Why should you commission structured patient education for adults with type 1 diabetes?

Helen Hopkinson

Greater Glasgow and Clyde Health Board, Glasgow, UK

Address for correspondence: Dr Helen Hopkinson
Chair UK DAFNE Executive Board and Consultant Physician,
Diabetes Dept, Clinic L, New Victoria Hospital,
Grange Road, Glasgow, G42 9LF
E-mail: helen.hopkinson@nhs.net

Br J Diabetes 2016;16:101-102


Dose Adjustment For Normal Eating (DAFNE) is the leading structured patient education programme for adults with type 1 diabetes in the UK. Provided by a not-for-profit NHS-governed consortium, it enables patients to self-manage their disease through a skills-based education programme. DAFNE is designed to be embedded within established NHS diabetes services. People applying DAFNE principles learn to stabilise their blood glucose, which reduces the risk of complications, improves quality of life for them and their families and reduces NHS costs.

Commissioning DAFNE will:

•        Achieve cost savings of £93,133 per 100,000 population annually1

•        Enable you to be compliant with the new NICE type 1 diabetes guideline (NG17)

The benefits of DAFNE

DAFNE has been shown to improve blood glucose control, to improve quality of life and to reduce the risk of severe hypoglycaemia.2,3 These improvements are associated with immediate savings in the cost of care and long-term savings through reduction in complications.

In the short term, DAFNE is associated with immediate savings from lower insulin doses and reduced hospital attendance due to ketoacidosis and hypoglycaemia.4 DAFNE training reduces progression to insulin pump therapy producing significant cost savings in reduced pump use.5 In the longer term, further savings accrue as a result of the impact of better diabetes control on diabetes complications. Diabetes is the most common cause of end stage kidney disease and preventable blindness in the UK, and the risk of these complications developing can be significantly reduced by improving blood glucose control. A Quality, Innovation, Productivity and Prevention (QIPP) case study published by NICE estimates these savings at over £93,000 per 100,000 population every year (£48 million nationally every year).1


The reliability, credibility, impact and effectiveness of DAFNE can be demonstrated through over 25 years of peer-reviewed published research in both the UK and Europe. Details of the published research can be found at www.dafne.uk.com.

Patient perspective

The improvements in blood glucose control and confidence in self-management are reflected in extensive positive feedback from service users: “My bottom line in life is to function and DAFNE gives me that ability. For me, it is not a diabetic treatment, it is my life. I have control. Together DAFNE and I are delivering the best results in diabetes care I’ve experienced in my 25 years.” – Jenny Mills Thomas, Cambridgeshire.

Over the years, peer support networks of DAFNE graduates have developed both within local services and nationally, including an active online community at www.dafneonline.co.uk.

Delivering DAFNE?

Patients are introduced to DAFNE through a five-day course delivered by your existing staff. DAFNE ‘trains the trainers’ and provides ongoing continuing professional development, audit of outcomes and quality assurance. There is a fixed annual contribution to support the central UK DAFNE office function, and the cost to deliver DAFNE per patient is therefore lower if more courses are delivered. Non-recurrent set-up costs include staff training, teaching aids and associated reusable resources. The cost per patient is a proportion of the annual contribution, dependent on the annual number of courses delivered. For centres delivering one course a month, this works out at approximately £50–55 per patient, including printed resources for individual patients.

Within the DAFNE portfolio there are three courses: the original one-week course delivered Monday to Friday; a five-week course delivered one day a week over five weeks; and the DAFNE pump curriculum developed for insulin pump users who never had the opportunity to complete structured education prior to getting a pump. The latter is ideal for transition patients whose parents received most of the self-management training in the paediatric service.

Want to know more?

More detailed information on the DAFNE programme and all of the research mentioned above are available at www.dafne.uk.com together with professional and user reviews of the programme. You can also contact central DAFNE for more information and for answers to specific questions at dafne@northumbria-healthcare. nhs.uk.


1.      Department of Health. Improving the quality of care for patients with type 1 diabetes: dose adjustment for normal eating (DAFNE) 2013. Available on the NICE website at https://www.nice.org.uk/savingsandproductivity andlocalpracticeresource?ci=http%3a%2f%2farms.evidence.nhs.uk%2fresources%2fQIPP%2f899091%3fniceorg%3dtrue (last accessed 21 Feb 2016).

2.      DAFNE Study Group. 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 2002; 325:746–52. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC128375/pdf/746.pdf

3.      Hopkins D, Lawrence I, Mansell P, et al. Improved biomedical and psychological outcomes 1 year after structured education in flexible insulin therapy for people with type 1 diabetes: the U.K. DAFNE experience. Diabetes Care 2012;35:1638–42. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402270/pdf/1638.pdf

4.      Elliott J, Jacques RM, Kruger J, et al. Substantial reductions in the number of diabetic ketoacidosis and severe hypoglycaemia episodes requiring emergency treatment lead to reduced costs after structured education in adults with type 1 diabetes. Diabet Med 2014;31:847–53. http://onlinelibrary.wiley.com/doi/10.1111/dme.12441/epdf

5.      Ray T, Choudhary P, Mansell P, et al. Dose Adjustment for Normal Eating (DAFNE) structured education reduces progression to continuous subcutaneous insulin infusion (CSII) among patients being considered for insulin pump therapy at enrolment. Diabet Med 2013;30(Suppl.1):7.