DAFNE Research News

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marke Site Administrator
South East Kent PCT
651 posts

The following article has been sent to us by the DAFNE Research programme. It contains all the developments in DAFNE. It is important to undertstand that this is research so the trials detailed below might never be rolled out nationwide. It does however show that things like 5 x 1 day courses verses 5day courses are being considered. Some of it is a bit 'technical', so if you have any questions let us know and we will try to get them answered.

DAFNE Research Update January 2011
The DAFNE Collaborative is committed to the continued improvement and development of DAFNE through Research and Development. The DAFNE programme provides a unique test-bed to conduct research not only to improve Type 1 diabetes management but also to learn more about educational interventions in diabetes and long-term conditions more generally.

The DAFNE Research group are currently involved in 3 research programmes:

1. National Institute for Health Research Grant
The £1.7 million research grant will fund a varied programme of research (A to F below) over a 5 year period, which will be underpinned by economic analyses to establish its cost effectiveness.

1A Research Database
Further development of the DAFNE web-based database to examine the relationship between biomedical and psychosocial outcomes. We will record important health events to calculate cost-effectiveness.

Commenced: December 2008
Centres involved: 10
No recruited: 1116
Completion date: September 2012

Update: Recruitment is ongoing until September 2011. Pre course data has been entered for the 1081 participants recruited to date and one year post course follow up data collection for 404 patients so far. Research investigators are already planning and developing protocols for the utilisation of this data to answer a range of questions regarding the impact of DAFNE. We are now actively encouraging DAFNE researchers to make use of the valuable data resource held within the DAFNE Research Database. It is anticipated that the publications using the data will commence in 2011. There will be an oral presentation on the Research Database at the Diabetes UK Annual Professional Conference 2011.

1B Mixed methods study
Undertake a combined quantitative and qualitative approach to understand factors which facilitate/impede self-management to help explain patterns and predictors of successful outcomes not only in type 1diabetes but will also inform programmes in Type 2 diabetes.

Commenced: June 2008
Centres involved: 11
No recruited: 263
Completion date: August 2010

Update: Recruitment completed. Follow-up data collection at 3, 6 and 12 months post course has been completed. Interim analysis of the 3 & 6 month data has been performed with 12 month analysis currently underway. A subgroup of 30 patients and 12 educators from 5 of the 11 DAFNE centres took part in an in-depth interview (Qualitative) study. Results from the Qualitative study will be presented as a poster at Diabetes UK Annual Professional Conference 2011. Some findings have already been published.

1C Comparison between DAFNE + MDI and DAFNE + CSII

Pilot study

Develop and conduct pilot study comparing DAFNE training plus continuous subcutaneous insulin infusion (CSII; pump) against DAFNE plus multiple daily injections (MDI). DAFNE curriculum developed to use with patients new to insulin pumps and training given to DAFNE educators.

Commenced: December 2009
Centres involved: 3
No recruited: 55
Completion date: September 2010

Update: 5 CSII courses and 4 MDI courses were completed. All follow up data , at 6 months post course, have been collected. Preliminary analysis of the results are underway. The experiences of this pilot have informed the development of a major RCT now funded by the NIHR HTA.

1D DAFNE delivered over 5 consecutive days and 1-day / week for 5 weeks
Undertake a trial to establish whether intermittent training is as good as the 5 day course. This has the potential to allow those who cannot attend for 1 week to benefit from training and permit more flexible delivery where educators work part-time.

Commenced: May 2010
Centres involved: 7
No recruited: 124 (to Feb 2011)
Courses run: June 2010 – May 2011
Completion date: June 2012

Update: 5-week course curriculum and resources have been developed. Educator training sessions completed in May/June 2010. 12/14 of the 5 week courses and 12/14 standard 1 week courses as control group have been run upto Feb 2011. Follow up data is collected at 6 weeks, 6 months and 12 months post course with data collection to be completed by May 2012.

1E Repeaters intervention
Develop and pilot an intervention, incorporating research described in study B above, for those DAFNE graduates needing additional input. In January 2011 an inaugural meeting was held for development of intervention

Commenced: Proposed December 2011 pilot any intervention
Completion date: July 2012

1F User involvement
Resource and develop our existing user group, who will contribute to all aspects of this programme.

Commenced: June 2009
Completion date: Sept 2012

Update: 15 DAFNE Graduates elected by the DAFNE User Group to form an active group – DAFNE User Action Group (DUAG). Training in how users can be involved with health research was provided in July 2009. Two DUAG representatives sit on each of the research groups.
Work to assess the impact of DUAG involvement in research has commenced with observations of research group meetings attended by DUAG and interviews with DUAG representatives and researchers.

2. REPOSE : Relative Effectiveness of Pumps over MDI and Structured Education
An NIHR HTA funded trial comparing optimised multiple insulin injection therapy (using rapid and twice daily long-acting insulin analogues) with continuous subcutaneous insulin infusion (CSII) in adult type-1 diabetic patients provided with high quality structured DAFNE.

Commencement: In final development stage
Centres involved: 7

3. The Irish DAFNE Study
In 2005 the Health Research Board in Ireland awarded the Irish DAFNE Study Group a five year programme grant under their Health Services R&D award.

Randomised controlled trial evaluating 2 methods of follow-up care post-DAFNE training, comparing structured group follow-up care with a return to usual clinical care.
  • To develop a new model of ongoing care for DAFNE graduates based on group follow-up and peer support.
  • To undertake an exploratory trial comparing this new model of care (group follow-up of DAFNE graduates) with “usual care”, i.e. a return to one-to-one clinic visits following DAFNE training
  • To incorporate a health economic analysis to inform future policy making

Commenced: October 2006
Centres involved: 6
No recruited: 439
Completion date: October 2012

Update: All baseline, 6, 12 and 18 month follow-up data has now been collected.

International Comparison Study
A cross country comparison study among people with Type 1 diabetes in Ireland, the UK and Germany who have completed a structured education programme.

Quantitative study
A common dataset is being collected across ten centres in Germany who deliver the precursor of DAFNE, the Insulin Training and Teaching Programme (ITTP), ten DAFNE research centres in the UK and seven DAFNE centres in Ireland. Follow up data to be collected at 12 months post-DAFNE or post-ITTP training.

Qualitative study
Interview 16 patients and 4 educators from each country before DAFNE or ITTP with repeat interviews within 6 months following the course to explore their experiences, behaviours and opinions. Courses in all three countries will also be observed in their entirety with in-depth field notes accompanying the observations.

Commenced : February 2010
Completion date: October 2012