Long-term biomedical and psychosocial outcomes following DAFNE (Dose Adjustment For Normal Eating) structured education to promote intensive insulin therapy in adults with sub-optimally controlled Type 1 diabetes

Aims: To explore long-term outcomes of participation in a Dose Adjustment For Normal Eating (DAFNE) training course, which provided one-off exposure to structured education in intensive insulin therapy to people with established Type 1 diabetes. Methods: A cohort design follow-up of original trial participants at a mean of 44 months (range: 37-51 months) in hospital diabetes clinics in three English health districts. 104(74%) original participants provided biomedical data; 88(63%) completed questionnaires including the ADDQoL, measuring impact of diabetes on quality of life (QoL). Results: At 44 months, mean improvement in HbA(1c) from baseline was 0.36% (9.32 +/- 1.1% to 8.96 +/- 1.2%, p < 0.01) remaining significant but deteriorated from 12 months (p < 0.05). Improvements in QoL seen at 12 months were sustained at 44 (e.g. impact of diabetes on dietary freedom: -1.78 +/- 2.33 at 44 months versus -4.27 +/- 2.94, baseline, p < 0.0001; versus 1.80 +/- 2.32 at 12 months, ns). Similar results were obtained using last observation carried forward for patients not supplying follow-up data. Conclusions: The impact of a single DAFNE course on glycaemic control remains apparent in the long term, although further interventions will be required to achieve recommended HbA(1c). In contrast, improvements in QoL and other patient-reported outcomes are well maintained over approximately 4 years. (C) 2010 Elsevier Ireland Ltd. All rights reserved.