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Dose Adjustment for Normal Eating: Longer Term Perspectives of Adults with Type 1 Diabetes

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DOI: 10.4236/jdm.2014.43026    2,325 Downloads   2,846 Views   Citations

ABSTRACT

Aim: To explore the longer term blood glucose self-monitoring outcomes and frequency of monitoring for outpatients with diabetes type 1 after completion of the Dose Adjustment for Normal Eating (DAFNE) course. The hypothesis was that DAFNE outcomes would differ according to frequency of glucose monitoring.Methods: A sequential data-triangulation design using existing baseline (T0) and 12-months (T12) DAFNE course data and interview data from 12 randomly selected participants who had completed the course two years ago. Results: Age range was 23 to 70 years with HbA1c 6.1% to 12.6% at T0 and 6.1% to 11.4% at T12. Comparisons of HbA1c, PAID, HAD subscales anxiety and depression, and covariate data between T0 and T12indicatedsignificant reductions in the mean depression and PAID scores (both P < 0.001) for the whole group. For the two groups who recorded their blood glucose less than three times or three or more times per day, changes were not significantly different. For both groups, the trend between T0 and T12 was downwards for change in mean blood glucose level and all survey scales. The proportion of all participants with T12 HbA1c at or below their T0 value was greater than 50% (Proportion = 69%, 95% CI: 56% - 79%) but only the highest HbA1c tertile group showed a significant difference (P = 0.003). There was an average decrease in the incidence of hypoglycaemic events of 0.6 overall: The greatest change was for the high HbA1c tertile with a mean decrease of 0.8. The interview data suggested that DAFNE graduates experimented more with food, exercise, and insulin; gained knowledge; learnt personal body needs; increased awareness of blood glucose level; gained confidence and improved their quality of life. Conclusions: There was insufficient evidence to conclude that frequency of blood glucose monitoring influenced metabolic control. However, people with type 1 diabetes who undertake the less restricted DAFNE approach to diabetes self-management can improve their quality of life and glycaemic control.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Rapley, P. , Axon, S. , Babel, G. , Creighton, K. , Kaye, J. and Brown, S. (2014) Dose Adjustment for Normal Eating: Longer Term Perspectives of Adults with Type 1 Diabetes. Journal of Diabetes Mellitus, 4, 179-188. doi: 10.4236/jdm.2014.43026.

