A five-day training course called DAFNE helps adults with Type 1 diabetes adjust their own insulin doses while eating flexibly, but not all patients benefit, and the NHS needs to know why. This matters because fewer than one in three UK adults with Type 1 diabetes maintain tight glucose control, leading to complications that cost the NHS millions and cause serious illness and early death. The DAFNE programme, already rolled out to over 60 centres, improved blood sugar levels by 0.7% at six months and paid for itself within three years. But some patients see no improvement, and many cannot sustain the approach long-term. The research team will build a national web-based database to track outcomes across all DAFNE centres, identifying which sites succeed and why. They will also run trials to test whether insulin pumps plus training are better than injections alone, and whether a shorter, more flexible course works as well as the full five-day version. For patients with psychological barriers, the team will develop a tailored support course. If successful, the findings could reshape how the NHS delivers structured education for Type 1 diabetes and inform similar programmes for Type 2 diabetes.
View original technical description
(8) To use the DAFNE collaborative as a research test-bed to improve complex educational interventions in the management of Type 1 diabetes and other longterm conditions. (9) Few adults with Type 1 diabetes in the UK maintain tight glucose control. The result is a high risk of complications causing morbidity, mortality and misery and a huge financial drain on the NHS. A multi-disciplinary team, from 3 of our centres, has undertaken a randomised controlled trial of a 5 day educational intervention, originally developed in Germany to train adults with Type 1 diabetes in insulin dose adjustment while eating flexibly and maintain better glycaemic control. The DAFNE (Dose Adjustment For Normal Eating) trial, (funded by Diabetes UK) demonstrated improved quality of life, up to 12 months (despite more injections and blood tests) and falls in HbA1c of 0.7% at 6 and 0.5% at 12 months. An economic analysis suggested that the intervention pays for itself within 3 years and recent audits report improved HbA1c, sustained for 3 years. DAFNE is recognised by DH as the only UK intervention meeting quality criteria for structured education in Type 1 diabetes. DAFNE will be delivered in over 60 centres and courses provided to over 5000 patients by 2007. We have set up a web-based database but have yet to exploit the clinical and research potential. Despite DAFNE’s success and major clinical impact, important questions remain. Not all patients do well, with HbA1c unchanged or worsening and many cannot sustain self-management. It is unclear which elements are critical to success or whether specific patient characteristics or experiences predict those who do well or poorly. We are currently evaluating group follow-up (to help patients sustain the approach) in an RCT across Ireland. However, follow-up addresses only one aspect and we propose a programme to answer other important questions.(10) We will: 1 Develop a web-based database so that patients undertaking DAFNE have outcomes continuously recorded. We will collect basic data in all centres but develop a more advanced database in 10 who have enrolled over 75% of DAFNE graduates. In time this database could evaluate all those in the UK undergoing structured education. The data will identify centres doing well (or badly), highlight best practice, indicate sites requiring further support and examine the relationship between biomedical and psychosocial outcomes. We will record important health events (complications, death, severe hypoglycaemia and ketoacidosis) to calculate cost-effectiveness. 2. We will use psychological and sociological expertise in a combined quantitative and qualitative approach to a) establish which components of DAFNE determine success, b) identify predictors of success or ‘failure’ c) learn why some cannot sustain intensive self-management and d) implement and evaluate further interventions. Understanding factors which facilitate/impede self-management will help to explain patterns and predictors of successful outcomes not only in type 1 diabetes but will also inform programmes in Type 2 diabetes (such as DESMOND). 3a) We will conduct an RCT comparing DAFNE training plus continuous subcutaneous insulin infusion (CSII) against DAFNE plus multiple injections. Pumps are expensive but there is pressure to provide them to many with Type 1 diabetes on the basis of largely uncontrolled research. Proving that benefit from CSII is due to the training that accompanies pump treatment could save money but is only possible in the context of high quality skills training. 3b) We will undertake a trial to establish whether intermittent training is as good as a 5 day course. This has the potential to allow those who cannot attend for 1 week to benefit from training and permit more flexible delivery where educators work part-time. 3c) Skills training alone is insufficient for those with psychological or adaptive difficulties. We will develop and pilot a psychologically based course, incorpor
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know