Dose adjustment for normal eating (DAFNE): doctor programme
Authors: Jonathan Schofield
Publication date: 18 Sep 2012
The dose adjustment for normal eating (DAFNE) course for people with type 1 diabetes is an evidence based, structured education programme that provides them with the skills they need to estimate the carbohydrate content in each meal and inject the right dose of insulin. A total of 3387 DAFNE courses were delivered up to June 2012.
Who is it for?
The DAFNE course is delivered to small groups by trained diabetes specialist nurses and dietitians over five consecutive days. Participants are taught to match their insulin dose to their chosen food intake on a meal by meal basis.
The DAFNE doctor programme enables doctors to provide leadership and clinical support to DAFNE educators in the delivery of DAFNE courses. Doctors who have completed the doctor programme can deliver the introduction and facilitate the question and answer session during the week long DAFNE course. The doctor programme is mainly for consultants and specialty trainees in diabetes, although I would recommend it to any doctor interested in the management of diabetes. To date over 300 doctors have been trained in DAFNE techniques.
When did you do it?
I observed the five day DAFNE course during my specialty training year 4 and completed the one day doctor programme the next year.
Why did you do it?
Structured education enables patients to participate in their own healthcare; guidance from the National Institute for Health and Clinical Excellence (NICE) on the management of type 1 diabetes underlines the importance of this. The DAFNE programme aims to give patients with type 1 diabetes a more flexible lifestyle and to improve outcomes through training in insulin dose adjustment and carbohydrate counting.
An evaluation of the DAFNE approach published in the BMJ in 2002 showed that structured education can improve glycaemic control, quality of life, and satisfaction with treatment in people with type 1 diabetes. Since then, nearly 25 000 people with type 1 diabetes have completed the DAFNE course, and feedback remains overwhelmingly positive.
What did it involve?
The DAFNE doctor programme consists of orientation and background reading (4-6 hours), observation of a five day DAFNE course (37.5 hours), and attendance at a one day training workshop (6.5 hours).
The workshop starts with a review of the DAFNE philosophy, evidence for this approach, and the role of quality assurance in the DAFNE programme. This is followed by revision of the DAFNE dose adjustment principles before a discussion of the issues likely to arise when DAFNE is embedded into services for patients with type 1 diabetes.
How much did it cost?
To become a DAFNE doctor, the five day observation course and one day workshop must be successfully completed. The cost is £285, which includes all training materials. For an additional fee, doctors can attend a one day “doctor as educator workshop” to learn how to deliver more than the introduction and question and answer sessions of the DAFNE courses.
Is there an exam?
Although there is no exam, doctors who want to deliver a DAFNE session from the patient curriculum are assessed to ensure that the quality of any course they deliver is of the expected standard. A certificate is posted on completion of the doctor programme.
Was it worth it?
Yes, this course was worth attending. After taking part in the doctor programme I understood the principles and some of the problems in carbohydrate counting and using dose adjustment algorithms. I can now support DAFNE educators in the incorporation of DAFNE into routine service delivery.
One of the concepts discussed is that clinicians have a responsibility to, but not for, people with diabetes. I strongly agree with this philosophy and believe that the DAFNE doctor programme lays the foundations for understanding the importance to this approach of structured education.
Attending the observation week before the doctor programme is valuable, not just for understanding DAFNE principles but also as an opportunity to listen to patients’ experiences.
Apply early—only four DAFNE doctor programmes are scheduled for 2012.
Competing interests: None declared.
- National Institute for Health and Clinical Excellence. Guidance on the use of patient-education models for diabetes. NICE technology appraisal 60. April 2003.
- DAFNE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002;325:746.
Jonathan Schofield specialist trainee year 6, diabetes and endocrinology
Central Manchester University Hospitals NHS Foundation Trust, UK
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