Long-term biomedical and psychosocial outcomes following DAFNE (Dose Adjustment For Normal Eating) structured education to promote intensive insulin therapy in adults with sub-optimally controlled Type 1 diabetes
Long-term biomedical and psychosocial outcomes following DAFNE (Dose Adjustment For Normal Eating) structured education to promote intensive insulin therapy in adults with sub-optimally controlled Type 1 diabetes
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DOI：
10.1016/j.diabres.2010.03.017
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发表时间：
2010-07-01
影响因子：
5.1
通讯作者：
Thompson, G.
中科院分区：
文献类型：
--
作者：
Speight, J.;Amiel, S. A.;Thompson, G.
目的：探讨长期的结果，参与正常饮食的剂量调整（DAFNE）培训课程，提供一次性暴露于结构化教育的强化胰岛素治疗的人与建立1型diabetes.Methods：队列设计随访的原始试验参与者在平均44个月（范围：37-51个月）在医院糖尿病诊所在三个英语健康区。104名（74%）原始参与者提供了生物医学数据; 88名（63%）完成了问卷调查，包括ADDQoL，测量糖尿病对生活质量（QoL）的影响。44个月时，HbA（1c）较基线平均改善0.36%（9.32 +/- 1.1%至8.96 +/-1.2%，p < 0.01）仍然显著，但从12个月开始恶化（p < 0.05）。12个月时观察到的生活质量改善在44岁时持续（例如，糖尿病对饮食自由的影响：44个月时为-1.78 +/- 2.33，基线为-4.27 +/- 2.94，p < 0.0001; 12个月时为1.80 +/- 2.32，ns）。使用末次观察结转的患者不提供后续data.Conclusions：单DAFNE过程中对血糖控制的影响仍然是显而易见的，从长远来看，虽然需要进一步的干预措施，以达到推荐的HbA（1C）。相比之下，QoL和其他患者报告结局的改善在约4年内保持良好。(C)2010爱思唯尔爱尔兰有限公司版权所有。
Aims: To explore long-term outcomes of participation in a Dose Adjustment For Normal Eating (DAFNE) training course, which provided one-off exposure to structured education in intensive insulin therapy to people with established Type 1 diabetes.Methods: A cohort design follow-up of original trial participants at a mean of 44 months (range: 37-51 months) in hospital diabetes clinics in three English health districts. 104(74%) original participants provided biomedical data; 88(63%) completed questionnaires including the ADDQoL, measuring impact of diabetes on quality of life (QoL).Results: At 44 months, mean improvement in HbA(1c) from baseline was 0.36% (9.32 +/- 1.1% to 8.96 +/- 1.2%, p < 0.01) remaining significant but deteriorated from 12 months (p < 0.05). Improvements in QoL seen at 12 months were sustained at 44 (e.g. impact of diabetes on dietary freedom: -1.78 +/- 2.33 at 44 months versus -4.27 +/- 2.94, baseline, p < 0.0001; versus 1.80 +/- 2.32 at 12 months, ns). Similar results were obtained using last observation carried forward for patients not supplying follow-up data.Conclusions: The impact of a single DAFNE course on glycaemic control remains apparent in the long term, although further interventions will be required to achieve recommended HbA(1c). In contrast, improvements in QoL and other patient-reported outcomes are well maintained over approximately 4 years. (C) 2010 Elsevier Ireland Ltd. All rights reserved.