Dose adjustment for normal eating (DAFNE) is a structured education programme for adults with type 1 diabetes for insulin adjustment on a meal-by-meal basis. It is based on carbohydrate estimation and is suitable for patients who can read or speak English.
DAFNE is delivered by specially trained educators (diabetes specialist nurses and diabetes specialist dietitians) to groups of 6–8 adults with type 1 diabetes over 5 consecutive days on an outpatient basis.
There is good evidence for the efficacy of DAFNE and it has been assessed as cost-effective by NICE. Further evidence is now provided that these benefits can be realised in large-scale practice from an updated case study by the Quality, Innovation, Productivity and Prevention (QIPP) Programme.
These are estimated at £48m nationally in England, or £93,133 per 100,000 population. Savings were realised through reduction in expenditure and improved productivity in healthcare delivery. Implementation costs were low, around £15,000 over three years per diabetic service.
Evidence of effectiveness
Evidence was found for improved HbA1c, reduced hypoglycaemia, reduced anxiety and improved quality of life. Further cost-effectiveness modelling has estimated that DAFNE improves quality of life whilst reducing costs.
Details of implementation
DAFNE was rolled out a total of 75 diabetes services in the UK and Ireland since 2004. 3,752 courses have been delivered, involving 25,062 people with type 1 diabetes.
Important barriers to implementation include the need for changes to team working practices and local care pathways
- Evidence of quality outcomes was from retrospective outcomes data. It does not include a comparison group. However, it is consistent with previous experimental evidence.
- Audit revealed that observed benefits were higher than anticipated. This may have been because non-compliant patients did not take part.
- This Case Study was assessed by NICE as scoring highly on all four of its domains: savings, quality, evidence and implementability.
- The It would be useful to include patient feedback in this evaluation.
Department of Health. Improving the quality of care for patients with type 1 diabetes: dose adjustment for normal eating (DAFNE). QIPP, Updated January 2013.