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Dose adjustment for normal eating (DAFNE) — an audit of outcomes in Australia

H David McIntyre, Brigid A Knight, Dianne M Harvey, Marina N Noud, Virginia L Hagger and Kristen S Gilshenan
Med J Aust 2010; 192 (11): 637-640.

Summary

Objective: To audit and describe the effects of participation in the Dose Adjustment for Normal Eating (DAFNE) course on clinical outcomes in people with type 1 diabetes mellitus (T1DM).

Design, setting and participants: Audit of clinical outcomes before and 1 year after DAFNE training for 145 people with T1DM who participated in courses at seven Australian diabetes centres between February 2005 and March 2007. Participants had been diagnosed with T1DM at least 1 year before and were beyond the “honeymoon phase”, with glycated haemoglobin (HbA1c) < 12% and no severe diabetes complications. They were aged over 17 years and able to understand written and spoken English.

Intervention: A 5-day structured education program covering T1DM management with an emphasis on unrestricted diet, precise carbohydrate estimation and prandial insulin dosing using insulin-to-carbohydrate ratios.

Main outcome measures: Glycaemic control (HbA1c levels), weight, severe hypoglycaemia, and quality of life scores on general (Hospital Anxiety and Depression) and diabetes-specific (Problem Areas in Diabetes) scales.

Results: Mean HbA1c fell from 8.2% to 7.8% (95% CI for change, 0.5% to 0.2%; P < 0.0001) and weight from 75.1 to 74.2 kg (95% CI for change, 1.6 to 0.2 kg; P = 0.012). Severe hypoglycaemia was less frequent after DAFNE training (P = 0.0001). Quality of life improved (P < 0.0001 for both scales).

Conclusions: One year after participation in the DAFNE program of structured education, people with T1DM showed improved glycaemic control, reduced incidence of severe hypoglycaemia, slightly reduced weight and improved quality of life. The DAFNE course offers one means of improving clinical outcomes in T1DM.

  • H David McIntyre1
  • Brigid A Knight2
  • Dianne M Harvey3
  • Marina N Noud2
  • Virginia L Hagger3
  • Kristen S Gilshenan2

  • 1 Endocrinology and Obstetric Medicine, University of Queensland and Mater Health Services, Brisbane, QLD.
  • 2 Mater Health Services, Brisbane, QLD.
  • 3 Diabetes Australia, Victoria, Melbourne, VIC.


Competing interests:

David McIntyre has received speaker fees and travel assistance from companies involved in provision of insulin/delivery systems for type 1 diabetes care, including Novo Nordisk, Eli Lilly, sanofi-aventis and Medtronic. He is a previous President of the DAFNE Association of Australia Inc (now delisted) and Director of a diabetes centre involved in the provision of DAFNE courses, but has derived no personal profit from this.

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