Endocrine Abstracts

Background: Dose adjustment for normal eating (DAFNE) structured education programme is an effective tool in improving glycaemic control in patients with type 1 diabetes while reducing the frequency of hypoglycemic episodes. DAFNE however, does not solve all glucose related problems and patients often request or are recommended continuous subcutaneous insulin infusion (CSII) therapy post DAFNE.

Objective: Out of our 370 DAFNE graduates, 46 have subsequently gone on to CSII therapy. The aim of our audit was to examine glycaemic control of these 46 graduates before and after they completed the DAFNE and then before and after starting CSII therapy and reason for CSII therapy.

Methods: The data was collected using the hospital’s electronic data base (Cellma and Pipe) and by contacting the patients via phone for further details.

Results: 56% patients were female. Mean age was 40±9.4 (mean±S.D.) years with BMI of 26.6+4.5 kg/m² and duration of diabetes was 17.2±8.5 years. Duration since completion of DAFNE at the time of study was 5.8±2.2 years and duration of CSII therapy was 4.0±2.2 years. HbA1c before DAFNE was 8.3±1.2% (67.2±9.8 mmol/mol) compared to 8.05±1.0% (64.5±11 mmol/mol) 12 months post DAFNE–P value=0.31. The indication of commencement of CSII therapy was to improve overall glycemic control in 45% patients, impaired awareness of hypoglycaemia in 26% and patient preference, felt it would suit their lifestyle, in 23%. HbA1c before commencement of CSII was 8.3%±1.07 (67.2±11.7 mmol/mol) compared to 7.9%±0.9 (62.8±9.9 mmol/mol) after 12 months of CSII therapy–P value=0.04.

Conclusion: DAFNE is an effective education programme for patients with type 1 diabetes but may not improve glycaemic control in all. Selected patients benefit from going on to CSII therapy post DAFNE and this can be associated with an improvement in HbA1c.