Diabetes UK funded the trial in 2 phases. Recruitment and planning for a 5-day outpatient course took place between September and December 1999, and the courses themselves between February 1999 and December 2000.
169 people were recruited following a single mailing to all those with Type 1 diabetes on local registers. Inclusion criteria included adults with Type 1 diabetes for more than 2 years with HbA1c >7.5%, <12% and no serious complications. The majority attended an evening session where full details of the approach were explained. Half were randomised to attend a DAFNE course initially, and half waited to attend 6 months later. The study was powered to detect 1% reduction in HbA1c. Biomedical and quality of life outcomes were measured at 0, 6 and 12 months. 141 of the 142 individuals who commenced the course completed it.
The DAFNE Course
An underlying assumption of the approach was that Type 1 diabetes should be managed by insulin replacement as needed and not by dietary manipulation to fit in with set amounts of prescribed insulin.
The course provided the skills necessary to enable patients to replace insulin by matching it to carbohydrate (CHO) in a free diet on a meal-by-meal basis. This was taught as a 5-day outpatient programme with patients attending for consecutive weekdays, using adult education principles with explicit learning objectives in a group setting.
The educators aimed to build confidence and appropriate independence, with patient autonomy as a goal. Thus, it was intended that participants would acquire the skills and confidence to adjust insulin to suit their lifestyle rather than being told to adapt the timing and content of meals, drinks and snacks to prescribed doses of insulin.
The educational resources (visual aids, supporting literature including patient handbook) and the curriculum were translated from the German by the Düsseldorf team in collaboration with the UK educators. Further details of the DAFNE course can be found in the ‘What is DAFNE?’ document, which is available as a free download from this website.
The DAFNE Trial Results
After 6 months, those who had attended the DAFNE training courses had experienced a fall in HbA1c of 1% compared to the control group.
At 1 year, although glycaemic control had slipped a little, HbA1c was still 0.5% lower than baseline, while the second group to undergo DAFNE training also had an improvement in HbA1c after 6 months of 0.7%.
Despite an increase in the number of injections and blood tests, those attending the training reported an improved quality of life and satisfaction with their treatment.
An important finding was that of the many areas in their lives in which they reported improvements, the greatest was observed in the area of freedom to eat as they liked.
The feasibility trial demonstrated that it is possible to run a Diabetes Treatment and Training Programme (DTTP) along the lines of the German intervention in a British healthcare setting and that it leads to both improved glycaemic control and quality of life.
The DAFNE trial results were published in the British Medical Journal (BMJ). [11] If you are interested in reading a full account of the DAFNE trial you can view the paper on the BMJ website.
You may also be interested in reading some personal accounts provided by DAFNE Graduates which detail their experiences of the DAFNE course.
| • | Experience 1 | |
| • | Experience 2 | |
| • | Experience 3 | |
| • | Experience 4 |