What are the benefits of the DAFNE approach?
DAFNE has been proven to:
- Achieve more glucose checks in target without increasing the risk of severe hypoglycaemia.
- Reduce the negative impact of diabetes on a person’s quality of life in terms of anxiety, stress and time spent at the doctor’s or hospital appointments.
- Improve treatment satisfaction by enabling individuals to understand how to get the best results from their insulin therapy.
By attending DAFNE and optimising glucose (achieving target HbA1c), the incidence of developing the complications of diabetes can be reduced. DAFNE graduates are more confident and have a sound knowledge of their diabetes and feel better able to discuss their condition with health professionals. The DAFNE programme is well researched and is based on adult learning philosophies; ensuring participants have the best possible learning experience.
My glucose control is already quite good - do I need to do DAFNE?
Improving the number of glucose checks in target is only one of the benefits of DAFNE. Attending a DAFNE course has been shown to improve the negative impact that diabetes may have on an individual’s quality of life by reducing the anxiety and stress that can often be seen when managing a long-term condition day to day.
DAFNE may also give you more freedom to eat as you like, for example safely miss a meal or reduce your food intake if you want to, without risking a hypo. It can also provide new ideas for you to manage exercise, drinking alcohol and eating out without upsetting your glucose, as well as how to avoid serious problems like ketoacidosis (DKA) when you are unwell.
How is DAFNE different from what I already do?
DAFNE is different because the programme has been well researched and the results have shown the benefits of being precise with your insulin doses without restricting a flexible lifestyle. Clinical trials have shown the DAFNE course improves glucose, reduces hospital admissions and improves quality of life in terms of self-managing your diabetes.
Can I really eat what I want?
Yes, the choice is yours. You can learn how to adjust your insulin for any food choices you make. DAFNE enables people to choose what, when and how much they eat and to match their insulin accordingly. This includes choosing not to eat if you do not feel like it.
DAFNE also includes training to develop an understanding of why certain food choices might be more challenging in terms of managing glucose.
If I improve my glucose control won't I have more hypos?
The results of clinical trials from DAFNE in the UK and from the original courses in Germany show that severe hypos are less frequent. Individuals can aim for a target range HbA1c and day to day glucose in single figures without experiencing more hypos.
Mild, self-treated hypos can occur for anyone with type 1 diabetes; however the DAFNE hypo treatment recommendations are very effective at treating the hypo and getting the glucose back into the target range without the glucose going above the target range afterwards.
Will I put on weight?
Some people will lose weight and others may gain weight after DAFNE. The freedom of food choices will enable you to eat the same things as people who don’t have diabetes. Therefore, if you choose less healthy options or you choose to eat larger portions you are likely to gain weight. However, if you choose to eat more healthily and watch your portion sizes, the flexible insulin regimen can help you to lose weight by eating less and exercising more but without the added stress of worrying about hypos.
I am planning a pregnancy, can DAFNE help?
The importance of glucose staying within target before and during pregnancy will have been discussed with you by your diabetes team. The DAFNE programme enables you to get your glucose into target quickly because of the flexibility of
the insulin regimen. If you are thinking about having a baby, contact your diabetes team to discuss it further. You will need to be looked after by a specialist diabetes in pregnancy team. Some hospitals have a ‘fast track’ DAFNE referral route for women who are planning a pregnancy so they can ensure their glucose is as near to target as possible before they get pregnant.
What happens if I can't get time off work to attend the course?
Some employers allow people to have paid time off work to attend a DAFNE course and a letter of support is available to explain the benefits of the course to employers. Some people choose to arrange annual leave for the 5 days. The 5 x 1 DAFNE course provides the flexibility to attend the same 5-day course but over 5 weeks. This involves attending 1 day a week (usually on the same day each week) over 5 weeks rather than attending for 5 days over 1 week. The Remote DAFNE course provides further flexibility because it involves some online learning from home each week for 6 weeks, with a group video support call for half a day each week. You can find out which course options are available in your area by contacting your local diabetes centre.
Managing diabetes can already have a huge impact on an individual and it can affect people at work if glucose is not in target. DAFNE teaches new skills and gives people the confidence to manage their diabetes more effectively. This can help individuals to feel more in control of their glucose and often results in fewer hospital and doctor appointments. The improvements in glucose may reduce the risk of long-term complications and the lost working hours that can be attributed to this. For example, one individual had terrible problems with impaired hypo awareness before attending a DAFNE course. Despite being a fit and athletic individual, he had been in and out of A&E with severe hypos for at least a couple of years. As a result he missed a significant amount of time from work.
