Welcome To The Dose Adjustment For Normal Eating (DAFNE) Website

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DAFNE is not a static programme. Those involved in the delivery of DAFNE appreciate that to remain effective, the course must be continually updated. In some cases further research is required to evaluate the effectiveness of any proposed change to the evaluated course.

Current additional research currently being undertaken by the DAFNE group are:

•		The long-term follow-up of the feasibility study participants
•		DAFNE Hub and Spoke Programme
•		DAFNE for the young

Long-term follow-up of the DAFNE feasibility study participants

Aim
To assess whether and for how long the benefits of participating in a single 5-day DAFNE course are sustained, and whether entry characteristics of participants can determine those who are likely to benefit most in the long term.

Funding
This is unfunded and being carried out by the DAFNE teams at the 3 DAFNE centres involved in the original feasibility study.

Current Position
115 of the 139 participants gave their consent to provide additional research data.

Data has since been collected and the analysis is currently underway.

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DAFNE Hub and Spoke Programme

Background
Everyone involved in DAFNE firmly believe that DAFNE should be available to anyone with Type 1 diabetes. However some diabetes units have found they cannot support the full DAFNE programme due to limited resources (both staff and financial). However patient demand is growing and there are major concerns about how to spread the availability of DAFNE more widely. Referral to a DAFNE centre is not an option for 2 reasons:

1.		The established DAFNE centres do not have the resources to provide education for out-of-area patients.

2.		There is real concern that the benefits of DAFNE may be eroded over time if DAFNE trained patients return to a service that has no DAFNE experience and cannot support them in their decision making.

Nevertheless, the philosophy underpinning the DAFNE Collaborative is the spread of DAFNE throughout the UK.

Aim
The Hub and Spoke Programme will enable DAFNE to be rolled out to smaller diabetes units as follows

1.		The Hub (King’s College Hospital, London) will provide healthcare professionals at the Spoke centers (Darent Valley, Orpington, and Ashford & St Peter’s Hospital NHS Trusts) with DAFNE training to enable them to recruit, collect audit data, and provide follow-up support of DAFNE trained patients within their service.

2.		The Hub will provide DAFNE training for patients referred from the Spoke.

Funding
King’s College Hospital, London, have received funding from Diabetes UK for an 18-month study to evaluate the effectiveness of this model.

If the model proves to be successful (ie patients receiving training and follow-up in this way achieve the same benefits and outcomes as patients receiving training and follow-up in a DAFNE centre) the model can be offered to other small diabetes units in the UK.

Current position
The feedback form the healthcare professionals and patients involved in the Hub and Spoke programme has been universally positive. The data from the study is currently being analysed.

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DAFNE for the young

Background
Although the DAFNE principles would be suitable for adolescents with Type 1 diabetes, the actual DAFNE course was developed for adults and as such is not suitable for younger people. However with substantial modification a DAFNE type programme could be developed for adolescents.

A group of doctors in Northern England have decided to develop a DAFNE type course aimed at 11-16 year olds.

Aim
To develop a structured education programme based on the DAFNE approach, for adolescents. The research will test the effectiveness of the new curriculum and course in a small pilot followed by a multicentre RCT.

Funding

Phase 1:		Developing and writing the curriculum. Funded by the Children’s Appeal, a Sheffield Childrens’ Hospital charity.

Phase 2:		The pilot study. Aims of the pilot study: • Refine the curriculum and course format. • Judge initial opinion of the course. • Identify possible changes in outcome to help inform sample size for the RCT. Funding from Diabetes UK

Phase 3:		Multicentre RCT Funding still to be obtained

Current position

Phase l:		Completed July 2004

		Input from parents, children (11-16 year olds) and secondary school teachers from King Edward VII school in Sheffield. Consultation with the Department of Psychology, University of Sheffield, in the development of psychological outcome questionnaires.

Phase ll:		Last course delivered March 2005. Evaluation and analysis of data underway.

		3 Research Educators (2 DSNs and 1 dieititian) received training in teaching children (collaboration between the Department of PGME, Sheffield Hallam University and the King Edward VII school) and delivered 6 courses, 2 each (one for 11-13 and one for 14-16 year olds) in Sheffield, Manchester and Derby, involving a total of 48 children.

		A professional Educationalist from the University of Sheffield observed the courses.

		Children and parents completed daily questionnaires and were interviewed pre and post course. Initial responses were positive and the courses were enjoyed.

		HbA1c, weight, incidence of hypoglycaemia and quality of life were assessed pre course, 3 and 6 months post course. Data currently being analysed.

		Some changes will be made to the course format, but not substantially to the content, for the RCT.

Phase lll:		Planning currently underway.

		No funding obtained for the RCT to date.

		Novo Nordisk and the Sheffield Childrens’ Hospital charity are providing some additional funding to allow staff to complete Phase II evaluation and aid planning of the RCT.

		In the meantime no further courses are planned.

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•	DAFNE Background
•	The DAFNE Trial
•	DAFNE Economics
•	DAFNE Roll-out
•	DAFNE Today
•	How to become a DAFNE Centre
•	Dates for DAFNE Educator and DAFNE Doctor Programmes
•	Further Research
•	FAQs

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