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

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 (HbA(1c)) <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 (HbA(1c) 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 HbA(1c) 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.