Many adults with type 1 diabetes struggle to manage their diabetes effectively because the limitations of current insulin therapy demand considerable input from patients themselves. To keep glucose at near-normal levels requires individuals to measure blood glucose frequently, and then calculate the correct insulin dose before every meal based on estimating carbohydrate intake. Patients who lack these skills have an increased risk of premature death and complications because their blood glucose runs high.

These concerns prompted Professor Simon Heller, and colleagues, to conduct the Dose Adjustment For Normal Eating (DAFNE) trial in 2002, which showed that structured training could help adults to self-manage their diabetes more successfully. Over 20,000 people have been trained and the Department of Health now advocates structured education for all individuals with diabetes.

However, although DAFNE training improves quality of life in nearly all participants (and also reduces the risk of severe hypoglycaemic episodes), subsequent blood glucose control is not always improved. The group therefore obtained NIHR Programme Grant funding to undertake a series of studies investigating why some patients benefit more than others and identified barriers with the aim of developing more effective training programmes. They found that, although courses could be delivered successfully over different time periods, participants found it difficult to make self-management part of their everyday lives and skills were not maintained; DAFNE graduates often needed continued and structured professional support. Courses were also developed to teach insulin pump therapy and to help people with continued problems with hypoglycaemia.

Professor Heller says: “NIHR funding has been vital to us in undertaking research which helps us to understand why individuals with type 1 diabetes find it so difficult to keep blood glucose levels close to normal. We intend to build on this work and improve DAFNE training programmes to equip patients for a lifetime of successful self-management.”

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