title: Structured type 1 diabetes education delivered in routine care in Australia reduces diabetes-related emergencies and severe diabetes-related distress: The OzDAFNE program.
abstract: OBJECTIVE
  To evaluate structured type 1 diabetes education delivered in routine practice throughout Australia.
  
  
  METHODS
  Participants attended a five-day training program in insulin dose adjustment and carbohydrate counting between April 2007 and February 2012. Using an uncontrolled before-and-after study design, we investigated: HbA1c (% and mmol/mol); severe hypoglycaemia; diabetes ketoacidosis (DKA) requiring hospitalisation, and diabetes-related distress (Problem Areas in Diabetes scale; PAID), weight (kg); body mass index. Data were collected pre-training and 6-18 months post-training. Change in outcome scores were examined overall as well as between groups stratified by baseline HbA1c quartiles. Data are mean ± SD or % (n).
  
  
  RESULTS
  506 participants had data eligible for analysis. From baseline to follow-up, significant reductions were observed in the proportion of participants reporting at least one severe hypoglycaemic event (24.7% (n=123) vs 12.1% (n=59), p<0.001); and severe diabetes-related distress (29.3% (n=145) vs 12.6% (n=60), p<0.001). DKA requiring hospitalisation in the past year reduced from 4.1% (n=20) to 1.2% (n=6). For those with above target baseline HbA1c there was a small, statistically significant improvement (n=418, 8.4 ± 1.1% (69 ± 12 mmol/mol) to 8.2 ± 1.1% (66 ± 12 mmol/mol). HbA1c improvement was clinically significant among those in the highest baseline quartile (n=122, 9.7 ± 1.1% (82 ± 11 mmol/mol) to 9.0 ± 1.2% (75 ± 13 mmol/mol), p<0.001).
  
  
  CONCLUSIONS
  The proportion of participants reporting severe hypoglycaemia, DKA and severe diabetes-related distress was at least halved, and HbA1c reduced by 0.7% (7 mmol/mol) among those with highest baseline levels. Structured type 1 diabetes education delivered in routine practice offers clinically important benefits for those with greatest clinical need.
authors.affiliation: The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia; AHP Research, 16 Walden Way, Hornchurch, UK. Electronic address: jspeight@acbrd.org.au.
authors.forename: Jane
authors.initials: J
authors.lastname: Speight
authors.affiliation: The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Holmes-Truscott
authors.affiliation: Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia.
authors.forename: Dianne M
authors.initials: DM
authors.lastname: Harvey
authors.affiliation: The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia.
authors.forename: Christel
authors.initials: C
authors.lastname: Hendrieckx
authors.affiliation: The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia; School of Psychology, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia; Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia.
authors.forename: Virginia L
authors.initials: VL
authors.lastname: Hagger
authors.affiliation: Diabetes Victoria, 570 Elizabeth Street, Melbourne 3000, VIC, Australia.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Harris
authors.affiliation: Mater Health Services, Raymond Terrace, South Brisbane 4101, QLD, Australia; Lady Cilento Children's Hospital, Stanley St, South Brisbane 4101, QLD, Australia.
authors.forename: Brigid A
authors.initials: BA
authors.lastname: Knight
authors.affiliation: Mater Health Services, Raymond Terrace, South Brisbane 4101, QLD, Australia; Mater Clinical School, The University of Queensland, Raymond Terrace, South Brisbane 4101, QLD, Australia.
authors.forename: Harold D
authors.initials: HD
authors.lastname: McIntyre
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000628:therapy*; D016883:Diabetic Ketoacidosis / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation; D012189:Retrospective Studies; D012648:Self Care / Q000592:standards*; D012720:Severity of Illness Index
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Diabetes distress; Hypoglycaemia; Structured diabetes education; Type 1 diabetes