Abstract
BackgroundStructured education programmes for individuals with Type 1 diabetes have become a recognised means of delivering the knowledge and skills necessary for optimal self-management of the condition. The Dose Adjustment for Normal Eating (DAFNE) programme has been shown to improve biomedical (HbA1c and rates of severe hypoglycaemia) and psychosocial outcomes for up to 12 months following course delivery. The optimal way to support DAFNE graduates and maintain the benefits of the programme has not been established. We aimed to compare 2 different methods of follow-up of DAFNE graduates in a pragmatic clinical trial delivered in busy diabetes clinics on the island of Ireland.MethodsSix participating centres were cluster randomised to deliver either group follow-up or a return to traditional one-to-one clinic visits. In the intervention arm group follow-up was delivered at 6 and 12 months post DAFNE training according to a curriculum developed for the study. In the control arm patients were seen individually in diabetes clinics as part of routine care. Study outcomes included HbA1c levels, self-reported rates of severe hypoglycaemia, body weight and measures of diabetes wellbeing and quality of life. These were measured at 6, 12 and 18 months after recruitment. Generalisability (external validity) was maximised by recruiting study participants from existing DAFNE waiting lists in each centre, by using broad inclusion criteria (including HbA1c values less than 13 percent with no lower limit) and by using existing clinic staff to deliver the training and follow-up. Internal validity and treatment fidelity were maximised by quality assuring the training of all DAFNE educators, by external peer review of the group follow-up sessions and by striving for full attendance at follow-up visits. Assays of HbA1c were undertaken in a central laboratory.DiscussionThis pragmatic clinical trial evaluating group follow-up after a structured education programme has been designed to have broad generalisability. The results should inform how best to manage the well educated patient with Type 1 diabetes in the real world of clinical practiceTrial registrationCurrent Controlled Trials ISRCTN79759174
Highlights
Structured education programmes for individuals with Type 1 diabetes have become a recognised means of delivering the knowledge and skills necessary for optimal self-management of the condition
Diabetes education to support self-management is widely accepted as an integral component of good diabetes care
It is only recently that attention has been paid in the UK to what constitutes effective diabetes education [12,29]
Summary
Structured education programmes for individuals with Type 1 diabetes have become a recognised means of delivering the knowledge and skills necessary for optimal self-management of the condition. The optimal way to support DAFNE graduates and maintain the benefits of the programme has not been established. Type 1 diabetes is a challenging condition to manage Once diagnosed it requires active patient involvement in self-management of lifestyle issues including diet, physical activity and stress reduction. Even in motivated patients it can be difficult to avoid dayto-day fluctuations in blood glucose levels resulting in symptomatic hyper- or hypoglycaemia. The risk of chronic microvascular complications of diabetes can be reduced by maintaining good glycaemic control, in an individual patient there is no guarantee that their genetic predisposition will not result in premature impairment of vital organs including the eyes, kidneys and peripheral nerves. Worry about complications and the fear of hypoglycaemia are significant burdens for many people living with the disease [1]
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