Does DAFNE work? Evidence and data
The DAFNE program has now been evaluated in a number of countries. Participants have seen improvements in a variety of key diabetes management areas. The following benefits have been shown in both Australia and the United Kingdom:
- Improved HbA1c (blood glucose control)
- Reduced diabetes distress, depression and anxiety symptoms
- Increased dietary freedom
- No weight gain
- No increase in blood fats
- No increase in severe hypoglycaemia (In Australian studies of DAFNE we have found that severe hypoglycaemia has been reduced).
Below is a brief summary of the findings of some key DAFNE research papers.
DAFNE Study Group. (2002) Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ; 325:746.
The DAFNE Study Group set up a randomised controlled trial to evaluate the DAFNE program in the UK. The program was based on the Dusseldorf model of intensive insulin therapy (read more). It was translated to English and run as an outpatient course in three clinics across the UK during the trial.
The trial demonstrated that DAFNE was effective over a short-term (12 month) period. Specifically, the HbA1c of participants significantly decreased from baseline to the 12 month mark (a mean difference of 0.5%). This improvement occurred without a significant increase in severe hypoglycaemia. Cardiovascular risk factors did not worsen despite the increased dietary freedom reported by participants. The trial results also showed significant improvements for participants’ psychological well-being, quality of life, and satisfaction with treatment.
Speight J, Amiel SA, Bradley C, Heller S, Oliver L, Roberts S, Rogers H, Taylor C, Thompson G. (2010) Long-term biomedical and psychosocial outcomes following DAFNE (Dose Adjustment For Normal Eating) structured education to promote intensive insulin therapy in adults with sub-optimally controlled Type 1 diabetes. Diabetes Research & Clinical Practice; 89:22–29.
This research aimed to assess the long-term outcomes for participants in the original DAFNE trial. Participants provided follow-up data at an average of 44 months after their DAFNE course. The results showed that the improvement in HbA1c reported at 12 months (0.5%) had deteriorated slightly to 0.32% at 44 months but this was still statistically significant.
On the other hand, the positive psychological outcomes reported at the 12 month point were fully sustained at 44 months. These improvements were maintained in areas such as the impact of diabetes on dietary freedom, the impact of diabetes on quality of life, and present quality of life.
The authors concluded that DAFNE “offers major long-term benefits for quality of life outcomes and treatment satisfaction and more modest long-term benefits for glycaemic control”.
McIntyre HD, Knight BA, Harvey DM, Noud MN, Hagger VL, Gilshenan KS. (2010) Dose Adjustment for Normal Eating (DAFNE) – an audit of outcomes in Australia. Medical Journal of Australia; 192(11):637–640.
The aim of this research was to assess the short-term outcomes for participants in the DAFNE program in Australia. At 12 months post-course, the mean HbA1c of participants had fallen from 8.2% to 7.8% (a decrease of 0.4%). Overall, the decrease in HbA1c was found to be greater for those participants whose baseline HbA1c was the highest pre-course. The incidence of severe hypoglycaemic episodes decreased in Australian DAFNE participants. This is different to the earlier UK DAFNE studies, which showed no change in severe hypoglycaemia post-course. The Australian DAFNE audit also showed improvements in diabetes-related distress, and anxiety and depression symptoms.