A short history of DAFNE
Beginnings in Germany
A five day structured training program was created in Germany in the 1980s. It was designed by the diabetes team at the Diabetes Centre in Dusseldorf, led by the late Michael Berger. This inpatient program focused on intensive insulin therapy and the self-management of type 1 diabetes (references 1 - 3).
The educational approach is based on the Assal model of "therapeutic education" (4). People learn to match their insulin dose to their food on a meal-by-meal basis. The aim is that they can keep healthy blood glucose control without a higher risk of severe hypoglycaemia. They can then continue this with minimal support from their diabetes team.
Across to the UK
In 1998, the Dose Adjustment For Normal Eating (DAFNE) Project in the UK looked at creating a course based on the Dusseldorf model. The main change was that people would attend the course on an outpatient basis (5). A similar outpatient course was developed in Graz, Austria, led by Thomas Pieber (6). The Austrian course produced equally successful 12-year outcomes to those shown by the Dusseldorf model in Germany (7). This approach has now been widely adapted and developed across Europe.
The UK-based DAFNE Study Group translated the curriculum and carried out a randomised controlled trial of the Dusseldorf approach. The results showed significant improvement in glycaemic control, without increased risk of severe hypoglycaemia. Participants' quality of life and treatment satisfaction were also significantly improved (5). Over 15,000 people with type 1 in the UK have now done a DAFNE course.
Down under to Australia
Diabetes teams from Victoria, Queensland and Western Australia visited the UK for DAFNE Educator training in November 2004. These teams started to run DAFNE courses in Australia for people with type 1 diabetes in 2005. Over 2000 people have now completed the course in Australia.
In Australia, we call the program "OzDAFNE". There are now OzDAFNE courses in most Australian states. DAFNE has also spread to nearby countries like New Zealand and Singapore. You can find your nearest centre here.
- Mühlhauser, I., Jörgens, V., Berger, M., Graninger, W., Gürtler, W., Hornke, L., Kunz, A., Schernthaner, G., Scholz, V., & Voss, H.E. (1983) Bicentric evaluation of a teaching and treatment programme for type 1 (insulin-dependent) diabetic patients: Improvement of metabolic control and other measures of diabetes care for up to 22 months. Diabetologia 25:470-476.
- Mühlhauser, I., Bruckner, I., Berger, M., Cheta, D., Jörgens, V., Ionescu-Tîrgoviste, C., Scholz, V., & Mincu, I. (1987) Evaluation of an intensified insulin treatment and teaching programme as routine management of type 1 (insulin-dependent) diabetes. The Bucharest-Düsseldorf Study. Diabetologia 30:681-690.
- Bott, S., Bott, U., Berger, M., & Mühlhauser, I. (1997) Intensified insulin therapy and the risk of severe hypoglycaemia. Diabetologia 40:926-932.
- Assal, J.P., Mühlhauser, I., Pernet, A., Gfeller, R., Jörgens, V., & Berger, M. (1985) Patient education as the basis for diabetes care in clinical practice and research. Diabetologia 28:602-613.
- The DAFNE Study Group. (2002) Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: the dose adjustment for normal eating (DAFNE) randomised control trial. BMJ 325:746.
- Pieber, T.R., Brunner, G.A., Schnedl, W.J., Schattenberg, S., Kaufmann, P., & Krejs, G.J. (1995) Evaluation of a structured outpatient group education program for intensive insulin therapy. Diabetes Care 18:625-630.
- Plank, J., Köhler, G., Rakovac, I., Semlitsch, B.M., Horvath, K., Bock, G., Kraly, B., & Pieber, T.R. (2004) Long-term evaluation of a structured outpatient education programme for intensified insulin therapy in patients with type 1 diabetes: a 12 year follow-up. Diabetologia 47:1370-1375.
- Howorka, K. (1996) Functional insulin treatment. Berlin: Springer.