DAFNE Collab 2013

A report on the DAFNE Collaborative held in Manchester on 14th June 2013 is available below. If you are wondering why it took so long to put it on the site, welcome to the wonderful world of the NHS, a couple of days to write then weeks and weeks to get approval for publication. Cest La Vie, hopefully it will be of interest to some of you !!

Once again the DUAG 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, gather to receive updates on audit and research. They also attend workshops to promote best practice. The DUAG which is the user representative body on the DAFNE programme are also invited to attend the meeting..
The first set of presentations for the day were about the research database and results that have been taken from it. The first two focused largely on the data collected and how it will be used to compare centres. This will provide a means to identify which centres/areas get the best results and then to look for patterns as to why. It was clear that the initial improvements in HbA1c are not fully maintained over the longer term. This is a major concern as one of the ‘selling points’ of DAFNE is improved HBA1c, of course there are many other factors and things that improve after doing DAFNE but there needs to be a way to identify these so that they can be measured. Another issue identified is how to get the HbA1c of more graduates after 1 year, everyone who goes on the course has an HbA1c test just before the course and in theory another test after 1 year, however it’s much harder to arrange after a year. The final presentation in the set focused on the improvements in severe hypos and DKA, these are both dramatically reduced by doing DAFNE which could present both a cost saving to the NHS and an improved quality of life for the DAFNE graduate. These are areas that have not really been emphasised in the past as the focus was largely on reductions in HbA1c.
The next set of presentations were on the DAFNE HART pilot study. This was a 6 week, 1 day a week, study focused on restoring Hypo awareness based on DAFNE principles. One of the key aspects of the pilot was the psychology around hypo’s, the 3 basic types of thinking about hypo’s were identified and these types were highlighted during the course in an attempt to ‘break the cycle’ causing behaviours that stopped the changes needed to improve hypo awareness. The course helps participants make small changes over the length of the course and reinforces the changes to move participants in the right direction. Although this was just a pilot study with 24 participants the results showed a definite improvement in hypos and psychological measures. The last of this group of presentations was probably the most ‘hard-hitting’ of the day. It focused on the results of discussions with the partners and family members of those approached to attend the HART pilot i.e those people living with someone experiencing hypo unawareness. As a Diabetic it really made you think about what it’s like to be on the ‘outside’ of a hypo and it is not a pleasant experience. It was certainly a sobering and though provoking presentation.
The first workshops of the day then occurred. This related to the collection of data at one year refreshers and how to increase the number of graduates data was gathered about. This is crucial to DAFNE because without post-course data about graduates it’s hard to show that the course really does have an effect on a graduates management of their diabetes. At many DAFNE Centres there is a large reduction in the number of graduates providing the data. A lot of discussion focused on how to address this and get the data needed.
Lunch was followed by the second workshop of the day. This focused on various studies, including the DUAG’s, on what follow-up graduates wanted after the course. It seems there is quite a lot of variation in what various centres offer as follow-ups and refreshers, The ultimate conclusion of this workshop is it’s still not clear what graduates want as follow-up and what the best methods of providing follow-up are. A number of options are being considered and some more research and studies will most likely be done to work out what should be offered as follow-up.
The final set of presentations focused on the results of various research studies. The first was on the DAFNE 5 x 1 day study, that was looking to compare the outcome of doing DAFNE over 5 weeks , 1 day a week rather than a 5 day course over 1 week. The result was that ultimately there is very little difference between the two courses in terms of results. The most interesting result was that in the study where you could randomly end up on either type of course all participants thought that their version of the course was the best regardless of the preference they expressed before the courses began. The second presentation looked at the type of background insulin recommended for use during and after the course and the correlation with outcomes of HbA1c. Ultimately it seems that those on twice daily background injections get better HbA1c results in the long term. The next presentation focused on people on pumps after doing DAFNE it showed that DAFNE reduced the need to go onto a pump by reducing HbA1C and the number of disabling Hypo’s. Unfortunately due to train time bookings the end of this presentation and the last presentation on the next phase of DAFNE research was missed and will have to be reported when the information is released.

Really interesting report, thanks for this. I'm intrigued by the course relating to hypo unawareness? Is this a course possible to attend?

Hi, not at the moment since the hypo unawareness was a trial course to see what results they would get. The results I think suggested that people would benefit however they now have to work out the practicalities of making it available at DAFNE Centres. I will update you if and when I hear more news about the course.