Commissioners

Why should you commission structured patient education for your type 1 diabetes patients?

Approximately 600 people per 100,000 in the UK are estimated to have type 1 diabetes. The estimated NHS spend on type 1 diabetes was £1.8bn in 2012. Around 80% of this spend was due to avoidable complications of the disease.

Diabetes is the most common cause of end-stage kidney disease and the most common cause of preventable blindness in the UK. The rate of depression is twice as high in people with diabetes.

Commissioning DAFNE is proven to deliver:

• Cost savings of £93,133 per 100,000 population per year

DAFNE (dose adjustment for normal eating) is the leading structured patient education programme for adults with type I diabetes. Provided by a not-for-profit NHS supported consortium, it enables patients to self-manage their condition through a skills-based education programme.

DAFNE is a five-day course delivered in an outpatients setting by diabetes specialist dietitians and nurses that have been trained as DAFNE educators, supported by a DAFNE trained doctor. The DAFNE course can be delivered over five consecutive days (Monday – Friday) or one-day per week for five consecutive weeks.

People applying DAFNE principles learn to stabilise their blood glucose which reduces the risk of complications, improves quality of life for them and their families and reduces NHS costs.

Immediate savings arise from lower insulin doses; recurrent cost savings accrue from reduced ambulance callouts, reduced A&E attendances and reduced admissions; long term savings accrue due to fewer costly diabetes complications

The reliability, credibility, impact and effectiveness of DAFNE can be demonstrated by over 25 years of peer-reviewed, published research in both the UK and Europe. Details of the published research can be found here

“My bottom line in life is to function and DAFNE gives me that ability. For me, it is not a diabetic treatment, it is my life. I have control. Together DAFNE and I are delivering the best results in diabetes care I’ve experienced in my 25 years”. Jenny Mills-Thomas, Cambridgeshire

Read more patient stories

Patients are introduced to DAFNE through a five-day course delivered by your existing staff. The national DAFNE programme ‘trains the trainers’ and provides ongoing CPD, audit of outcomes and quality assurance. There is an annual contribution to support the central DAFNE office services. The cost to deliver DAFNE per patient is lower if more courses are delivered. Non-recurrent set-up costs include staff training and approx £330 for teaching aids and associated reusable resources. Cost per patient above staff time is approximately £60 per patient if 1 course is delivered per month.

If you have any questions please contact dafne@nhct.nhs.uk. Alternatively, you can review all of the research mentioned above plus more professional and user reviews on this site

Specialist diabetes services are not configured to support the delivery of group programmes within their existing traditional format of 1:1 formal clinics and informal reviews. Consequently, many teams struggle to introduce high-quality structured education as a core component of their type 1 diabetes service. There is a widely held belief that such education cannot be delivered without significant additional specialised staff resource.

Service redesign is the best way to support the delivery of DAFNE within existing diabetes teams. Healthcare professionals find themselves delivering the same 1:1 intervention repeatedly and often to the same individuals. Adult education theory helps us understand why the 1:1 method of information sharing is often ineffective. Delivering DAFNE to a group instead is time-efficient and effective.

Below, consultant physician (and DAFNE Chair) Helen Hopkinson, describes the evolution of a cross-site structured type 1 diabetes education programme (DAFNE) within Greater Glasgow and Clyde (GGC) without any increase in specialist diabetes staff resource.

In 2007 I received funding from the Scottish Diabetes Group (SDG) for DAFNE training for myself (a consultant physician), a dietitian and a diabetes specialist nurse, as well as two years of the annual DAFNE central contribution. Our DAFNE team of two reorganised our job plans, proposing that much of the 1:1 informal patient review that forms the backbone of traditional diabetes follow-up might not be an effective use of time. Anecdotally this was effective in all cases by reducing episodes of severe hypoglycaemia, DKA admissions and in most cases by a reduction in HbA1c, thereby reducing patients’ need for further 1:1 attention. DAFNE has worked most effectively for us by empowering the patients who have completed a DAFNE course (known as DAFNE graduates) to solve their own problems and encouraging the educators to facilitate self-management rather than indulging in parental instruction.

By 2009 I was receiving requests from colleagues and directly from patients at other hospital services who were desperate to get onto a DAFNE course. We had a waiting list of 80 people from my own hospital and it was one of the harder decisions I made not to agree to take on patients from other hospitals. Two consultant colleagues from other GGC hospitals decided to set up DAFNE teams, and with the support of the Diabetes MCN we established a DAFNE subgroup, and we became a single GGC DAFNE centre.

Without additional manpower resource, job redesign has enabled a sustainable programme of DAFNE course delivery. Now all seven acute sites have DAFNE teams delivering courses within GGC. We are united by the life-changing experience that is a person with type 1 diabetes telling you that ‘You have given me my life back’.

DAFNE is not simply a gold-standard package available to a proportion of our adults with type 1 diabetes; it offers a philosophy and a set of principles which provide a core of consistency underpinning everything we do from diagnosis in type 1 diabetes. DAFNE brings clarity to the type 1 diabetes treatment pathway and patient journey because all team members work to the same targets using the same language, and embrace the same self-management philosophy.