title: Improved biomedical and psychological outcomes 1 year after structured education in flexible insulin therapy for people with type 1 diabetes: the U.K. DAFNE experience.
abstract: OBJECTIVE
  DAFNE (Dose Adjustment For Normal Eating), a structured education program in flexible insulin therapy, has been widely adopted in the U.K. after validation in a randomized trial. To determine benefits in routine practice, we collected biomedical and psychological data from all participants attending during a 12-month period.
  
  
  METHODS
  HbA(1c), weight, self-reported hypoglycemia awareness, severe hypoglycemia frequency, PAID (Problem Areas In Diabetes), HADS (Hospital Anxiety and Depression Scale), and EuroQol Group 5-Dimension Self-Report Questionnaire scores were recorded prior to DAFNE and after 1 year.
  
  
  RESULTS
  Complete baseline and follow-up HbA(1c) data were available for 639 (54.9%) of 1,163 attendees. HbA(1c) fell from 8.51 ± 1.41 (mean ± SD) to 8.24 ± 1.29% (difference 0.27 [95% CI 0.16-0.38]; P < 0.001), with a greater mean fall of 0.44% from baseline HbA(1c) >8.5%. Severe hypoglycemia rate fell from 1.7 ± 8.5 to 0.6 ± 3.7 episodes per person per year (1.1 [0.7-1.4]) and hypoglycemia recognition improved in 43% of those reporting unawareness. Baseline psychological distress was evident, with a PAID score of 25.2 and HADS scores of 5.3 (anxiety) and 4.8 (depression), falling to 16.7 (8.5 [6.6-10.4]), 4.6 (0.7 [0.4-1.0]), and 4.2 (0.6 [0.3-0.8]), respectively (all P < 0.001 at 1 year). Clinically relevant anxiety and depression (HADS ≥ 8) fell from 24.4 to 18.0% and 20.9 to 15.5%, respectively.
  
  
  CONCLUSIONS
  A structured education program delivered in routine clinical practice not only improves HbA(1c) while reducing severe hypoglycemia rate and restoring hypoglycemia awareness but also reduces psychological distress and improves perceived well-being.
authors.affiliation: Department of Diabetic Medicine, King’s College Hospital National Health Service Foundation Trust, London, UK. dhopkins3@nhs.net
authors.forename: David
authors.initials: D
authors.lastname: Hopkins
authors.forename: Ian
authors.initials: I
authors.lastname: Lawrence
authors.forename: Peter
authors.initials: P
authors.lastname: Mansell
authors.forename: Gillian
authors.initials: G
authors.lastname: Thompson
authors.forename: Stephanie
authors.initials: S
authors.lastname: Amiel
authors.forename: Michael
authors.initials: M
authors.lastname: Campbell
authors.forename: Simon
authors.initials: S
authors.lastname: Heller
mesh_terms: D000328:Adult; D001007:Anxiety; D003863:Depression; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000188:drug therapy; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin