DAFNE is agile and responsive—a beacon of best practice
DOI:
https://doi.org/10.15277/bjd.2024.466Abstract
The original Dose Adjustment For Normal Eating (DAFNE) randomised controlled trial (RCT) was conducted nearly 25 years ago.1 It has transformed structured education for type 1 diabetes (T1DM) across the UK and is still evolving through its evidence base of further RCTs,2-3 and routine collection of real-world evidence (RWE),4 thereby proving that what works in a research setting, also benefits people with T1DM in the large number (more than half) of the hospital Trusts that have adopted DAFNE countrywide.
This review summarises the latest national audit data, and describes future work responding to the rapid changes in technology used in T1DM, how we are evolving to support people living with type 2 diabetes (T2DM), and adapting our learning materials in the digital age. Through the strength and depth of committed multidisciplinary healthcare professionals (HCPs) we have been able to expand our portfolio of learning materials available to DAFNE centres, who pay a nominal annual fee of ~£5,000. By partnering with the Open University we now offer free accredited online learning to a wide range of HCPs, thereby helping to upskill the diabetes workforce at no extra cost to the NHS.
Finally, in a new and exciting collaboration with the Diabetes Technology Network (DTN) and industry colleagues, DAFNE offers free online training to all people living with T1DM to prepare them for closed-loop therapy.
References
DAFNE Study 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. https://doi.org/10.1136/bmj.325.7367.746
The REPOSE Study Group. Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE). BMJ 2017;356:j1285. https://doi.org/10.1136/bmj.j1285
Elliott J, Rankin D, Jacques RM, Lawton J, et al. A cluster-randomized trial comparing a 5-day DAFNE course delivered over 1 week against DAFNE training delivered over 1 day a week for 5 consecutive weeks. Diabet Med 2015; 32:391-8. https://doi.org/10.1111/dme.12621
Gunn D, Mansell P. Glycaemic control and weight 7 years after Dose Adjustment For Normal Easing (DAFNE) structured education in Type 1 diabetes. Diabet Med 2012;29:807-12. https://doi.org/10.1111/j.1464-5491.2011.03525.x
Harris S, Miller A, Amiel S, Mulnier H. Characterisation of adults with type 1 diabetes not attending self-management education courses: The barrier to uptake of type 1 diabetes education (BUD1E) study. Qual Health Res 2019;29: 1174-85. https://doi.org/10.1177/1049732318823718
Elliott J, Jacques R, Kruger J, Campbell M, et al. Substantial reduction in episodes of diabetic ketoacidosis and savings in emergency treatment costs following structured education in patients with Type 1 diabetes. Diabet Med 2013;30:6-8. https://doi.org/10.111/dme.12095_5
https://www.nice.org.uk/guidance/ta943 (last accessed 7 Nov 2024)
https://dafne.nhs.uk/ (last accessed 7 Nov 2024)
https://dafne.nhs.uk/dafne-for-healthcare-professionals/how-to-become-a-dafne-centre (last accessed 7 Nov 2024)
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Manuscripts published in the June 2024 edition and after in the BJD have been published in open access under a Creative Commons Attribution 4.0 International License and available at https://www.bjd-abcd.com. Prior year articles are available free of charge via our website.