References

[1] Anderson, R., Funnell, M., Butler, P., Arnold, M., Fitzgerald, J. and Feste, C. (1995) Patient Empowerment. Results of a Randomized Controlled Trial. Diabetes Care, 18, 943-949.
[2] Colagiuri, S., Brnabic, A., Gomez, M., Fitzgerald, B., Buckley, A. and Colagiuri, R. (2009) Diabco$t Australia Type 1: Assessing the Burden of Type 1 Diabetes in Australia. Diabetes Australia, Canberra, 1-27.
[3] Moss, S., Klein, R. and Klein, B. (1999) Risk Factors for Hospitalisation in People with Diabetes. Archives of Internal Medicine, 159, 2053-2057. http://dx.doi.org/10.1001/archinte.159.17.2053
[4] Rutten, G. (2005) Diabetes Patient Education: Time for a New Era. Diabetic Medicine, 22, 671-673. http://dx.doi.org/10.1111/j.1464-5491.2005.01497.x
[5] Krichbaum, K., Aarestad, V. and Buethe, M. (2003) Exploring the Connection between Self-Efficacy and Effective Diabetes Self-Management. The Diabetes Educator, 29, 653-662.
http://dx.doi.org/10.1177/014572170302900411
[6] Lowe, J., Linjawi, S., Mensch, M., James, K. and Attia, J. (2008) Flexible Eating and Flexible Insulin Dosing in Patients with Diabetes: Results of an Intensive Self-Management Course. Diabetes Research and Clinical Practice, 80, 439-443. http://dx.doi.org/10.1016/j.diabres.2008.02.003
[7] Glasgow, R. (1999) Outcomes of and for Diabetes Education Research. The Diabetes Educator, 25, 74-88. http://dx.doi.org/10.1177/014572179902500625
[8] Shearer, A., Bagust, A., Sanderson, D., Heller, S. and Roberts, S. (2004) Cost-Effectiveness of Flexible Intensive Insulin Management to Enable Dietary Freedom in People with Type 1 Diabetes in the UK. Diabetic Medicine: A Journal of the British Diabetic Association, 21, 460-467.
http://qelibresources.health.wa.gov.au/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=15089791&site=ehost-live&scope=site
[9] DAFNE Study Group (2002) Training in Flexible, Intensive Insulin Management to Enable Dietary Freedom in People with Type 1 Diabetes: Dose Adjustment for Normal Eating (DAFNE) Randomised Controlled Trial. British Medical Journal, 325, 746-751. http://dx.doi.org/10.1136/bmj.325.7367.746
[10] Speight, J., Amiel, S.A., Bradley, C., et al. (2010) Long-Term Biomedical and Psychosocial Outcomes Following DAFNE (Dose Adjustment for Normal Eating) Structured Education to Promote Intensive Insulin Therapy in Adults with Sub-Optimally Controlled Type 1 Diabetes. Diabetes Research and Clinical Practice, 89, 22-29. http://dx.doi.org/10.1016/j.diabres.2010.03.017
[11] Samann, A., Muhlhauser, I., Bender, R., Kloos, C. and Muller, U.A. (2005) Glycaemic Control and Severe Hypoglycaemia Following Training in Flexible, Intensive Insulin Therapy to Enable Dietary Freedom in People with Type 1 Diabetes: A Prospective Implementation Study. Diabetologia, 48, 1965-1970. http://dx.doi.org/10.1007/s00125-005-1905-1
[12] Speight, J., Conn, J., Dunning, T. and Skinner, T.C. (2012) Diabetes Australia Position Statement. A New Language for Diabetes: Improving Communications with and about People with Diabetes. Diabetes Research and Clinical Practice, 97, 425-431.
http://dx.doi.org/10.1016/j.diabres.2012.03.015
[13] Siminerio, L., Piatt, G. and Zgibor, J. (2005) Implementing the Chronic Care Model for Improvements in Diabetes Care and Education in a Rural Primary Care Practice. The Diabetes Educator, 31, 225-234. http://dx.doi.org/10.1177/0145721705275325
[14] Welch, G., Rose, G. and Ernst, D. (2006) Motivational Interviewing and Diabetes: What Is It, How Is It Used, and Does It Work? Diabetes Spectrum, 19, 5-11. http://dx.doi.org/10.2337/diaspect.19.1.5
[15] Bandura, A. (1997) Self-Efficacy: The Exercise of Control. W. H. Freeman and Company, New York.
[16] Bandura, A. (2004) Health Promotion by Social Cognitive Means. Health Education & Behavior, 31, 143-164. http://dx.doi.org/10.1177/1090198104263660
[17] Montgomery, B. (2008) Helping People Live with Diabetes: The Keys to Successful Behaviour Change. Australian Diabetes Educator, 11, 11-12, 14.
[18] Shannon, B., Bagby, R., Wang, M.Q. and Trenker, L. (1990) Self-Efficacy: A Contributor to the Explanation of Eating Behavior. Health Education Research, 5, 395-407.
http://dx.doi.org/10.1093/her/5.4.395
[19] Skinner, T. (2006) What Does Make the Difference? Diabetic Medicine, 23, 933-934.
http://dx.doi.org/10.1111/j.1464-5491.2006.01908.x
[20] Miller, K., Beck, R., Bergenstal, R., Goland, R.S., Haller, M.J., McGill, J.B., et al. (2013) Evidence of a Strong Association between Frequency of Self-Monitoring of Blood Glucose and Hemoglobin A1c Levels in T1d Exchange Clinic Registry Participants. Diabetes Care, 36, 2009-2014.
http://dx.doi.org/10.2337/dc12-1770
[21] Piette, J. and Glasgow, R. (2001) Education and Home Glucose Monitoring. In: Gerstein, H. and Haynes, R., Eds., Evidence Based Diabetes Care, BC Decker, Hamilton/London, 207-251.
