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Training in flexible intensive insulin management improved glycaemic control and quality of life in type 1 diabetes

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 QUESTION: Does training in flexible intensive insulin management (combining dietary freedom and insulin adjustment) improve glycaemic control and quality of life in patients with type 1 diabetes?


Randomised (allocation concealed*), unblinded,* wait list controlled trial with follow up at 6 months (Dose Adjustment for Normal Eating [DAFNE]).


3 hospital diabetes clinics in Sheffield, Northumbria, and London, UK.


169 patients >18 years of age with clinical features of type 1 diabetes, moderate or poor glycaemic control (glycated haemoglobin [HbA1c] 7.5–12%), and duration of diabetes >2 years without advanced complications. Exclusion criteria were inability to understand English, severe psychiatric illness, pregnancy, and unawareness of hypoglycaemia. 136 patients (80%) completed baseline and 6 month assessments (mean age 40 y, 56% women).


84 patients were allocated to the intervention, which comprised a 5 day skills course delivered by 2–3 educators (diabetes specialist nurses or dieticians) to groups of 6–8 participants in each …

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  • Source of funding: Diabetes UK.

  • For correspondence: Dr S Heller, Northern General Hospital, Sheffield, UK. s.heller{at}

  • Abstract and commentary also appear in ACP Journal Club and a modified version of the abstract appears in Evidence-Based Nursing.

  • * See glossary.