This approach has been developed in Germany, but has not been widely adopted elsewhere. Patients in the UK often have impaired quality of life and a high risk of diabetic complications. Researchers in Sheffield, London and North Tyneside set out to test this approach in the UK with the dose adjustment for normal eating (DAFNE) trial.
They identified 169 adults with type 1 diabetes attending hospital clinics in Sheffield, Northumbria, and London. Patients either attended a five day training course, or continued to receive usual care for six months as controls and then attend a course.
The course trained patients to adjust their insulin doses to match their food choices, rather than being expected to sacrifice dietary preferences to fit in with prescribed insulin doses. Participants in DAFNE had improved glycaemic control and, despite intensified insulin treatment, reported greater satisfaction with treatment, general wellbeing, and quality of life.
The personal importance of these improvements are illustrated by patient's comments. One said, "I now feel able to travel abroad without worry about not eating or eating on time." Another said, "I have found my whole lifestyle and outlook on life has improved."
Skills training enables patients to fit diabetes into their lives rather than their lives into diabetes, and can be applied successfully across different healthcare systems, say the authors. This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation, they conclude.