Aims: To determine the impact of the structured type 1 diabetes education program Dose Adjustment For Normal Eating (OzDAFNE) delivered in routine practice in Australia.
Methods: Baseline data were recorded for 1428 OzDAFNE participants (1 April 2007 to 28 February 2012; excluding data previously reported1 and allowing for 12m follow-up by March 2013). Participants were eligible for inclusion if HbA1c was available at both baseline and 12m follow-up. Data analysed included: HbA1c, BMI, severe hypoglycaemia (SH; percent reporting at least one event requiring assistance) and diabetes ketoacidosis (DKA; percent resulting in hospital admission) in the past 12m, diabetes-related distress (PAID). Data are mean±SD or %(n).
Results: Compared with included participants (N=506; 35.4%), those who were ineligible (N=1277) were younger (46.7±13.9 years vs 41.2±14.3 years, p<0.001), and at baseline had higher HbA1c levels (8.1±1.2% vs 8.3±1.5%, p<0.001), and greater diabetes-related distress (30.3±18.8 vs 32.8±20.4, p<0.025).
Among the 506 included participants, baseline vs 12m comparisons revealed improvements in: HbA1c (8.10±1.2% vs 8.0±1.1%, p=0.01); BMI (26.9±4.7 vs 26.5±4.4, p=0.003); SH (24.7% (n=123) vs 12.1% (n=59)); DKA (4.1% (n=20) vs 1.2% (n=6)); and diabetes-related distress (PAID score 30.3±18.8 vs 20.2±16.0, p<0.001). HbA1c improvement was greatest among those in the highest quartile at baseline (N=122, 9.7±1.1% vs 9.0±1.2%, p<0.001).
Conclusions: OzDAFNE training offered clinically relevant benefits for many: SH events and DKA requiring hospital admission were halved, HbA1c was reduced by 0.7% among those with highest baseline levels, and diabetes-related distress was reduced significantly. These findings suggest OzDAFNE training can be offered to benefit those with greatest clinical need. Cost-effectiveness analyses are now needed. The large ineligible group highlights the ongoing challenge of collecting high quality data in routine care with limited systemic resources.