Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial

doi:10.1136/bmj.325.7367.746

BMJ 2002;325:746 ( 5 October )

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Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial

DAFNE Study Group.

Correspondence to: S Heller, Clinical Sciences Centre, Northern General Hospital, Herries Road, Sheffield S5 7AU s.heller{at}sheffield.ac.uk

Objectives: To evaluate whether a course teaching flexibleintensive insulin treatment combining dietary freedom and insulinadjustment can improve both glycaemic control and quality of lifein type 1diabetes.
Design: Randomised design with participants eitherattending training immediately (immediate DAFNE) or acting aswaiting list controls and attending "delayed DAFNE" training 6monthslater.
Setting: Secondary care diabetes clinics in three Englishhealthdistricts.
Participants: 169 adults with type 1 diabetes and moderateor poor glycaemiccontrol.
Main outcome measures: Glycated haemoglobin (HbA_1c), severe hypoglycaemia,impact of diabetes on quality of life(ADDQoL).
Results: At 6 months, HbA_1c was significantly betterin immediate DAFNE patients (mean 8.4%) than in delayed DAFNEpatients (9.4%) (t=6.1, P<0.0001). The impact of diabetes on dietaryfreedom was significantly improved in immediate DAFNE patientscompared with delayed DAFNE patients (t= $-$ 5.4, P<0.0001), as wasthe impact of diabetes on overall quality of life (t=2.9, P<0.01).General wellbeing and treatment satisfaction were also significantlyimproved, but severe hypoglycaemia, weight, and lipids remainedunchanged. Improvements in "present quality of life" did not reachsignificance at 6 months but were significant by 1year.
Conclusion: Skills training promoting dietary freedomimproved quality of life and glycaemic control in people withtype 1 diabetes without worsening severe hypoglycaemia or cardiovascularrisk. This approach has the potential to enable more people toadopt intensive insulin treatment and is worthy of furtherinvestigation.

What is already known on this topic
Current treatment of type 1 diabetes fails to engage many patients in intensive self management and is associated with poor glycaemic outcomes and impaired quality of life

An approach to intensive insulin treatment in which participants match insulin dose to unrestricted food choices has been developed in Germany

This approach has been shown to lead to sustained improvements in glycaemic control but has not been widely adopted elsewhere

What this study adds
Training in flexible, intensive insulin treatment can improve glycaemic control in the United Kingdom

This approach also leads to significant improvements in treatment satisfaction, psychological wellbeing, and quality of life measures

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Rapid Responses:

Read all Rapid Responses

Routines: Dr.Robert M Ehrlich
bmj.com, 5 Oct 2002 [Full text]
Spend the money curing diabetes!: Ellen H. Ullman
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What is news here?: Katie Black
bmj.com, 6 Oct 2002 [Full text]
Re: Spend the money curing diabetes!: mihaela rosu
bmj.com, 6 Oct 2002 [Full text]
Agreement: Joseph C Stynchula, et al.
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Re: Spend the money curing diabetes!: Alan Reed
bmj.com, 9 Oct 2002 [Full text]
DAFNE - Proceed with Caution.: james m lawrence, et al.
bmj.com, 9 Oct 2002 [Full text]
adjusting carbohydrate and meal insulin only part of the problem: Abigail L King
bmj.com, 11 Oct 2002 [Full text]
DAFNE: a novel intervention?: Steven J Hunter, et al.
bmj.com, 11 Oct 2002 [Full text]
Not again....: Claudia N. Chaufan
bmj.com, 12 Oct 2002 [Full text]
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bmj.com, 16 Oct 2002 [Full text]
More evidence is needed before DAFNE approach becomes standard care: Richard C Jenkins, et al.
bmj.com, 17 Oct 2002 [Full text]
Re: More evidence is needed before DAFNE approach becomes standard care: Abigail L King
bmj.com, 20 Oct 2002 [Full text]
DAFNE: New name, old treatment: Matthew Cohen
bmj.com, 22 Oct 2002 [Full text]
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bmj.com, 23 Oct 2002 [Full text]
DAFNE: authors� response to electronic letters from 5th October to 22nd October 2002: Simon R Heller, et al.
bmj.com, 29 Oct 2002 [Full text]
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