title: 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.
abstract: OBJECTIVE
  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.
authors.affiliation: AHP Research, Brunel Science Park, Uxbridge, UK. jane.speight@ahpresearch.com
authors.forename: J
authors.initials: J
authors.lastname: Speight
authors.forename: S A
authors.initials: SA
authors.lastname: Amiel
authors.forename: C
authors.initials: C
authors.lastname: Bradley
authors.forename: S
authors.initials: S
authors.lastname: Heller
authors.forename: L
authors.initials: L
authors.lastname: Oliver
authors.forename: S
authors.initials: S
authors.lastname: Roberts
authors.forename: H
authors.initials: H
authors.lastname: Rogers
authors.forename: C
authors.initials: C
authors.lastname: Taylor
authors.forename: G
authors.initials: G
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000523:psychology; D004435:Eating; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000523:psychology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D011584:Psychology; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin