19 Nov Setting: Secondary care diabetes clinics in three English
Participants were subsequently reviewed at six month intervals for the next two years (waves 3 to 6), with a final follow up (wave 7) at the age of 20 21, three years after the final school year in Victoria. In waves 1 to 6, participants self administered the questionnaire on laptop computers,13 and those absent from school were followed up by telephone. The seventh wave of data collection used computer assisted telephone interviews.
Guys are human, says Dickenson. Got a lot of trust in our guys, I really do. We have good leadership. 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, Pt=5.4, Pt=2.9, P: 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.What is already known on this topicCurrent treatment of type 1 diabetes fails to engage many patients in intensive self management and is associated with poor glycaemic outcomes and impaired quality of lifeAn approach to intensive insulin treatment in which participants match insulin dose to unrestricted food choices has been developed in GermanyThis approach has been shown to lead to sustained improvements in glycaemic control but has not been widely adopted elsewhereWhat this study addsTraining in flexible, intensive insulin treatment can improve glycaemic control in the United KingdomThis approach also leads to significant improvements in treatment satisfaction, psychological wellbeing, and quality of life measuresSelf management is essential to successful treatment of type 1 diabetes, yet few patients alter their insulin from day to day or achieve the degree of glycaemic control known to be ideal.1The diabetes control and complications trial showed the long term benefits of strict glycaemic control.2However pandora bracelets, the intensive approach used in the trial involved frequent outpatient visits with close supervision of insulin dose adjustment and has not been incorporated into general diabetes practice. The increased risk of severe hypoglycaemia in the diabetes control and complications trial may be unacceptable, and the staffing ratio of around three patients to each healthcare professional is beyond the scope of most healthcare systems.Other reasons why intensified treatment has not been widely adopted may exist.