Group follow-up compared to individual clinic visits after structured education for type 1 diabetes: A cluster randomised controlled trial

Abstract

Our data suggest that group follow-up as the sole means of follow-up after structured education for individuals with type 1 diabetes is as effective as a return to one-to-one clinic visits.

Improving management of type 1 diabetes in the UK: the Dose Adjustment For Normal Eating (DAFNE) programme as a research test-bed. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes

“…It is noteworthy that another recent trial of the DAFNE intervention has also failed to show much improvement in HbA 1c levels. 85 We also assessed psychosocial outcomes, which reinforce the findings of other DAFNE studies 12,14,74,85 in demonstrating marked improvements across a range of measures at 6 months and maintenance at 12 months, with no differences between participants in the two different arms.…”

“…Our findings also offer insights into what this continuing support should comprise. Despite growing interest in the use of group-based follow-up support to promote self-management of diabetes and other chronic conditions, our results, alongside those of others, 85,86 raise questions and concerns about promoting group-based support in routine clinical practice, particularly if this type of support is offered in isolation from other inputs and interventions. This is because a group-based approach may be incompatible with type 1 diabetes patients' need for individualised input from health professionals post course.…”

Predictors of quality of life gains among people with type 1 diabetes participating in the Dose Adjustment for Normal Eating (DAFNE) structured education programme

“…In the Irish DAFNE Study 10 , we showed improvements in (1) perceived burden of diabetes (measured by PAID) and (2) both the total quality of life and treatment satisfaction scores on the DSQOLS among a cohort of 437 DAFNE graduates, at 18 month follow up post participation in the DAFNE intervention. From baseline to 18 month follow up, PAID scores decreased on average by 9.13 percentage points, where lower scores indicated lower levels of distress (95% CI -10.63 to -7.64, p<0.001).…”

A cluster randomised trial, cost-effectiveness analysis and psychosocial evaluation of insulin pump therapy compared with multiple injections during flexible intensive insulin therapy for type 1 diabetes: the REPOSE Trial

“…81 They carried out a large randomised trial of group follow-up compared with individual clinic visits for patients who had understands how to use it and is physically able to use the system and l agrees to use the system while having a structured education programme on diet and lifestyle, and counselling.…”