640 MJA • Volume 192 Number 11 • 7 June 2010
some participants did not attend for data
collection 1 year after DAFNE training are
not known, but these participants do not
appear to differ in terms of baseline clinical
characteristics from those who did attend.
This audit reports outcomes on a pre- and
post-intervention basis, with no control
group to assess changes over time without
the intervention. However, such data are
available from the UK DAFNE study
our results are consistent with other pub-
Structured patient education has been
endorsed as a routine part of diabetes man-
agement by the National Institute for Clini-
cal Excellence in the UK,
being recognised as one program suitable for
people with T1DM. Cost modelling in the
UK has suggested that DAFNE is cost-sav-
ing, due to reduced diabetic complications,
rather than just cost-effective.
tured education courses, such as the
Empowerment program developed and con-
ducted in Newcastle, Australia,
ble insulin therapy teaching courses in
have also shown bene-
fits, including reduced hypoglycaemia and
improved quality of life, although reduc-
tions in HbA
levels have not always been
shown, perhaps due to differing participant
Despite the positive outcomes of DAFNE
in Australia, funding for this type of inten-
sive, structured education program remains
difficult to secure. Limited support for
group education is available to people with
type 2 diabetes.
However, the current
Medicare Benefits Schedule rebate of $16.00
per group service (Item 81105) is clearly
inadequate to fund an intensive education
program, and T1DM is excluded. Many
OzDAFNE centres have been charging no or
minimal fees for the DAFNE course. This
allows some people with T1DM to access
the program, but limits the number of
courses that centres are able to provide.
In summary, our audit of people with
T1DM undergoing the DAFNE course dem-
onstrates clinical benefits similar to those
reported in other health care settings.
DAFNE provides one potential means of
improving glycaemic control and other
important health outcomes in people with
T1DM. We believe that OzDAFNE merits
consideration for more widespread availabil-
ity, predicated on more systematic funding.
David McIntyre has received speaker fees and
travel assistance from companies involved in provi-
sion of insulin/delivery systems for type 1 diabetes
care, including Novo Nordisk, Eli Lilly, sanofi-
aventis and Medtronic. He is a previous President
of the DAFNE Association of Australia Inc (now
delisted) and Director of a diabetes centre
involved in the provision of DAFNE courses, but
has derived no personal profit from this.
H David McIntyre, MB BS, FRACP, Head of
Mater Clinical School and Director
Brigid A Knight, BSc, GradDipNutrDiet,
Dietitian and Diabetes Educator
Dianne M Harvey, BSc, GradDipDietetics,
Dietitian and OzDAFNE Coordinator
Marina N Noud, MNurs, DipEd, CDE, Clinical
Nurse Consultant, Diabetes and
Virginia L Hagger, MPH, RN-CDE, GradDipVet,
Health and Education Services Manager
Kristen S Gilshenan, BMaths(Hons), BInfoTech,
Statistician, Mater Research Support Centre
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(Received 28 May 2009, accepted 3 Feb 2010) ❏