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The DAFNE project grew out of dissatisfaction with the care and outcomes achieved for Type 1 diabetes in the UK and poor quality of the research and evidence on which much current practice is based.

Diabetes Care in the UK
In 1997, 3 diabetes units (Sheffield Teaching Hospitals, Northumbria Healthcare Trust and King’s College Hospital, London) began to discuss their own dissatisfaction with current achievements in diabetes control, the reasons for this and search for evidence on how they might improve. The outcomes for diabetes in young people and levels of glycaemic control in the UK were poor when compared with our European neighbours, in addition the impact of diabetes on quality of life was substantially negative. [16]

The DCCT [14] in 1993 had posed a dilemma for UK diabetes teams. It appeared that the long-term benefits of improved glycaemic control could only be achieved at the risk of a 3-fold increase in short-term severe hypoglycaemia. Many clinicians were reluctant to impose this on their patients and many patients were anxious about the risks.

The literature
A review of the effectiveness of educational interventions sponsored by Diabetes UK concluded that imaginative, non-didactic approaches to ‘education’ were most likely to be effective. However the benefits achieved were small and the overriding message was that studies were poorly described and thus would be difficult to evaluate or replicate.

The 3 UK teams were aware of the structured education and training programmes developed by the late Michael Berger’s team at the WHO Coordinating Centre in Düsseldorf. However, the prevailing attitude in UK diabetes circles was that these programmes would be ‘prescriptive’ and thus unsuitable, unworkable and possibly harmful and unethical in the UK.

The visit
Eight sceptical multidisciplinary diabetes professionals, from the 3 units, and including a German-speaking doctor, made a structured observational visit to Düsseldorf in June 1998. They were able to learn about and question the work of the Unit, and observed an entire 5-day training programme. They became convinced that the principles and practice of the Unit and the published evidence were sound, and that the programme would be suitable for the UK and should be tested.


	Background to DAFNE The DAFNE project grew out of dissatisfaction with the care and outcomes achieved for Type 1 diabetes in the UK and poor quality of the research and evidence on which much current practice is based. Diabetes Care in the UK In 1997, 3 diabetes units (Sheffield Teaching Hospitals, Northumbria Healthcare Trust and King’s College Hospital, London) began to discuss their own dissatisfaction with current achievements in diabetes control, the reasons for this and search for evidence on how they might improve. The outcomes for diabetes in young people and levels of glycaemic control in the UK were poor when compared with our European neighbours, in addition the impact of diabetes on quality of life was substantially negative. [16] The DCCT [14] in 1993 had posed a dilemma for UK diabetes teams. It appeared that the long-term benefits of improved glycaemic control could only be achieved at the risk of a 3-fold increase in short-term severe hypoglycaemia. Many clinicians were reluctant to impose this on their patients and many patients were anxious about the risks. The literature A review of the effectiveness of educational interventions sponsored by Diabetes UK concluded that imaginative, non-didactic approaches to ‘education’ were most likely to be effective. However the benefits achieved were small and the overriding message was that studies were poorly described and thus would be difficult to evaluate or replicate. The 3 UK teams were aware of the structured education and training programmes developed by the late Michael Berger’s team at the WHO Coordinating Centre in Düsseldorf. However, the prevailing attitude in UK diabetes circles was that these programmes would be ‘prescriptive’ and thus unsuitable, unworkable and possibly harmful and unethical in the UK. The visit Eight sceptical multidisciplinary diabetes professionals, from the 3 units, and including a German-speaking doctor, made a structured observational visit to Düsseldorf in June 1998. They were able to learn about and question the work of the Unit, and observed an entire 5-day training programme. They became convinced that the principles and practice of the Unit and the published evidence were sound, and that the programme would be suitable for the UK and should be tested.