The provision of the DAFNE (Dose Adjustment For
Normal Eating) structured education course is increasingly suggested for the
management of type 1 diabetes. An assessment of HbA1c over a 7 year period is
summarised
“Abstract
Aims The
provision of structured education is increasingly prevalent in the management
of Type 1 diabetes. There are little long-term follow-up data from such
programmes. We have assessed HbA1c and weight over
a 7-year period following the Dose Adjustment For Normal Eating (DAFNE)
structured education course.
Methods We obtained annual HbA1c and weight data
in 111 patients who attended the initial series of DAFNE courses in our centre
from June 2002 to end 2003 and in a matched group of 111 patients with Type 1
diabetes of similar age and duration of diabetes seen over the same period who
had not undergone structured education.
Results With DAFNE structured education, the mean (± sd) HbA1c fell from 71 ± 12 mmol/mol
(8.6 ± 1.1%) at baseline to 65 ± 12 mmol/mol (8.1 ± 1.1%) at year 1, with
a subsequent rise to 67 ± 13 mmol/mol (8.3 ± 1.2%) at year 7 (P = 0.0048 vs. baseline). In the comparator group, the
baseline HbA1c level was 70 ± 14 mmol/mol (8.5 ± 1.3%) and
remained approximately constant during 7 years of follow-up. Weight increased
by 2.4 ± 6.0 and 2.8 ± 6.6 kg in the DAFNE and comparator group, respectively,
during follow-up (not significant).
Conclusions DAFNE structured education is associated with an improvement in
glycaemic control at 1 year, and there remains a persistent and clinically relevant reduction in HbA1c of 3 mmol/mol (0.3%) after 7 years. The
improvement in glycaemic control after DAFNE is achieved without excess weight
gain.” [My italics]
So with the best educational provision currently available over a
7 year period a reduction in HbA1c of 0.3% to an average of 8.3% was achieved and thought to be
clinically relevant! The tragedy of accepting average HbA1c in the region of 8.3% is illustrated in the post:
I don't expect any long term studies of DAFNE + LOW-CARB will ever be considered, but we all know of Type 1s who low-carb and maintain HbA1c below 6.5% and some individuals below 5%.
John
7 comments:
10 year old stats! Can't you do better than that?
One of the complications of poor blood glucose control is retinopathy which may account for your inability to read and or simple arithmetic. You seem to be one of Carbo’s acolytes, why not take his advice and have a visit to the optician.
The project was initiated in 2003/2003 and the data collected for 7 years. Now please read slowly because this is also going to involve some arithmetic:
2003 +7 = 2010.
It normally takes an academic paper at least a year to go through the peer review process. Again, please read slowly because this is also going to involve some arithmetic:
2010 + 1 = 2011
If an academic paper is accepted for publication, there is normally a queuing time of a year waiting for actual publication. Again, please read slowly because this is also going to involve some arithmetic:
2011 + 1 = 2012
Publication date 2012
"Over the years I have often wondered and asked the question “what motivates a lowcarb anti” recently I stated they were nutters. I have amended that opinion to they are thick nutters."
He was right.
The problem with DAFNE is the 'Normal Eating' bit - until diabetics learn that 'normal eating' is not 'normal' then progress won't be made.
'Normal eating' of course means 50% energy from carbs, which is, of course, nonsense. As a Type 1 I can say it is virtually impossible to keep low blood sugars at that sort of level; you will constantly be going from hypo to hyper chasing the glucose peeks and troughs.
The only way to manage diabetes of any kind is to limit your carb intake.
An HbA1c in the 8's is shocking and a hopeless failure of control.
To misquote an old Democrat war cry; 'it's the carbs, stupid'.
Best
Dillinger
Breaking News:
An outbreak of Foot in Mouth disease has been confirmed in the sheep at carbos Funny Farm.
A Defra spokesman said:
Action will be taken to confine the outbreak, due to the severity of the disease a cull may be required. A further update will be issued as soon as the situation has been assessed.
"The only way to manage diabetes of any kind is to limit your carb intake."
Absolutely correct, as I have discovered in recent months.
Sal
Found this an interesting article, thanks.
We still have a long, long way to go. For many, perhaps most, carbs are addictive and until the habit can be broken the numbers of diabetics having far too high BG numbers are not going to improve. NICE guidelines of 7.5 is way too high, good figures should surely be nearer 5.5.
DAFNE needs a overhaul, the so called educators need better educating. A vicious circle, which is ever increasing and not improving.
As others have said we need to keep spreading the word lower the carb intake PLEASE and see the effect it can have in such a short space of time.
CHANGE your lifestyle - I dare you if you haven't done so already.
Joe
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