Long-term biomedical and psychosocial outcomes following DAFNE (Dose Adjustment For Normal Eating) structured education to promote intensive insulin therapy in adults with sub-optimally controlled Type 1 diabetes



      To explore long-term outcomes of participation in a Dose Adjustment For Normal Eating (DAFNE) training course, which provided one-off exposure to structured education in intensive insulin therapy to people with established Type 1 diabetes.


      A cohort design follow-up of original trial participants at a mean of 44 months (range: 37–51 months) in hospital diabetes clinics in three English health districts. 104 (74%) original participants provided biomedical data; 88 (63%) completed questionnaires including the ADDQoL, measuring impact of diabetes on quality of life (QoL).


      At 44 months, mean improvement in HbA1c from baseline was 0.36% (9.32 ± 1.1% to 8.96 ± 1.2%, p < 0.01) remaining significant but deteriorated from 12 months (p < 0.05). Improvements in QoL seen at 12 months were sustained at 44 (e.g. impact of diabetes on dietary freedom: −1.78 ± 2.33 at 44 months versus −4.27 ± 2.94, baseline, p < 0.0001; versus 1.80 ± 2.32 at 12 months, ns). Similar results were obtained using last observation carried forward for patients not supplying follow-up data.


      The impact of a single DAFNE course on glycaemic control remains apparent in the long term, although further interventions will be required to achieve recommended HbA1c. In contrast, improvements in QoL and other patient-reported outcomes are well maintained over approximately 4 years.


      ADDQoL (Audit of Diabetes-Dependent Quality of Life), ANOVA (analysis of variance), BMI (body mass index), DAFNE (Dose Adjustment For Normal Eating), DCCT (Diabetes Control and Complications Trial), DTSQ (Diabetes Treatment Satisfaction Questionnaire), HbA1c (haemaglobin A1c), HDL (high-density lipoprotein), QoL (quality of life), STTP (Structured Teaching and Treatment Programme)


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