Q&A with Professor Simon Heller, the co-founder of DAFNE

DAFNE (Dose Adjustment For Normal Eating) is an education course for those living with Type 1 diabetes. You learn how to estimate the carbohydrates in each meal and inject the right dose of insulin, so you can fit diabetes into your own lifestyle.

We funded the first trial of DAFNE in 1998 and following the publication of results in 2002, DAFNE has gone on to help over 40,000 people with Type 1 diabetes get to grips with their diabetes management and blood glucose control.

But we know that for some the benefits of DAFNE can drop off over time, so Professor Simon Heller is working to take DAFNE up a gear. DAFNEplus hopes to help people maintain improvements over the long term and ensure graduates aren’t cut off from support once the course ends.

What prompted you to look into improving DAFNE?

DAFNE does make a big difference to people’s lives – it’s transformational and gives you the skills to manage your Type 1 diabetes. But the results show that DAFNE on its own for five days isn’t enough for many.

When we looked into what people thought of the course, we found some parts haven’t been as effective as they could be. Blood glucose targets were sometimes forgotten and people weren’t keeping up key self-management behaviours – like record keeping and insulin adjustments.

We also heard that people wanted access to structured professional support, but felt like they couldn’t make contact.

So, what is DAFNEplus?

DAFNEplus is bringing together DAFNE graduates, psychologists, and diabetes teams to develop a more effective course. We’re trying to harness a better understanding of behaviour and incorporate those theories to help people change their diabetes self-management behaviour.

We’ll also address numeracy around calculating insulin doses and consistently meeting glucose targets. And deliver the course over a five-week period, rather than five days in a row.

We want to provide structured follow-up support by revisiting motivation and knowledge, and identifying and contacting those who may be struggling. DAFNEplus also incorporates new technology, which is transforming Type 1 diabetes management.

If we can combine this into the original DAFNE concept then we can help people to achieve targets which are safer for them in the long term, but without damaging the quality of life benefits that we have seen.

Can you tell us more about the research behind DAFNEplus?

The research we have been doing is applied research, it’s not discovering a cure. It’s saying ‘can we develop a complex intervention which has different elements?’. We’re looking at education, technology, the theory of behaviour change and whether we can incorporate this into a teaching programme. We’re also looking at the benefits it can have on people, for example, quality of life and blood glucose goals.

How is DAFNEplus using new technology?

Technology doesn’t take diabetes away but it can make it easier. We’ll be using new technologies in a number of ways including:

• Automated diaries
• Pattern recognition
• Aids for carb counting and dose adjustment
• Online educational modules and skill based exercises
• Remote monitoring for professionals
• Prioritisation of individuals
• Flexible working

What’s been the progress of the DAFNEplus trial so far?

It’s a randomised controlled trial which is taking place in 13 DAFNE centres, and we have a total of 660 participants involved.

At the moment DAFNEplus is just a trial which is ongoing and we may find that DAFNEplus is not any better. When you’re a researcher, things don’t always work. But if it doesn’t work I won’t stop there. With the extra work we are doing that measures how people are responding, we can see what works best and then tweak or change it. It can be frustrating and it takes time, but it’s robust science.

It’s the most rewarding research in some ways – we’re able to see a change in practice and care across the country and have a direct impact on the lives of people with Type 1 diabetes.

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