TITLE:
Dose Adjustment for Normal Eating: Longer Term Perspectives of Adults with Type 1 Diabetes
AUTHORS:
Pat Rapley, Stephanie Axon, Gwen Babel, Krystina Creighton, Joey M. Kaye, Suzanne Brown
KEYWORDS:
DAFNE, Adults, Type 1 Diabetes, Long Term
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.4 No.3,
July
31,
2014
ABSTRACT: Aim:To explore the longer term blood
glucose self-monitoring outcomes and frequency of monitoring for outpatients
with diabetes type 1 after completion of the Dose Adjustment for Normal Eating
(DAFNE) course. The hypothesis was that DAFNE outcomes would differ according
to frequency of glucose monitoring.Methods:Asequential data-triangulation design
using existingbaseline (T0)
and 12-months (T12)DAFNE
course data and interview data from 12 randomly selected participants who had
completed the course two years ago.Results:
Age range was 23 to 70 years with HbA1c 6.1% to 12.6% at T0and 6.1% to 11.4% at T12.
Comparisons of HbA1c, PAID, HAD subscalesanxietyanddepression,and covariate data between T0and T12indicatedsignificant
reductions in the mean depression and PAID scores (bothP0and T12was downwards for change in mean blood
glucose level and all survey scales. The proportion of all participants with T12HbA1c at or below their T0value was greater than 50% (Proportion
= 69%, 95% CI: 56% - 79%) but only the highest HbA1c tertile group showed a
significant difference (P=
0.003). There was an average decrease in the incidence of hypoglycaemic events
of 0.6 overall: The greatest change was for the high HbA1c tertile with a mean
decrease of 0.8. The interview data suggested that DAFNE graduates experimented
more with food, exercise, and insulin; gained knowledge; learnt personal body
needs; increased awareness of blood glucose level; gained confidence and
improved their quality of life. Conclusions: There was insufficient evidence to
conclude that frequency of blood glucose monitoring influenced metabolic
control. However, people with type 1 diabetes who undertake the less restricted
DAFNE approach to diabetes self-management can improve their quality of life
and glycaemic control.