title: Group follow-up compared to individual clinic visits after structured education for type 1 diabetes: a cluster randomised controlled trial.
abstract: OBJECTIVE
  To compare the effectiveness of group follow-up with individual follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme.
  
  
  METHODS
  Cluster randomised controlled trial involving 437 adults with type 1 diabetes attending hospital diabetes clinics in Ireland. All participants received DAFNE at baseline. Intervention arm participants received 2 group education sessions post-DAFNE and did not attend clinics. Control arm participants received 2 one-to-one clinic visits post-DAFNE.
  
  
  RESULTS
  We observed no significant difference in the primary outcome (change in HbA1c) at 18 months follow-up (mean difference 0.14%; 95% CI -0.33 to 0.61; p=0.47). Secondary outcomes, including rates of severe hypoglycaemia, anxiety, depression, the burden of living with diabetes and quality of life did not differ between groups. Mean level of HbA1c for the entire sample (regardless of treatment arm) did not change between baseline and 18 month follow-up (p=0.09), but rates of severe hypoglycaemia, diabetes related hospital attendance, levels of anxiety, depression, the burden of living with diabetes, quality of life and treatment satisfaction all significantly improved.
  
  
  CONCLUSIONS
  Our data suggest that group follow-up as the sole means of follow-up after structured education for individuals with type 1 diabetes is as effective as a return to one-to-one clinic visits.
authors: School of Medicine, NUI Galway, Galway, Ireland. sean.dinneen@nuigalway.ie
authors: Sean F
authors: SF
authors: Dinneen
authors: Mary Clare
authors: MC
authors: O'Hara
authors: Molly
authors: M
authors: Byrne
authors: Diarmuid
authors: D
authors: Smith
authors: Christopher H
authors: CH
authors: Courtney
authors: Colm
authors: C
authors: McGurk
authors: Simon R
authors: SR
authors: Heller
authors: John
authors: J
authors: Newell
authors: Norma
authors: N
authors: Coffey
authors: Cathy
authors: C
authors: Breen
authors: Mary
authors: M
authors: O'Scannail
authors: Donal
authors: D
authors: O'Shea
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001007:Anxiety / Q000453:epidemiology*; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D003863:Depression / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000191:economics / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D011785:Quality Assurance, Health Care; D011788:Quality of Life; D011795:Surveys and Questionnaires