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 (HbA(1c)), severe hypoglycaemia, impact of diabetes on quality of life (ADDQoL). RESULTS: At 6 months, HbA(1c) was significantly better in immediate DAFNE patients (mean 8.4%) than in delayed DAFNE patients (9.4%) (t=6.1, P<0.0001). The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients (t=-5.4, P<0.0001), as was the impact of diabetes on overall quality of life (t=2.9, P<0.01). General wellbeing and treatment satisfaction were also significantly improved, but severe hypoglycaemia, weight, and lipids remained unchanged. Improvements in "present quality of life" did not reach significance at 6 months but were significant by 1 year. 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.
RCT Entities:
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 (HbA(1c)), severe hypoglycaemia, impact of diabetes on quality of life (ADDQoL). RESULTS: At 6 months, HbA(1c) was significantly better in immediate DAFNEpatients (mean 8.4%) than in delayed DAFNEpatients (9.4%) (t=6.1, P<0.0001). The impact of diabetes on dietary freedom was significantly improved in immediate DAFNEpatients compared with delayed DAFNEpatients (t=-5.4, P<0.0001), as was the impact of diabetes on overall quality of life (t=2.9, P<0.01). General wellbeing and treatment satisfaction were also significantly improved, but severe hypoglycaemia, weight, and lipids remained unchanged. Improvements in "present quality of life" did not reach significance at 6 months but were significant by 1 year. 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.
Authors: I Mühlhauser; V Jörgens; M Berger; W Graninger; W Gürtler; L Hornke; A Kunz; G Schernthaner; V Scholz; H E Voss Journal: Diabetologia Date: 1983-12 Impact factor: 10.122
Authors: I Mühlhauser; I Bruckner; M Berger; D Cheţa; V Jörgens; C Ionescu-Tîrgovişte; V Scholz; I Mincu Journal: Diabetologia Date: 1987-09 Impact factor: 10.122