Structured education using Dose Adjustment for Normal Eating (<scp>DAFNE</scp>) reduces long‐term HbA<sub>1c</sub> and HbA<sub>1c</sub> variability

Walker, G. S.; Chen, J. Y.; Hopkinson, Helen; Sainsbury, Christopher; Jones, Gill

doi:10.1111/dme.13621

Cited by 20 publications

(15 citation statements)

References 27 publications

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“…Another possibility could be that DAFNE is not tailored to FSL use, although neither are other available structured education courses. Nevertheless, DAFNE is NICE recommended, 21 has been shown to improve glycaemic control [22][23][24][25][26] and hypoglycaemia awareness, 24 reduces severe hypoglycaemia episodes, 24,27 reduces diabetes-related distress, 24,27 improves the quality of life (QoL), 22,25,27 is cost-effective 28 and so remains integral to the management of T1D. A possible reason for a significant improvement in HbA1c in the other (non-DAFNE) structured education group could be an over-representation of the paediatric population in this subgroup.…”

Section: Discussionmentioning

confidence: 99%

Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit

et al. 2021

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Background: Dose Adjustment For Normal Eating (DAFNE) is the gold standard National Institute for Health and Care Excellence (NICE) recommended structured education programme that promotes self-management in people living with type 1 diabetes (T1D). We have recently shown that FreeStyle Libre (FSL) is associated with improved haemoglobin A1c (HbA1c) and hypoglycaemia awareness. Aims: To explore the effect of structured education including DAFNE on HbA1c and GOLD score when combined with FSL use. Methods: The ABCD national audit data on FSL users were used to conduct this prospective longitudinal study. The Stu- dent’s t test was used to compare the baseline and follow-up HbA1c and a change in the GOLD score for hypoglycaemia awareness. The baseline demographic and clinical characteristics of the study population were compared using ANOVA. Linear regression analysis identiﬁed predictors of change in HbA1c with FSL use. Results: The study consisted of 14,880 people living with insulin-dependent diabetes mellitus (IDDM), 97% of whom had T1D, of which 50% were female, with a mean±SD base- line HbA1c of 70±18 mmol/mol and baseline body mass index (BMI) of 25.3±6.2 kg/m2. Follow-up data for HbA1c were avail- able for 6,446 participants while data for GOLD score were available for 5,057 participants. The study population was divided into three groups: 6,701 people with no prior structured education (Group 1), 3,964 with other structured education (Group 2), and 4,215 had previously attended DAFNE structured education (Group 3). Groups 2 and 3 who had previously attended structured education had a lower initial HbA1c than those in Group 1 (p<0.0001). However, there was a signiﬁcant but similar magnitude of the fall in HbA1c across all groups (−8.10 mmol/mol vs −6.61 mmol/mol vs −6.22 mmol/mol in Groups 1, 2 and 3, respectively), with p (ANOVA)=0.83. Similarly, the decline in GOLD score was comparable in Groups 1, 2 and 3 (−0.33 vs −0.30 vs −0.34, respectively), with p (ANOVA)=0.43. Linear regression analysis identiﬁed higher baseline HbA1c (β=0.585, p<0.0001), number of FSL scans over 14 days (β=−0.026, p=0.00135) and other structured education (β=−1.207, p=0.02483) as predictors of HbA1c reduction. Prior DAFNE training was not associated with improved HbA1c reduction in the linear regression model. Conclusions: FSL use was associated with improvements in HbA1c and GOLD score. Although DAFNE is an evidence- based intervention to improve outcomes in those with T1D, DAFNE attendance prior to commencing FSL did not inﬂuence HbA1c or GOLD score outcomes when compared with FSL use alone. Other structured education was identiﬁed as a predictor of HbA1c reduction when combined with FSL use.

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Section: Discussionmentioning

confidence: 99%

Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit

et al. 2021

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“…However, the lack of flexibility and patient control may in fact predispose patients to severe hypoglycemia. In contrast, structured education programs studied in type 1 diabetes, like DAFNE, have allowed patients to retain more control and flexibility in their self-management [ 32 , 33 ], while also improving glycemic control [ 32 , 34 , 35 ] and reducing severe hypoglycemia [ 4 , 35 , 36 ]. Due to a lack of existing literature [ 4 ], we propose that further research should expand upon the role of structured education programs on the management of type 2 diabetes and severe hypoglycemia, while also addressing the prevalence of self-management challenges in older adults who experience severe hypoglycemia.…”