In the 12 months following his DAFNE course, he didn’t miss any work days and did not have any A&E attendances.
I've been adjusting my own insulin for years, so why should I do DAFNE?
Some people with type 1 diabetes have learnt over many years of trial and error how to adjust their insulin to match their food. DAFNE gives people the skills to take the guesswork out of insulin adjustment, enabling them to optimise their glucose while reducing the risks of having a severe hypo and improving their quality of life.
DAFNE builds skills and confidence quickly and individuals on the course feel safe to make quite radical changes to their insulin regimen. By focusing on their insulin requirements on a meal by meal basis, taking into account things like exercise, alcohol or eating out, unrestricted food choices can be made without worry. In addition to managing insulin doses for their food choices, DAFNE participants learn how to take the right amount of basal insulin for their individual needs and how to adjust their basal insulin for illness and exercise.
The added benefit of attending a DAFNE course is that you are part of a small group of individuals who have the same condition and purpose for attending the course. There is evidence to show that learning new skills or behaviours is more successful when done within small groups. DAFNE is delivered by trained educators who ensure there is a safe learning environment for adults with a focus on everyone learning from each other.
Why can't I do DAFNE myself, do I really need to attend a course?
DAFNE is a nationally recognised structured education programme, recommended by NICE (National Institute for Health and Care Excellence). It is delivered by trained healthcare professionals who not only have knowledge about type 1 diabetes, but also of adult learning principles which enhance learning within the group.
Experiential learning is a term used to describe “learning from doing” and it means that you can try new behaviours around food and insulin in the learning environment so that you gain confidence as well as knowledge. People on the DAFNE course can learn by sharing their own experiences (past and present) and the experiences of others in the group. These powerful benefits do not feature in online learning alone or one to one training.
It is the whole DAFNE package that has proved to be successful in clinical trials conducted here in the UK and in Europe. By delivering the course over 5 days, people are able to discuss how they are progressing and can learn and reflect on the new knowledge and skills they are developing. Individuals in the group learn from each other and can experiment with new ways of managing their insulin, knowing they are in a safe environment with trained educators.
I thought carbohydrate counting was an old approach?
Carbohydrate counting used to be an old approach. In the past it was used to control and regulate the amount of carbohydrate people with type 1 diabetes had in their diet. Individuals were told how much carbohydrate they could eat each day and varying the amount of carbohydrate specified was frowned upon because the insulin doses were fixed or set with no flexibility. The opposite approach is used in the DAFNE course.
In DAFNE, insulin doses are flexible and individualised therefore people can choose to eat when and what they like by varying the amount of insulin they use to match the amount of carbohydrate. This includes having no mealtime insulin if you choose not to eat, as long as your glucose is within your target range.
What if DAFNE is not for me?
We all have choices and making a choice about our health is important. The majority of people find the DAFNE insulin regimen is suitable for them; however some people may prefer not to take this option.
A few people who have attended a DAFNE course have chosen not to continue to use the DAFNE regimen afterwards. Nevertheless, they have found the course very useful because the skills they learned still help them to make sound decisions around insulin adjustment. Remember, whether you decide to attend DAFNE or not, you will still be offered the same support and treatment from your diabetes healthcare team.
Isn’t it dangerous to mess about with my insulin?
Not if you have been given the skills to do this. The DAFNE course is delivered over 5 days and participants practice insulin dose adjustment in a safe environment with trained educators. Dose adjustment takes place on each day of the course; participants are encouraged to experiment by having foods they wouldn’t usually eat, exercising (if they want to) and by eating out to see the effect on their glucose. Their choices / experiences are discussed with the group at the following session. On each day of the DAFNE course there are multiple opportunities to discuss dose adjustment based on participants’ own lifestyle choices, plus the experience gained from observing the choices made by other members of their group.
As a general rule many people will end up on smaller insulin doses than they were taking before attending DAFNE. This is usually because they have been taking more insulin than necessary on their previous insulin regimen. Even individuals who have had glucose above their target range can see their insulin doses reduce – it may simply be that their insulin was not balanced optimally.
I have type 2 diabetes, would DAFNE be suitable for me?
DAFNE was developed for people with type 1 diabetes and the research and evidence associated with its success is based on this. There is no evidence that the DAFNE intensive insulin programme is of benefit to people with type 2 diabetes.
There are a few individuals who have other types of diabetes who may benefit from attending a DAFNE programme. These individuals are carefully assessed by their diabetes team before being put forward for a DAFNE course.
There are other education programmes specifically designed for people with type 2 diabetes. Examples of these can be found at the DESMOND website and the
X-PERT health website.