[22] Kolb, H., Kempf, K., Martin, S., Stumvoll, M. and Landgraf, R. (2010) On What Evidence-Base Do We Recommend Self-Monitoring of Blood Glucose? Diabetes Research and Clinical Practice, 87, 150-156. http://www.sciencedirect.com/science/article/B6T5Y-4XR5W11-2/2/f99583b836338a09eae4aa9969020e38 http://dx.doi.org/10.1016/j.diabres.2009.10.014
[23] Ingadottir, B. and Halldorsdottir, S. (2008) To Discipline a “Dog”: The Essential Structure of Mastering Diabetes. Qualitative Health Research, 18, 606-619. http://dx.doi.org/10.1177/1049732308316346
[24] Fisher, E.B., Thorpe, C.T., DeVellis, B.M. and DeVellis, R.F. (2007) Healthy Coping, Negative Emotions, and Diabetes Management. The Diabetes Educator, 33, 1080-1103.
http://dx.doi.org/10.1177/0145721707309808
[25] Hopkins, D., Lawrence, I., Mansell, P., Thompson, G., Amiel, S. and Heller, S. (2008) DAFNE (Dose Adjustment for Normal Eating) Training Delivered in Routine Clinical Practice Is Associated with Significant Improvements in Measure of Quality of Life and Psychological Distress. Diabetic Medicine, 25, 16.
[26] Keen, A., Duncan, E., McKillop-Smith, A., Evans, N. and Gold, A. (2012) Dose Adjustment for Normal Eating (DAFNE) in Routine Clinical Practice: Who Benefit? Diabetic Medicine, 29, 670-676.
http://dx.doi.org/10.1111/j.1464-5491.2011.03479.x
[27] McIntyre, D. (2006) DAFNE (Dose Adjustment for Normal Eating): Structured Education in Insulin Replacement Therapy for Type 1 Diabetes. Medical Journal of Australia, 184, 317-318.
[28] Evans, J.M.M., Newton, R.W., Ruta, D.A., MacDonald, T.M., Stevenson, R.J. and Morris, A.D. (1999) Frequency of Blood Glucose Monitoring in Relation to Glycaemic Control: Observational Study with Diabetes Database. British Medical Journal, 319, 83-86. http://dx.doi.org/10.1136/bmj.319.7202.83
[29] Zigmond, A. and Snaith, R. (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361-370. http://dx.doi.org/10.1111/j.1600-0447.1983.tb09716.x
[30] Polonsky, W., Anderson, B., Lohrer, P., Welch, G., Jacobson, A.M., Aponte, J.E. and Schwartz, C.E. (1995) Assessment of Diabetes-Related Distress. Diabetes Care, 18, 754-760.
http://dx.doi.org/10.2337/diacare.18.6.754
[31] R Core Team (2013) R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, 2238.
[32] Faul, F., Erdfelder, E., Lang, A.G. and Buchner, A. (2007) G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences. Behavior Research Methods, 39, 175-191. http://dx.doi.org/10.3758/BF03193146
[33] Welch, G., Weinger, K., Anderson, B. and Polonsky, W. (2003) Responsiveness of the Problem Areas in Diabetes (PAID) Questionnaire. Diabetic Medicine, 20, 69-72.
http://dx.doi.org/10.1046/j.1464-5491.2003.00832.x
[34] Oliver, L., Thompson, G. and on Behalf of the DAFNE Programme (2009) The DAFNE Collaborative. Experiences of Developing a Nationally Delivered Evidence-Based, Quality-Assured Programme for People with Type 1 Diabetes. Practical Diabetes International, 26, 371-377. http://dx.doi.org/10.1002/pdi.1424
[35] Papanas, N. and Maltezos, E. (2008) Education for Dietary Freedom in Type 1 Diabetes? Yes, It’s Possible. The Diabetes Educator, 34, 54-58. http://dx.doi.org/10.1177/0145721707312464
[36] Egede, L.E. and Ellis, C. (2010) Diabetes and Depression: Global Perspectives. Diabetes Research and Clinical Practice, 87, 302-312. http://dx.doi.org/10.1016/j.diabres.2010.01.024
[37] Grigsby, A.B., Anderson, R.J., Freedland, K.E., Clouse, R.E. and Lustman, P.J. (2002) Prevalence of Anxiety in Adults with Diabetes: A Systematic Review. Journal of Psychosomatic Research, 53, 1053-1060. http://dx.doi.org/10.1016/S0022-3999(02)00417-8
[38] Lloyd, C., Dyert, P. and Barnett, A. (2002) Prevalence of Symptoms of Depression and Anxiety in a Diabetes Clinic Population. Diabetic Medicine, 17, 198-202.
http://dx.doi.org/10.1046/j.1464-5491.2000.00260.x
[39] Goldney, R., Phillips, P., Fisher, L. and Wilson, D. (2004) Diabetes, Depression, and Quality of Life. Diabetes Care, 27, 1066-1070. http://dx.doi.org/10.2337/diacare.27.5.1066
[40] Barnard, K., Skinner, T. and Peveler, R. (2006) The Prevalence of Co-Morbid Depression in Adults with Type 1 Diabetes: Systematic Literature Review. Diabetic Medicine, 23, 445-448.
http://dx.doi.org/10.1111/j.1464-5491.2006.01814.x
[41] Shaban, M.C., Fosbury, J., Kerr, D. and Cavan, D.A. (2006) The Prevalence of Depression and Anxiety in Adults with Type 1 Diabetes. Diabetic Medicine, 23, 1381-1384. http://dx.doi.org/10.1111/j.1464-5491.2006.02012.x
[42] Smith, C.B., Choudhary, P., Pernet, A., Hopkins, D. and Amiel, S.A. (2009) Hypoglycemia Unawareness Is Associated with Reduced Adherence to Therapeutic Decisions in Patients with Type 1 Diabetes: Evidence from a Clinical Audit. Diabetes Care, 32, 1196-1198. http://dx.doi.org/10.2337/dc08-2259

  
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