Dose adjustment for normal eating (DAFNE) - An audit of outcomes in Australia

Endocrinology and Obstetric Medicine, University of Queensland and Mater Health Services, Brisbane, QLD, Australia.
The Medical journal of Australia (Impact Factor: 4.09). 06/2010; 192(11):637-40.
Source: PubMed


To audit and describe the effects of participation in the Dose Adjustment for Normal Eating (DAFNE) course on clinical outcomes in people with type 1 diabetes mellitus (T1DM).
Audit of clinical outcomes before and 1 year after DAFNE training for 145 people with T1DM who participated in courses at seven Australian diabetes centres between February 2005 and March 2007. Participants had been diagnosed with T1DM at least 1 year before and were beyond the "honeymoon phase", with glycated haemoglobin (HbA(1c)) < 12% and no severe diabetes complications. They were aged over 17 years and able to understand written and spoken English.
A 5-day structured education program covering T1DM management with an emphasis on unrestricted diet, precise carbohydrate estimation and prandial insulin dosing using insulin-to-carbohydrate ratios.
Glycaemic control (HbA(1c) levels), weight, severe hypoglycaemia, and quality of life scores on general (Hospital Anxiety and Depression) and diabetes-specific (Problem Areas in Diabetes) scales.
Mean HbA(1c) fell from 8.2% to 7.8% (95% CI for change, - 0.5% to - 0.2%; P < 0.0001) and weight from 75.1 to 74.2 kg (95% CI for change, - 1.6 to - 0.2 kg; P = 0.012). Severe hypoglycaemia was less frequent after DAFNE training (P = 0.0001). Quality of life improved (P < 0.0001 for both scales).
One year after participation in the DAFNE program of structured education, people with T1DM showed improved glycaemic control, reduced incidence of severe hypoglycaemia, slightly reduced weight and improved quality of life. The DAFNE course offers one means of improving clinical outcomes in T1DM.

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    • "The dietary elements of the programme have been specifically adapted to Australian food choices, but the core curriculum is entirely consistent with resources developed and used in the United Kingdom. The Oz DAFNE programme has shown results similar to those reported in Germany and the United Kingdom, with reduction in HbA1c, reduced severe hypoglycemia, improved quality of life and minor weight reduction [9]. "
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    ABSTRACT: The Dose Adjustment for Normal Eating (DAFNE) programme of intensive insulin therapy for type 1 diabetes provides a structured educational intervention to improve glycemic control, reduce hypoglycemia and improve quality of life. Enhancement of self-management skills is a key element of DAFNE and patients acquire detailed skills in insulin dose adjustment. Following DAFNE training, patients report improved confidence in their ability to manage their own insulin dosing, but generally still seek and require the assistance of health professionals when making substantial changes to their insulin regimens. Some DAFNE trained patients may be able to assist their peers in aspects of diabetes management within a group environment, but widespread introduction of the expert patient/peer educator role in the self-management of type 1 diabetes, in particular related to insulin dose management, would require formal and detailed evaluation, preferably in randomized controlled clinical trials, before being introduced into routine clinical practice.
    Diabetes & metabolism journal 04/2014; 38(2):87-91. DOI:10.4093/dmj.2014.38.2.87
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    • "The Insulin Treatment and Training programs developed by Mühlhauser and Berger (100) have reported improved glycemic control comparable with DCCT while reducing the rates of severe hypoglycemia (101,102). These programs have been successfully delivered in other settings (103,104) with comparable reductions in hypoglycemic risk (105). Patients with frequent hypoglycemia may also benefit from enrollment in a blood glucose awareness training program. "
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    ABSTRACT: OBJECTIVE To review the evidence about the impact of hypoglycemia on patients with diabetes that has become available since the past reviews of this subject by the American Diabetes Association and The Endocrine Society and to provide guidance about how this new information should be incorporated into clinical practice.PARTICIPANTSFive members of the American Diabetes Association and five members of The Endocrine Society with expertise in different aspects of hypoglycemia were invited by the Chair, who is a member of both, to participate in a planning conference call and a 2-day meeting that was also attended by staff from both organizations. Subsequent communications took place via e-mail and phone calls. The writing group consisted of those invitees who participated in the writing of the manuscript. The workgroup meeting was supported by educational grants to the American Diabetes Association from Lilly USA, LLC and Novo Nordisk and sponsorship to the American Diabetes Association from Sanofi. The sponsors had no input into the development of or content of the report.EVIDENCEThe writing group considered data from recent clinical trials and other studies to update the prior workgroup report. Unpublished data were not used. Expert opinion was used to develop some conclusions.CONSENSUS PROCESSConsensus was achieved by group discussion during conference calls and face-to-face meetings, as well as by iterative revisions of the written document. The document was reviewed and approved by the American Diabetes Association's Professional Practice Committee in October 2012 and approved by the Executive Committee of the Board of Directors in November 2012 and was reviewed and approved by The Endocrine Society's Clinical Affairs Core Committee in October 2012 and by Council in November 2012.CONCLUSIONS The workgroup reconfirmed the previous definitions of hypoglycemia in diabetes, reviewed the implications of hypoglycemia on both short- and long-term outcomes, considered the implications of hypoglycemia on treatment outcomes, presented strategies to prevent hypoglycemia, and identified knowledge gaps that should be addressed by future research. In addition, tools for patients to report hypoglycemia at each visit and for clinicians to document counseling are provided.
    Diabetes care 04/2013; 36(5). DOI:10.2337/dc12-2480 · 8.42 Impact Factor
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    • "Flexible intensive insulin therapy (FIIT) is being increasingly recommended and used in the management of type 1 diabetes, as it can lead to improvements in blood glucose control [1] [2] [3], quality of life [1], and reductions in the incidence of severe hypoglycaemia [4]. FIIT was originally pioneered and used in the Diabetes Treatment and Teaching programme, developed in Dü sseldorf in the late 1970s [5] [6]. "
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    ABSTRACT: To explore whether, and why, patients change their food and eating practices following conversion to flexible intensive insulin therapy (FIIT), a regimen which requires quick acting insulin doses to be matched to the carbohydrate content of meals/snacks consumed. repeat, in-depth interviews with 30 type 1 diabetes patients converted to FIIT recruited from Dose Adjustment for Normal Eating (DAFNE) courses in the UK. Data were analysed using an inductive, thematic approach. despite the potential of FIIT to enable greater dietary flexibility and freedom, most patients reported food and eating practices which were remarkably resistant to change. In some cases, FIIT adoption resulted in greater dietary rigidity over time. The opportunities FIIT presented for greater dietary freedom were counterbalanced by new challenges and burdens (e.g. having to simplify food choices to make carbohydrate estimation easier). Due to the emphasis FIIT places on carbohydrate counting, and patients' fears of hypos, low/no carbohydrate foodstuffs sometimes came to be seen as the healthiest or safest options. concerns that FIIT may result in more excessive or unhealthy eating appear largely unfounded; however, consideration needs to be paid to the ways in which patients' conceptualisations of, and relationship with, food may change following FIIT conversion.
    Diabetes research and clinical practice 01/2011; 91(1):87-93. DOI:10.1016/j.diabres.2010.11.007 · 2.54 Impact Factor
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