline or are not expected to be missing at random. Cox proportional hazard regression and time to event modelling adjusted a priori for cofounding during multivariate analysis will be used. Ethics and Dissemination: This study was approved by CPRD (24_003744). Study findings will be disseminated through peer‐reviewed publications and international conferences.