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
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
复制标题
DOI：
10.1136/bmj.325.7367.746
复制
发表时间：
2002-10-05
影响因子：
105.7
通讯作者：
Wright, F
中科院分区：
文献类型：
--
作者：
Amiel, S;Beveridge, S;Wright, F
目的评价一个课程教学的灵活强化胰岛素治疗结合饮食自由和胰岛素调整是否可以改善血糖控制和1型糖尿病患者的生活质量。（立即DAFNE）或作为候补名单控制并参加“延迟DAFNE”6个月后进行培训。在三个英国卫生区设立二级护理糖尿病诊所。参与者169名患有1型糖尿病且血糖控制中度或较差的成年人。主要结局指标糖化血红蛋白（HbA（1c），结果6个月时，即刻DAFNE组HbA 1c（平均8.4%）明显优于延迟DAFNE组（平均9.4%）（t = 6.1，P < 0.0001）。与延迟DAFNE患者相比，糖尿病对即刻DAFNE患者饮食自由的影响显著改善（t=-5.4，P < 0.0001），糖尿病对总体生活质量的影响也是如此（t=2.9，P < 0.01）。总体健康状况和治疗满意度也显著改善，但重度低血糖、体重和血脂保持不变。改善“目前的生活质量”没有达到显着的6个月，但显着的1 year. Conclusions技能培训，促进饮食自由改善生活质量和血糖控制的人与1型糖尿病没有恶化严重的低血糖或心血管疾病的风险。这种方法有可能使更多的人采用强化胰岛素治疗，值得进一步研究。
Objectives To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes.Design Randomised design with participants either attending training immediately (immediate DAFNE) or acting as waiting list controls and attending "delayed DAFNE" training 6 months later.Setting Secondary care diabetes clinics in three English health districts.Participants 169 adults with type 1 diabetes and moderate or poor glycaemic control.Main outcome measures Glycated haemoglobin (HbA(1c), severe hypoglycaemia, impact of diabetes on quality of life (ADDQoL).Results At 6 months, HbA(1c) was significantly better in immediate DAFNE patients (mean 8.4%) than in delayed DAFNE patients (9.4%) (t-6.1, P < 0.0001). The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients (t= - 5.4, P < 0.0001), as was the impact of diabetes on overall quality of life (t=2.9, P < 0.01). General wellbeing and treatment satisfaction were also significantly improved, but severe hypoglycaemia, weight, and lipids remained unchanged. Improvements in "present quality of life" did not reach significance at 6 months but were significant by 1 year.Conclusion Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk. This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation.