Summary
DAFNE is a cost-effective and cost-saving structured education programme (SEP) for adults with Type 1 Diabetes (T1D), proven to improve biomedical and psychological outcomes.
The developed infrastructure enables off-the-peg access to a high-quality SEP, which fully meets national criteria; it is recognised as delivering on QIPP (Quality Improvement Productivity and Prevention) agenda and is included in the NHS Evidence database.
Delivered in 133 localities, by more than 1000 DAFNE trained HCPs. There have been more than 3,300 courses delivered to over 24,000 adults with TID – numbers increase weekly.
Research is ongoing to refine DAFNE and understand the benefits of SEPs.
Results
DAFNE significantly improves glycaemic control, QoL and treatment satisfaction.
An economic evaluation showed DAFNE to be cost-effective and has resulted in cost savings through reduced risk of developing long-term complications.
Additionally audit data reveals opportunities for short-term cost savings via:
- Significantly reduced:
- Severe hypo and DKA rates
- Prevalence of psychological distress
- Improved outcomes using twice daily isophane compared to more costly analogue insulin
Evidence from DAFNE has been useful in the development of national policy for diabetes care.
DAFNE is an exemplar of current NHS practice assessed as delivering on the QIPP agenda and is included in the NHS Evidence Database.
The developed training, QA and audit infrastructure has enabled DAFNE to be rolled out in 133 localities to over 24,000 adults with TID.
Challenge
Despite evidence that tight glycaemic control in Type 1 diabetes (T1D) – achieved through engaging patients in skills-based structured education programmes (SEP) in intensive self-management therapy (IIT) – reduces the risk diabetes related complications, such programmes were not adopted into UK general diabetes practice, resulting in worse biomedical and quality of life (QoL) outcomes compared to those in Europe.
There was a need to demonstrate the effectiveness of SEP in IIT and embed this approach into routine T1D management in the UK.
Solution
The aim was to develop a proven SEP in IIT, developed in Dusseldorf, and evaluate the effectiveness in the UK healthcare setting – the DAFNE trial.
Following the successful trial, the DAFNE study group began to develop:
- A robust ‘train the trainers programme’
- Quality assurance and audit process in order to maintain course integrity and quality to avoid dilution of the benefits of DAFNE as it was rolled out.
Going forward DAFNE would be a whole off-the-peg package rather than just a curriculum.
It was also apparent that there was a need for ongoing research to continue to develop DAFNE and understand the determinants of success to achieve better outcomes.
Client Verdict
Patients- Since doing DAFNE my life has changed completely. I have not had any major hypos. DAFNE has given me freedom to live a normal life without restriction.
- The frameworks that I need to independently self regulate my actions are in place
Commissioner
It was really important to ensure that DAFNE was incorporated as a routine part of care for people with T1D. I am aware of how important this is to people and what a difference it can make to their lives.
