DAFNE Collaborative 2012

(disclaimer: this report has been proof read by HCP's so is slightly more 'technical' than I would have written in places )

Once again the DAFNEOnline team was present at the DAFNE Collaborative to bring you all the news and views of what is going on in the DAFNE Programme. For those that don’t know what it is, the DAFNE Collaborative is the annual event at which representatives of all DAFNE Centres, the DAFNE Executive, the DAFNE Programme team and the DAFNE User Action Group (DUAG) gather to receive presentations and attend workshops related to what is happening in the DAFNE Programme. The last of the groups mentioned in that list the DUAG is the user representative body on the DAFNE programme.

So what happened this year ? Well the day ‘kicked off’ with a presentation about ‘KICk -OFF’ ( pun intended !). This is a programme that I know will be of great interest to some since it is the juvenile equivalent of DAFNE for 11-16 year olds. At this stage it is still in the trial stage and is scheduled to report results in Spring 2013. Presuming that the results do show sufficient benefits to enable it to be rolled out there are still some challenges to be overcome. However things do look positive and a programme of this kind would provide major benefits to many. Of course it is slightly different to the adult DAFNE Course, mainly because teaching/engaging teenagers is obviously not the same as teaching a group of adults and their approach to their diabetes is different. However listening to some of the quotes given by those that took part in the pilot courses, there is a distinct feeling of déjà vu. One example “I liked watching everyone share their thoughts about diabetes” could just as easily be about a DAFNE Course. I did ask about a link-up to DAFNEOnline for Kick-Off however it seems teenagers don’t like talking about their diabetes and while they continue to talk to other attendees it’s not about diabetes, so maybe something to consider in future.

The next presentation was on something that I am sure will provoke discussion. It concerned what happens to blood glucose overnight and if rebound hypo’s ( the somogyi effect) exist i.e high BGs in the morning caused by night time hypos. The overall conclusion was that high fasting readings due to rebound form overnight hypoglycaemia was very rare - if it happened at all and that the cause of high morning BGs was a lot more complex. The conclusions were drawn from a number of surveys including a dawn phenomenon survey of 100 patients. however a A number of the results used to demonstrate conclusions were based on Continuous Glucose monitoring traces to try to give a better understanding to what is actually happening. It was shown that although night time hypos do occur regularly - when asleep the body produces a much weaker hormone response and much smaller sugar / glucagon response. Therefore another cause is more likely to be the source of high morning BG’s. This is where it was shown that you need to see the high BG in context with BG readings over previous days. This suggests that other factors or a combination of other factors are likely to be the cause rather than possibility of overnight hypo. The main problem with all of this is most of us were told to do a 3am test to rule out hypos causing high morning BGs and now we and educators need to take on board that things are not as clear cut as that. I’m sure there will be a lot of further discussion on this subject.

There then followed a workshop that was not attended by your correspondent due to their being a DUAG sub-meeting so my report resumes post lunch with the afternoon session. The first afternoon session was co-ordinated by Prof. Simon Heller and featured a number of presentations on various research programmes that have been ongoing. The first was on a psychosocial study on DAFNE that asked graduates and educators to complete a series of questionnaires and interviews before, during and after the DAFNE Course. The second and third studies were on qualative work and the DAFNE database respectively. Not much of this is sharable publically at this time. The fourth study was on how the length of time someone has been Type 1 affects how successful DAFNE is. The conclusion was that DAFNE is just as effective with long term diabetics as it is with newly diagnosed diabetes. There was also an update on the 5 x 1 day DAFNE Course at the end of this presentation, although final results from this trial are not yet available. The last presentation in this session concerned the cost effectiveness of DAFNE and was given by Prof. Alan Brennan from ScHARR who also work with NICE to determine the cost effectiveness of treatments. The work they have done involves developing health econoimic modelling and is similar to previous work to assess if DAFNE is cost effective. Preliminary results suggest it is cost effective however these are just preliminary results.

The day finished with a workshop and the one I attended was related to the presentation given in the morning about rebound hypos. A lot of discussion centred around how to get the message out to educators let alone graduates that rebound hypos and 3am checks were not as clear cut as previously believed. This was a very interesting discussion and a number of other issues were covered, including post meal injections ( not a good idea since profiles of insulin and food don’t match) and advice from non-DAFNE Health Care Professionals conflicting with DAFNE educators ( generally not accepted unless backed up by Educator).

Overall an interesting and informative day and for those interested the presentations are on the DAFNE website ( www.dafne.uk.com ) by clicking on the DAFNE
Collaborative 2012 section on the front page.

Very Interesting Marke.
Thanks very much for the update and typing this all out

Cheers,
Anele.

interesting read..................

can I paste this on diabetessupport.co.uk?

of course, it was approved for public consumption ( after being vetted and changed ) so there should be no limitation to where it is posted,

Interesting read Marke.
*I get Hypo's quite a lot including rebound ones, after going onto a pump in the hope it would reduce them.
*Young people can ignore this disease all they want, but isn't going anywhere anytime soon. I've had it for 38 years and hated every minute and always will, but you have to get on with it.
*Educators & health care professionals don't listen enough, in my experience. Perhaps we should turn it round and EDUCATE THEM. Do you think they'd listen?