Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit


  • Najeeb Shah Hull University Teaching Hospitals NHS Trust and the University of Hull.
  • Harshal Deshmukh Hull University Teaching Hospitals NHS Trust and the University of Hull.
  • Emma G. Wilmot University Hospitals of Derby and Burton NHS Foundation Trust, Derby.
  • Jane Patmore Hull University Teaching Hospitals NHS Trust, Hull.
  • Pratik Choudhary Leicester General Hospital, University of Leicester, Leicester.
  • Peter Christian William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Kent.
  • Roselle Herring Royal Surrey County Hospital, Guildford.
  • Niall Furlong St Helens and Knowsley Teaching Hospitals NHS. Trust, St Helens.
  • Simon Saunders Warrington and Halton N.H.S. Foundation Teaching Trust, Warrington.
  • Parth Narendran Queen Elizabeth Hospital Birmingham and the University of Birmingham, Birmingham.
  • Dennis J. Barnes Tunbridge Wells Hospital, Kent.
  • Chris Walton Hull University Teaching Hospitals NHS Trust, Hull.
  • Robert E.J. Ryder Sandwell and West Birmingham NHS Trust, City Hospital, Birmingham.
  • Thozhukat Sathyapalan Hull University Teaching Hospitals NHS Trust and the University of Hull.



Type 1 diabetes mellitus, FreeStyle Libre monitoring, DAFNE structured education, Structured education in diabetes, Self-management in diabetes, improvement in HbA1c


Background: Dose Adjustment For Normal Eating (DAFNE) is the gold standard National Institute for Health and Care Excellence (NICE) recommended structured education programme that promotes self-management in people living with type 1 diabetes (T1D). We have recently shown that FreeStyle Libre (FSL) is associated with improved haemoglobin A1c (HbA1c) and hypoglycaemia awareness.

Aims: To explore the effect of structured education including DAFNE on HbA1c and GOLD score when combined with FSL use.

Methods: The ABCD national audit data on FSL users were used to conduct this prospective longitudinal study. The Stu- dent’s t test was used to compare the baseline and follow-up HbA1c and a change in the GOLD score for hypoglycaemia awareness. The baseline demographic and clinical characteristics of the study population were compared using ANOVA. Linear regression analysis identified predictors of change in HbA1c with FSL use.

Results: The study consisted of 14,880 people living with insulin-dependent diabetes mellitus (IDDM), 97% of whom had T1D, of which 50% were female, with a mean±SD base- line HbA1c of 70±18 mmol/mol and baseline body mass index (BMI) of 25.3±6.2 kg/m2. Follow-up data for HbA1c were avail- able for 6,446 participants while data for GOLD score were available for 5,057 participants. The study population was divided into three groups: 6,701 people with no prior structured education (Group 1), 3,964 with other structured education (Group 2), and 4,215 had previously attended DAFNE structured education (Group 3). Groups 2 and 3 who had previously attended structured education had a lower initial HbA1c than those in Group 1 (p<0.0001). However, there was a significant but similar magnitude of the fall in HbA1c across all groups (−8.10 mmol/mol vs −6.61 mmol/mol vs −6.22 mmol/mol in Groups 1, 2 and 3, respectively), with p (ANOVA)=0.83. Similarly, the decline in GOLD score was comparable in Groups 1, 2 and 3 (−0.33 vs −0.30 vs −0.34, respectively), with p (ANOVA)=0.43. Linear regression analysis identified higher baseline HbA1c (β=0.585, p<0.0001), number of FSL scans over 14 days (β=−0.026, p=0.00135) and other structured education (β=−1.207, p=0.02483) as predictors of HbA1c reduction. Prior DAFNE training was not associated with improved HbA1c reduction in the linear regression model.

Conclusions: FSL use was associated with improvements in HbA1c and GOLD score. Although DAFNE is an evidence- based intervention to improve outcomes in those with T1D, DAFNE attendance prior to commencing FSL did not influence HbA1c or GOLD score outcomes when compared with FSL use alone. Other structured education was identified as a predictor of HbA1c reduction when combined with FSL use.


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