Background: The Dose Adjustment for Normal Eating (DAFNE) is a type 1 diabetes (T1D) group education program to enable self-management. Shown to improve outcomes in the UK, its application in Asian countries remains uncertain. We assessed the outcomes of Singapore (Sg)DAFNE, which remains the only Asian centre, from 2011-2018.
Methods: Prior to DAFNE entry, most had received one-on-one education from DAFNE educators. HbA1c, total daily dose (TDD) of insulin were retrieved at these timepoints: 1y before, at entry, 1y after, latest profile. Paired sample t-tests and Chi square tests were used; data is presented as means±SD.
Results: n=115 (33.9% male), age 28.3±8.5y, T1D duration 11.2± 8.4y, follow-up post-DAFNE 3.5 ±2.3y. n=104 completed 1y follow-up post-DAFNE. Mean HbA1c pre-DAFNE fell by entry into DAFNE: pre-vs.-entry: 8.5±1.68% (68 mmol/mol) vs. 7.9±1.4%, p<0.001. This fall was sustained 1y post-DAFNE and at latest follow-up (HbA1c 7.8±1.3%, 7.9±1.3%, all p<0.001). Proportion of those in HbA1c category ≤ 7.5% rose while the proportion in higher HbA1c categories fell post-DAFNE (Figure). TDD insulin fell alongside improvement in glycaemic control (pre-vs.-post-DAFNE: 45.5+14.9 vs. 42.5+12.0, p=0.02).
Conclusion: This demonstrates the effectiveness of SgDAFNE. Sustained improved glycaemic control was achieved with reduced insulin dosages, reinforcing that the quality of insulin use matters more than the quantity.
S. Tan: None. S. Rama Chandran: None. H. Lim: None. K. Adaikan: None. S. Goh: None. D. Gardner: None.