Background: Structured education programmes for individuals with Type 1 diabetes have become a recognised means of delivering the knowledge and skills necessary for optimal self-management of the condition. The Dose Adjustment for Normal Eating (DAFNE) programme has been shown to improve biomedical (HbA 1c and rates of severe hypoglycaemia) and psychosocial outcomes for up to 12 months following course delivery. The optimal way to support DAFNE graduates and maintain the benefits of the programme has not been established. We aimed to compare 2 different methods of follow-up of DAFNE graduates in a pragmatic clinical trial delivered in busy diabetes clinics on the island of Ireland.

Aims: To examine predictors of quality of life gains among people with type 1 diabetes following DAFNE (Dose Adjustment for Normal Eating) self-management training programme.Methods: Clinical and questionnaire data were collected from 437 patients from 6 hospital centres before, and at 18 month post, DAFNE intervention. Glycated haemoglobin (HbA 1c ), weight and height, and blood pressure levels were recorded by clinicians during clinic appointments. Questionnaires included the Diabetes-Specific Quality of Life Scale (DSQOLS), the Problem Areas in Diabetes Scale (PAID) and the Hospital Anxiety and Depression Scale (HADS). Basic demographics were recorded at baseline. Linear mixed models were fitted to identify predictors of change in quality of life at 18 month follow up.Results: Those with high levels of diabetes-related distress experienced greatest improvement in DSQOLS quality of life scores (p=0.001). Those with poor glycaemic control (higher levels of HbA 1c ; p=0.03) and those with high levels of anxiety (p=0.001) experienced greatest reductions in diabetes-related distress.Conclusions: Those with higher baseline levels of anxiety, higher levels of diabetes-related distress and higher baseline levels of HbA 1c are most likely to experience quality of life gain from participation in self-management programmes like DAFNE.

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Overweight and obesity are common health risks, but it can be difficult to effect weight change. This randomized controlled trial examined the effects of a novel Cookery skills intervention on body mass index (BMI) in overweight and obese patients with cardiovascular disease, who had previously attended a cardiac rehabilitation programme. Patients with BMI >27 kg/m(2) were randomized to either a 5-week cookery skills course with written educational materials, or to written materials only. Questionnaires on lifestyle risk factors and food frequencies were administered at baseline, 6 and 24 months. The primary outcome in an intention-to-treat analysis was a change in BMI at 6 months. Secondary outcome was a change in BMI at 24 months. Changes in macronutrient consumption were examined in both analysis of covariance and repeated measures ANOVA models. Of the 172 patients, 116 (67.4%) patients consented to participate in the study. The intervention was found to be well accepted and attended by the patients (70.5% of patients in the intervention group attended the sessions). Whilst both intervention and control groups were noted to have a small reduction in BMI, there was no significant difference between the groups. There was no significant group effect noted for any change in macronutrient consumption at 6- or 24-month follow-up. This pilot study of a novel cookery skills project was well accepted amongst this population. Although the majority of participants had a net loss in BMI, the cookery skills intervention was not associated with any change in BMI beyond that achieved by written information alone.