Introduction
The Dose Adjustment For Normal Eating (DAFNE) program assists people with type 1 diabetes (T1D) manage glycaemic control whilst providing freedom of food choices. DAFNE training results in a reduction in severe hypoglycaemia, insulin requirements, weight, and improved quality of life1. Improvements in HbA1C have been reported with DAFNE, however, a reduction in glycaemic variability is arguably a clinically more important outcome as it correlates with a reduction in markers of oxidative stress and microvascular complications as well as less hypoglycaemia2. There is limited data on the effect of DAFNE training upon glycaemic variability.
Aim
The aim of this study was to assess glycaemic variability using Continuous Glucose Monitoring System (CGMS) in people with T1D before and after completion of a DAFNE course.
Method
The prospective study cohort included people with T1D who had been enrolled in DAFNE training in two major diabetes centres in Queensland. CGMS was inserted before and at next follow up appointment following DAFNE training. The primary measure was glycaemic variability as measured by total standard deviation (SDT) and coefficient of glucose variation (CV%). Secondary measures were time spent in euglycaemia (4 - 7.8mmol/L), hypoglycaemia (<4mmol/L) and hyperglycaemia (> 7.8mmol/L).
Results
Twelve participants (ten men) completed the study protocol with baseline mean±SD age of 46±10 years and Hba1c 62±18mmol/mol (7.8±1.6%). Glycaemic variability was reduced post DAFNE as measured by SDT (3.32 mmol/L vs. 3.99 mmol/L, p = 0.044) and CV% (35.2% vs. 40%, p = 0.046). There was no difference in mean time spent in hyperglycemia, euglycemia or hypoglycaemia.
Conclusion
In people with T1D, DAFNE training results in reduced glycaemic variability. In this small cohort, no increase in time spent in hypoglycaemia was demonstrated. A reduction in glycaemic variability may lead to a reduced risk of microvascular complications.