Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomized controlled trial

Study Group DAFNE, S Amiel, S Beveridge , Clare Bradley, C Gianfrancesco , S Heller , P James, N McKeown , D Newton , L Newton, L Oliver, H Reid, S Roberts, S Robson , J Rollington , V Scott, J Speight, C Taylor , G Thompson, E TurnerF Wright

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Objectives: To evaluate whether a course teaching flexible intensive insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes.<br /> <br /> Design: randomized design with participants either attending training immediately (immediate DAFNE) or acting as waiting list controls and attending "delayed DAFNE" training 6 months later.<br /> <br /> Setting: Secondary care diabetes clinics in three English health districts.<br /> <br /> Participants: 169 adults with type 1 diabetes and moderate or poor glycaemic control.<br /> <br /> Main outcome measures: Glycated haemoglobin (HbA 1c), severe hypoglycaemia, impact of diabetes on quality of life (ADDQoL).<br /> <br /> Results: At 6 months, HbA 1c was significantly better in immediate DAFNE patients (mean 8.4%) than in delayed DAFNE patients (9.4%) (t=6.1, P<0.0001). The impact of diabetes on dietry freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients (t= -5.4, P<0.0001), as was the impact of diabetes on overall quality of life (t = 2.9, P<0.01). General wellbeing and treatment satisfaction were also significantly improved, but severe hypoglycaemia, weight, and lipids remained unchanged. Improvements in "present quality of life" did not reach significance at 6 months but were significant by 1 year.<br /> <br /> Conclusion: Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk. This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation.
Original languageEnglish
Pages (from-to)1-6
JournalBritish Medical Journal
Publication statusPublished - 2002


  • Diabetes
  • DAFNE training
  • Quality of life
  • Insulin Treatment
  • Diet
  • Glycaemic control

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