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DAFNE – Dose Adjustment For Normal Eating
The DAFNE programme was first launched in Germany in the 1980’s by Michael Berger, a German diabetologist. This was a revolutionary approach to managing diabetes which consisted of allowing dietary freedom while adjusting insulin doses to control blood sugars. Notwithstanding initial scepticism, the programme has been trialled in the UK since the year 2000 and is the subject of ongoing research.
The DAFNE programme requires increased contact and education by a team of dieticians, nurses and doctors. Five day courses for small groups of eight people at a time, have been used to educate people to assess the content of their diet and adjust insulin doses accordingly.
· How your blood glucose concentrations react to insulin
· Carbohydrate content of a variety of foods
· How to interpret food labels on packaging
· How to adjust doses for exercise
Yes. The British Medical Journal of October 2002 published preliminary results which showed improved qualtiy of life and blood sugar control without an increase in the risk of severe hypoglycaemia.
Yes. The aim of this programme is to allow you complete freedom to choose what you want to eat. This does not mean that the recommendations for a healthy diet are any different in your case.
Yes. Since you take short acting insulin whenever you eat you may need as many as five injections a day. You would also need to monitor your blood sugars at least four times a day. DAFNE is based on two injections of long acting insulin each day plus injections of rapid acting insulin each time you eat.
At this time DAFNE is still very much a research initiative funded independently of the NHS. The costs are considerable given the number of staff involved. The costs of blood sugar testing are also high. The cost of education per participant in the programme is estimated to be in the region of £500. It is not known whether the funding will be made available to roll out the programme to the rest of the NHS.
Described benefits of this approach include
· Greater enjoyment of food
· Satisfaction with treatment
· Ability to cope better with flexible meal times and travel
· Improved blood sugar control
· Reduction in severe hypoglycaemia
· Improved quality of life
It is not known what the impact will be on complications of diabetes, though it has been postulated that better control will translate into reduced risk.
Not everyone is suitable for this programme. There are several criteria which need to be fulfilled; You should
· have had Type 1 diabetes for at least six months
· be prepared to test your blood sugars and inject insulin several time a day
· have the time to attend the five day course
· attend one of the diabetes centres which are currently participating in the research trial
The approach clearly demands a high degree of motivation of individuals with diabetes and their carers.
DAFNE involves attending a 5-day training course, 9am to 5pm Monday to Friday. The teaching programme is for groups of 6-8 people and covers topics including carbohydrate estimation, blood glucose monitoring, insulin regimens, hypos, illness and exercise.
During the course you would practice carbohydrate estimation and insulin adjustment under the supervision of DAFNE-trained nurses and dietitians. Most of the training is built around group work, which allows you to share and compare experiences with other people with Type 1 diabetes. There are also opportunities for each person to speak to a doctor, nurse or dietitian individually.
Diabetes UK and the Department of Health have contributed to the research fund.
Dr Nishan Wijenaike
West Suffolk Diabetes Service