Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2014

Structured type 1 diabetes education delivered in routine care reduces diabetes-related emergencies and emotional distress: results from OzDAFNE (#76)

Elizabeth Holmes-Truscott 1 2 , Christel Hendrieckx 1 2 , Dianne Harvey 3 , Virginia Hagger 3 , Susan Harris 3 , Brigid Knight 4 , David H McIntyre 4 5 , Jane Speight 1 6
  1. The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia - Vic, Melbourne, VIC, Australia
  2. School of Psychology, Deakin University, Burwood, Vic, Australia
  3. Diabetes Australia - Victoria, Melbourne, Vic, Australia
  4. Queensland Diabetes Centre, Mater Health Services, Brisbane, QLD, Australia
  5. Mater Clinical School, University of Queensland, Brisbane, QLD, Australia
  6. Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, VIC, Australia

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.

  1. McIntyre HD et al. MJA 2010; 192: 637-640.