Dose Adjustment for Normal Eating: Longer Term Perspectives of Adults with Type 1 Diabetes

Abstract

Aim: To explore the longer term blood\rglucose self-monitoring outcomes and frequency of monitoring for outpatients\rwith diabetes type 1 after completion of the Dose Adjustment for Normal Eating\r(DAFNE) course. The hypothesis was that DAFNE outcomes would differ according\rto frequency of glucose monitoring.Methods: A sequential data-triangulation design\rusing existing baseline (T0)\rand 12-months (T12) DAFNE\rcourse data and interview data from 12 randomly selected participants who had\rcompleted the course two years ago. Results:\rAge range was 23 to 70 years with HbA1c 6.1% to 12.6% at T0 and 6.1% to 11.4% at T12.\rComparisons of HbA1c, PAID, HAD subscales anxiety and depression, and covariate data between T0 and T12indicatedsignificant\rreductions in the mean depression and PAID scores (both P 0 and T12 was downwards for change in mean blood\rglucose level and all survey scales. The proportion of all participants with T12 HbA1c at or below their T0 value was greater than 50% (Proportion\r= 69%, 95% CI: 56% - 79%) but only the highest HbA1c tertile group showed a\rsignificant difference (P =\r0.003). There was an average decrease in the incidence of hypoglycaemic events\rof 0.6 overall: The greatest change was for the high HbA1c tertile with a mean\rdecrease of 0.8. The interview data suggested that DAFNE graduates experimented\rmore with food, exercise, and insulin; gained knowledge; learnt personal body\rneeds; increased awareness of blood glucose level; gained confidence and\rimproved their quality of life. Conclusions: There was insufficient evidence to\rconclude that frequency of blood glucose monitoring influenced metabolic\rcontrol. However, people with type 1 diabetes who undertake the less restricted\rDAFNE approach to diabetes self-management can improve their quality of life\rand glycaemic control.