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

http://dx.doi.org/10.1136/ebm.8.3.80

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    (2002) BMJ 325, 746. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial.. ;. :. –9..
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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?

    Design

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

    Setting

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

    Patients

    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).

    Intervention

    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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    Footnotes

    • Source of funding: Diabetes UK.

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

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

    • ↵* See glossary.