Improved Biomedical and Psychological Outcomes 1 Year After Structured Education in Flexible Insulin Therapy for People With Type 1 Diabetes

The U.K. DAFNE experience

  1. Simon Heller, MD7
  1. 1Department of Diabetic Medicine, King’s College Hospital National Health Service Foundation Trust, London, U.K.
  2. 2Department of Diabetes, University Hospitals of Leicester National Health Service Trust, Leicester, U.K.
  3. 3School of Biomedical Sciences, University of Nottingham, Nottingham, U.K.
  4. 4Central DAFNE Office, Northumbria Healthcare Foundation Trust, Northumbria, U.K.
  5. 5Diabetes Research Group, King’s College School of Medicine, London, U.K.
  6. 6School of Health and Related Research, University of Sheffield, Sheffield, U.K.
  7. 7Academic Unit of Diabetes, Endocrinology and Metabolism, University of Scheffield, Sheffield, U.K.
  1. Corresponding author: David Hopkins, dhopkins3{at}


OBJECTIVE DAFNE (Dose Adjustment For Normal Eating), a structured education program in flexible insulin therapy, has been widely adopted in the U.K. after validation in a randomized trial. To determine benefits in routine practice, we collected biomedical and psychological data from all participants attending during a 12-month period.

RESEARCH DESIGN AND METHODS HbA1c, weight, self-reported hypoglycemia awareness, severe hypoglycemia frequency, PAID (Problem Areas In Diabetes), HADS (Hospital Anxiety and Depression Scale), and EuroQol Group 5-Dimension Self-Report Questionnaire scores were recorded prior to DAFNE and after 1 year.

RESULTS Complete baseline and follow-up HbA1c data were available for 639 (54.9%) of 1,163 attendees. HbA1c fell from 8.51 ± 1.41 (mean ± SD) to 8.24 ± 1.29% (difference 0.27 [95% CI 0.16–0.38]; P < 0.001), with a greater mean fall of 0.44% from baseline HbA1c >8.5%. Severe hypoglycemia rate fell from 1.7 ± 8.5 to 0.6 ± 3.7 episodes per person per year (1.1 [0.7–1.4]) and hypoglycemia recognition improved in 43% of those reporting unawareness. Baseline psychological distress was evident, with a PAID score of 25.2 and HADS scores of 5.3 (anxiety) and 4.8 (depression), falling to 16.7 (8.5 [6.6–10.4]), 4.6 (0.7 [0.4–1.0]), and 4.2 (0.6 [0.3–0.8]), respectively (all P < 0.001 at 1 year). Clinically relevant anxiety and depression (HADS ≥8) fell from 24.4 to 18.0% and 20.9 to 15.5%, respectively.

CONCLUSIONS A structured education program delivered in routine clinical practice not only improves HbA1c while reducing severe hypoglycemia rate and restoring hypoglycemia awareness but also reduces psychological distress and improves perceived well-being.

  • Received August 17, 2011.
  • Accepted March 25, 2012.

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  1. Diabetes Care
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