Table 3 Overview of the six primary studies: participants, types of structured education and follow up interventions studied

Irish DAFNE Study

Ireland

[36,37,38]

A cluster randomised trial to compare the outcomes for patients receiving individual routine care with those receiving additional group based follow up support.

Purposive sample (n = 40) from 5 DAFNE centres, making up approximately 10% of the total study sample (n = 437).

Years since diagnosis ranging from 2 to 31+ years,

Gender: 15 males, 25 females.

Most participants under the age of 50, with 5 between the ages of 51–70 and most (27.5%) in the 10–20 year bracket.

Socioeconomic background not reported.

DAFNE course delivered over 5 consecutive days.

Group follow-up was delivered at 6 and 12 months post-course using a curriculum designed for the study. Group follow up was delivered by the same DAFNE educators who delivered the course and reviewed progress and goals. Participants in the control arm received individual support from health professionals in diabetes clinics as part of routine care.

UK DAFNE study

UK

[39,40,41,42,43,44,45,46,47]

A qualitative study exploring barriers and facilitators to sustaining a FITT approach following course attendance and over time to provide insight into why some people cannot sustain intensive self-management.

Patients (n = 30) from UK DAFNE centres (n = 5). Recruited using an opt-in procedure, with purposive sampling of participants from the last two courses to ensure diversity.

Years since diagnosis ranging from 1 to 45 years.

Gender: 16 women, 14 men

Ages ranged from18-56 yrs.

Occupation: 30% professional 36.7% semiskilled, 20% unskilled, 10% students,3.3% unemployed

Participants attended standard DAFNE courses delivered over 5 consecutive days

Post course, patients received routine clinical care, either in hospital or general practice, provided by health professionals from whom they received clinical care and reviews prior to DAFNE. Patients also received DAFNE educators’ contact details and were invited to contact them if they had questions/concerns. Patients were given the opportunity to attend a group-based, half-day follow up session six weeks post course, facilitated by their course educators and involving their fellow course attendees. Some DAFNE centres offered a further group session at 6 or 12 months post course.

REPOSE (Relative Effectiveness of Pumps Over MDI and Structured Education)

UK

[48, 49]

A randomised controlled trial to establish the added benefit of a pump over multiple injections on glycaemic control and hypoglyceamia in individuals with Type 1 diabetes receiving similar high quality structured training.

Purposive sample (n = 42) of participants from seven REPOSE centres. 23 participants using a pump, 19 using MDI. 36 participants were using bolus advisors at baseline, with 32 still using them 6 months later.

Gender: 20 female, 22 male

Ages ranged from 24 to 66 and

Occupation: 31% had a professional occupation, 36% were semi-skilled, 9.5% unskilled, 7% were students, and 16.5% were unemployed.

Participants in both trial arms attended a DAFNE course over 5 consecutive days. Participants in both arms were taught how to use bolus advisors during the course.

Routine care was provided to all participants from their usual healthcare providers. Additionally, participants were required to attend appointments at 6, 12 and 24 months in order for data to be collected for the trial. DAFNE educators were also available at these time points to provide advice and respond to any issues.

DAFNE

UK

[50, 51]

Qualitative patient led study of experiences of diabetes structured education.

Purposive sample (n = 21) from three established UK DAFNE centres.

The ‘new student group’ (n = 11) attended DAFNE during the study dates. The ‘graduate group’ (n = 10) had taken part in DAFNE between 3 and 11 years previously (mean of 7).

10 had been diagnosed as children or teenagers, and 11 as adults

Gender: 12 female, 9 male

Ages ranged from 20s–60s

Employment: 12 were in full time employment, 3 part-time, 2 students, 2 on sick leave and 2 retiresd.

Ethnicity: 17 were White British, 1 White other, 3 Black Caribbean

All participants had attended a standard DAFNE course delivered over 5 consecutive days.

Routine care and usual support provided following standard DAFNE courses, which can differ across sites.

DAFNE-HART (Hypoglycaemia Awareness Restoration Therapy)

UK

[52]

To develop and carry out a qualitative evaluation of the DAFNE-HART intervention for DAFNE graduates with ongoing problematic hypoglycaemia.

24 adults with problematic hypoglycaemia (2 or more episodes of severe hypoglycaemia, requiring 3rd party assistance since they first completed standard DAFNE), and a Gold score of 4 or more, were recruited from two UK DAFNE centres to attend a DAFNE-HART course. 21 of the 24 participants took part in the qualitative evaluation.

Years since diagnosis: mean 31.2 (SD 11.3 years)

Gender: 9 female, 15 male

Age: mean 53.3 (SD 8.1 years)

Occupation not reported.

All participants had previously attended a standard DAFNE course but still had persistent impaired awareness of hypoglycaemia.

The course was delivered over 6 weeks (3 full day group sessions in weeks 1–3, individual face-to-face and phone appointments in weeks 4–5, a full day session with invited significant others in week 6). The programme revised DAFNE principles in relation to hypoglycaemia and drew upon cognitive behavioural therapy and motivational interviewing to address the motivational and perceptual barriers to restoring hypoglycaemia awareness. Participants received a workbook and a personalised ‘hypo-prevention plan’.

RapidCalc

Australia

[53]

Qualitative interview study to obtain user feedback on the usability of a phone based bolus calculator application called ‘RapidCalc’.

Graduates of a DAFNE course (n = 7) who had completed a standard DAFNE course within the past 13 months.

Years since diagnosis: mean 27 years. Gender: 5 female, 2 male

Age: mean 36 years

DAFNE graduates given the RapidCalc app, which enables: bolus dose determination; diabetes diary recording; report generation; communication with health professionals. Participants received one group based app education session with the app developer a diabetes educator who programmed the app with each individuals’ insulin adjustment algorithms.

Participants were invited to contact the diabetes educator for assistance with dose adjustment at any time between the app education session and taking part in the focus group one month later.