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

TLDR

The study aimed to determine if flexible intensive insulin training that allows dietary freedom improves glycaemic control and quality of life in type 1 diabetes. A randomized trial enrolled 169 adults with type 1 diabetes in three English secondary care clinics, assigning them to immediate or delayed DAFNE training and measuring HbA1c, severe hypoglycaemia, and diabetes‑related quality of life. Immediate DAFNE training lowered HbA1c from 9.4 % to 8.4 % at 6 months, improved quality of life, and did not increase severe hypoglycaemia or cardiovascular risk, suggesting the approach could broaden intensive insulin adoption.

Abstract

Objectives: To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes. Design: Randomised design with participants either attending training immediately (immediate DAFNE) or acting as waiting list controls and attending “delayed DAFNE” training 6 months later. Setting: Secondary care diabetes clinics in three English health districts. Participants: 169 adults with type 1 diabetes and moderate or poor glycaemic control. Main outcome measures: Glycated haemoglobin (HbA1c), severe hypoglycaemia, impact of diabetes on quality of life (ADDQoL). Results: At 6 months, HbA1c was significantly better in immediate DAFNE patients (mean 8.4%) than in delayed DAFNE patients (9.4%) (t=6.1, P Conclusion: Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk. This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation.