Triumph over adversity: Remote Dose Adjustment For Normal Eating (DAFNE). Is remote DAFNE an even more effective intervention for adults with type 1 diabetes than traditional face to face DAFNE education?

ABSTRACT

Aims: The lockdown and ongoing restrictions as a result of covid-19 halted DAFNE face to face (F2F) education, consequently remote DAFNE was developed and began in July 2020. It consists of a blended learning programme, combining online modules with weekly group video support calls facilitated by a trained Remote DAFNE educator. F2F DAFNE is known to decrease HbA1cs by 4-8 mmol/ mol, as well as reducing episodes of severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA) by 75-80%. As a quality assured programme, effectiveness, as measured by 12 month biochemical data, must be assessed. Methods: Using the national DAFNE audit database, records of the first 233/1434 remote DAFNE graduates with both baseline and 12 month data were examined 55% female, baseline mean±SD age 40.9±14.3, duration of diabetes 15.9±13.1 years. Results: At 1 year HbA1c fell by 3.6mmol/mol (63.4±14.5 to 59.8±12.1, p < 0.00001). In the year following Remote DAFNE, in these 233 participants the number of participants experiencing DKA or SH decreased from 10 and 11, down to 0 and 1 respectively, a reduction of 95%. The target HbA1c of ≤ 58mmol/mol was achieved by 40% of participants at baseline, and increased to 52% at 1 year. In the cohort whose baseline HbA1c was >58mmol/mol, HbA1c reduced by 7.2mmol/mol (71.9±12.3 to 64.7±11.9, p < 0.00001). Conclusions: Remote DAFNE delivers highly significant HbA1c improvements and reductions in SH and DKA episodes at least comparable to traditional F2F DAFNE. More NHS trusts should offer this clinically proven intervention to adults with type 1 diabetes.