Section: Discussionmentioning

confidence: 99%

Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes

Pasciak

Berg

Cherlin³

et al. 2021

BMC Geriatr

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Background Hospital admissions for severe hypoglycemia are associated with significant healthcare costs, decreased quality of life, and increased morbidity and mortality, especially for older adults with diabetes. Understanding the reasons for hypoglycemia hospitalization is essential for the development of effective interventions; yet, the causes and precipitants of hypoglycemia are not well understood. Methods We conducted a qualitative study of non-nursing home patients aged 65 years or older without cognitive dysfunction admitted to a single tertiary-referral hospital with diabetes-related hypoglycemia. During the hospitalization, we conducted one-on-one, in-depth, semi-structured interviews to explore: (1) experiences with diabetes management among patients hospitalized for severe hypoglycemia; and (2) factors contributing and leading to the hypoglycemic event. Major themes and sub-themes were extracted using the constant comparative method by 3 study authors. Results Among the 17 participants interviewed, the mean age was 78.9 years of age, 76.5% were female, 64.7% African American, 64.7% on insulin, and patients had an average of 13 chronic conditions. Patients reported: (1) surprise at hypoglycemia despite living with diabetes for many years; (2) adequate support, knowledge, and preparedness for hypoglycemia; (3) challenges balancing a diet that minimizes hyperglycemia and prevents hypoglycemia; (4) the belief that hyperglycemia necessitates medical intervention, but hypoglycemia does not; and (5) tension between clinician-prescribed treatment plans and self-management based on patients’ experience. Notably, participants did not report the previously cited reasons for hypoglycemia, such as food insecurity, lack of support or knowledge, or treatment errors. Conclusions Our findings suggest that some hypoglycemic events may not be preventable, but in order to reduce the risk of hypoglycemia in older individuals at risk: (1) healthcare systems need to shift from their general emphasis on the avoidance of hyperglycemia towards the prevention of hypoglycemia; and (2) clinicians and patients need to work together to design treatment regimens that fit within patient capacity and are flexible enough to accommodate life’s demands.

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“…The efficacy of DAFNE has been widely proved: improvement in glycaemic control is sustained even after 7 years and the number of hospitalizations is reduced, as are long‐term costs . A recent report also supports a reduction in HbA 1c variability . Indeed, its excellent results have led the National Institute of Health and Care Excellence (NICE) to consider DAFNE a high‐quality, structured education programme, and its costs are covered by the UK National Health Service.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Alimentación Normal con Ajuste de Insulina (ANAIS), a Spanish version of the DAFNE programme, in people with Type 1 diabetes: a randomized controlled parallel trial

et al. 2019

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Aim To evaluate the effects of Alimentación Normal con Ajuste de Insulina (ANAIS), a group‐based, therapeutic education programme for Type 1 diabetes based on a flexible insulin regimen adjusted to the individual's food intake. Methods Participants with Type 1 diabetes and HbA1c levels of 53–86 mmol/mol (7–10%) were recruited from outpatient clinics at a tertiary care centre. They were randomized (using opaque, sealed envelopes, with a 2:1 treatment allocation ratio) to attend the training course immediately (immediate ANAIS; intervention group) or a year later (delayed ANAIS; control group). The main outcome was HbA1c level at 1 year. Secondary outcomes included lipid levels, weight, hypoglycaemic events, insulin dose, treatment satisfaction, self‐perceived dietary freedom, quality of life and participant‐defined goals. Results A total of 48 participants were assigned to the intervention group and 32 to the control group. Twelve months after completing the training, adjusted HbA1c was not significantly different in the intervention group [64 ± 1.3 vs 68 ± 1.6 mmol/mol (8.0 ±0.1% vs 8.4 ±0.1%); P=0.081]. Treatment satisfaction was significantly higher in the intervention group, but no differences were found in hypoglycaemic events, weight, insulin dose or changes in dietary freedom. At 1 year after the intervention, 72% of the participants (vs 33% in the control group; P=0.046) reported exceeding their expectations regarding achievement of their main personal goal. Conclusion Promoting dietary freedom and empowering people with Type 1 diabetes through structured education programmes, such as ANAIS, improves treatment satisfaction and self‐defined goals. No significant improvement in HbA1c level was achieved.

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Structured education using Dose Adjustment for Normal Eating (DAFNE) reduces long‐term HbA_1c and HbA_1c variability

Cited by 20 publications

References 27 publications

Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit

Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit

Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes

Assessment of Alimentación Normal con Ajuste de Insulina (ANAIS), a Spanish version of the DAFNE programme, in people with Type 1 diabetes: a randomized controlled parallel trial

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Structured education using Dose Adjustment for Normal Eating (DAFNE) reduces long‐term HbA1c and HbA1c variability

Cited by 20 publications

References 27 publications

Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit

Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit

Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes

Assessment of Alimentación Normal con Ajuste de Insulina (ANAIS), a Spanish version of the DAFNE programme, in people with Type 1 diabetes: a randomized controlled parallel trial

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Structured education using Dose Adjustment for Normal Eating (DAFNE) reduces long‐term HbA_1c and HbA_1c variability