paraphrase, "From the published literature of randomized controlled trials, the optimal programme structure remains unclear. Some studies suggest that more sessions, more contact time or spread of input over a longer period are related to better outcomes, however other studies support a more compact programme. All studies demonstrate an attenuation of the improvement in HbA1C over time. Together this might suggest that refresher courses after 6 months are likely to be required. This is supported by the three year follow up of the original DESMOND study which showed that initial benefits were lost and no difference between the self-management education group and usual care group at three years