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

Heller, Simon; Lawton, Julia; Amiel, Stephanie A.; Cooke, Debbie; Mansell, Peter; Brennan, Alan; Elliott, Jackie; Boote, Jonathan; Emery, Celia; Baird, Wendy; Basarir, Hasan; Beveridge, Susan; Bond, Rod; Campbell, Mike; Chater, Tim; Choudhary, Pratik; Clark, Marie; Zoysa, Nicole de; Dixon, Simon; Gianfrancesco, Carla; Hopkins, David; Jacques, Richard; Kruger, Jen; Moore, Susan; Oliver, Lindsay; Peasgood, Tessa; Rankin, David; Roberts, Sue; Rogers, Helen; Taylor, Carolin; Thokala, Praveen; Thompson, Gill; Ward, Candice

doi:10.3310/pgfar02050

Cited by 41 publications

(91 citation statements)

References 179 publications

(270 reference statements)

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“…27 The 5-day structure of the standard adult DAFNE course was maintained while incorporating the additional skills and learning outcomes that were considered necessary to use pumps successfully. The principles of insulin dose adjustment taught on the standard adult course were maintained.…”

Section: Dose Adjustment For Normal Eating With Pumpmentioning

confidence: 99%

“…The Model has been developed and used over several years, and a detailed description is provided in a journal article 108 and a detailed report to the NIHR on the DAFNE programme grant research. 27 In this analysis, we have updated some aspects of the evidence used within the Model. We term the version used here as 'The Sheffield Type 1 Diabetes Policy Model version 1.3'.…”

Section: The Sheffield Type 1 Diabetes Policy Model Overviewmentioning

confidence: 99%

“…For each microvascular complication (retinopathy, neuropathy and nephropathy), individuals progress to the more severe health states within each annual time cycle according to the probabilities reported in table 29 of Heller et al 27 The health states included for retinopathy include no retinopathy, background retinopathy, proliferative retinopathy and blindness. The health states included for neuropathy include no neuropathy, clinical neuropathy, clinically confirmed neuropathy, diabetic foot syndrome and peripheral arterial disease (PAD) with amputation.…”

Section: Microvascular Events and Disease Progressionmentioning

confidence: 99%

“…As part of our recent work funded by a NIHR programme grant (PGfAR), 27 15 DAFNE graduates were recruited to act as a 'user group' and contribute to different aspects of the work. We invited two members METHODS NIHR Journals Library www.journalslibrary.nihr.ac.uk to join both the steering group and other investigator meetings.…”

Section: Patient and Public Involvementmentioning

confidence: 99%

“…During recent work funded by a National Institute for Health Research (NIHR) programme grant [Programme Grants for Applied Research (PGfAR)] we measured cost-effectiveness and identified which components of the course are crucial, as well as identifying the factors determining which DAFNE patients managed their diabetes more effectively. 27 This work included funding to pilot a combined DAFNE and pump course, which enabled us to develop a pump curriculum and associated pump-specific resources, ensure that the outcome measures that we wanted to use were feasible and estimate the likely recruitment and retention rates.…”

Section: Rationale For the Trialmentioning

confidence: 99%

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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

Heller

White

Lee

et al. 2017

Health Technol Assess

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This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 08/107/01. The contractual start date was in June 2011. The draft report began editorial review in March 2016 and was accepted for publication in July 2016. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. Published by the NIH...

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Section: Dose Adjustment For Normal Eating With Pumpmentioning

confidence: 99%

Section: The Sheffield Type 1 Diabetes Policy Model Overviewmentioning

confidence: 99%

Section: Microvascular Events and Disease Progressionmentioning

confidence: 99%

Section: Patient and Public Involvementmentioning

confidence: 99%

Section: Rationale For the Trialmentioning

confidence: 99%

See 3 more Smart Citations

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

Heller

White

Lee

et al. 2017

Health Technol Assess

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Psychological Factors and Diabetes Mellitus

Pouwer

Speight

2016

Textbook of Diabetes

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Type 1 diabetes: dietary modification over 100 years since insulin

Dyson

2021

Practical Diabetes

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Diet has been central for the management of type 1 diabetes for over three thousand years, and the discovery of insulin in 1921 was associated with the introduction of formal dietary education. Carbohydrate was soon identified as the macronutrient responsible for postprandial glucose excursions and over the past one hundred years, dietary interventions have alternated between severe carbohydrate restriction and so‐called free diets. The very low carbohydrate diets of the 1920s gave way to the free diets of the 1930s, and carbohydrate restriction was then reintroduced in the 1940s to the 1960s. In the 1970s, carbohydrate intake was increased with an emphasis on dietary fibre and low fat, healthy eating was recommended in the 1980s. The past few decades have reflected the growing evidence following the DCCT and DAFNE trials and dietary interventions are now individualised and emphasise carbohydrate counting and insulin adjustment and quality of life. Copyright © 2021 John Wiley & Sons.

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Cited by 41 publications

References 179 publications

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

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

Psychological Factors and Diabetes Mellitus

Type 1 diabetes: dietary modification over 100 years since insulin

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