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

Aim: To explore the longer term blood glucose self-monitoring outcomes and frequency of monitoring for outpatients with diabetes type 1 after completion of the Dose Adjustment for Normal Eating (DAFNE) course. The hypothesis was that DAFNE outcomes would differ according to frequency of glucose monitoring.Methods: A sequential data-triangulation design using existing baseline (T0) and 12-months (T12) DAFNE course data and interview data from 12 randomly selected participants who had completed the course two years ago. Results: Age range was 23 to 70 years with HbA1c 6.1% to 12.6% at T0 and 6.1% to 11.4% at T12. Comparisons of HbA1c, PAID, HAD subscales anxiety and depression, and covariate data between T0 and T12indicatedsignificant reductions in the mean depression and PAID scores (both P < 0.001) for the whole group. For the two groups who recorded their blood glucose less than three times or three or more times per day, changes were not significantly different. For both groups, the trend between T0 and T12 was downwards for change in mean blood glucose level and all survey scales. The proportion of all participants with T12 HbA1c at or below their T0 value was greater than 50% (Proportion = 69%, 95% CI: 56% - 79%) but only the highest HbA1c tertile group showed a significant difference (P = 0.003). There was an average decrease in the incidence of hypoglycaemic events of 0.6 overall: The greatest change was for the high HbA1c tertile with a mean decrease of 0.8. The interview data suggested that DAFNE graduates experimented more with food, exercise, and insulin; gained knowledge; learnt personal body needs; increased awareness of blood glucose level; gained confidence and improved their quality of life. Conclusions: There was insufficient evidence to conclude that frequency of blood glucose monitoring influenced metabolic control. However, people with type 1 diabetes who undertake the less restricted DAFNE approach to diabetes self-management can improve their quality of life and glycaemic control.