New ACBRD research explores whether some adults with type 1 diabetes benefit more than others from DAFNEplus, an enhanced structured diabetes education programme
Structured education helps people build the knowledge, skills and confidence to manage diabetes in their daily lives. One of the best-known structured education programmes for adults with type 1 diabetes is DAFNE (Dose Adjustment For Normal Eating). This five-day group course teaches participants how adjust their insulin dose based on what they choose to eat. The program is designed to support greater flexibility in everyday life. It has shown several benefits, including improving quality of life. More than 60,000 adults worldwide have taken part.
An updated programme, DAFNEplus, added new techniques, more use of technology and more follow-up support. Researchers wanted to know if the updated program was more beneficial than the original. A large trial in the UK compared the programmes, with 471 adults with T1D taking part and around half receiving each programme. After 12 months, glucose levels and quality of life had improved in both groups, on average. However, there was no difference in HbA1c or quality of life between groups. This suggests that the original DAFNE and the new DAFNEplus programme were similarly effective overall. However, people who attend these programmes are not all the same. Some people may benefit more from one programme than the other.
Researchers from ACBRD were involved in the main DAFNEplus trial. We wanted to better understand whether certain groups of people benefited more from one programme than the other. To explore this question, Dr Uffe Søholm led a new analysis of the trial data. We grouped participants according to their starting characteristics, including their HbA1c, quality of life, diabetes distress and wellbeing. We then looked at whether those groups responded differently to DAFNE and DAFNEplus.
We found two groups of participants at the start of the study:
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- Group 1: People with higher HbA1C, more diabetes distress and more worry about low blood glucose. They also had lower wellbeing, lower quality of life and were less aware when their glucose was low.
- Group 2: People with opposite characteristics, such as lower HbA1c, less diabetes distress and better quality of life.
In Group 1, people who took part in DAFNEplus reported a greater improvement in diabetes-specific quality of life after 12 months than those who attended DAFNE. In Group 2, we saw no difference between the programmes.
What does this mean?
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- DAFNEplus may offer some added benefit to people who are experiencing greater emotional and practical challenges in managing their diabetes.
- When deciding which programme to offer, we need to consider several factors, including quality of life and diabetes distress.
This was an exploratory study, and many people had missing data at 12-month follow up. The results need to be confirmed in future research, over a longer time.
Still, the study highlights an important message: people with type 1 diabetes do not all have the same experiences, needs or challenges. Looking beyond the “average person” helps us to ensure that the right support is offered to the right people.
Reference:
Søholm U, Thuraisingam S, Holmes-Truscott E, de Zoysa N, Cooke D, Heller S, Speight J; DAFNEplus Study Group. Changes in HbA1c and diabetes-specific quality of life following structured type 1 diabetes education: Exploratory latent profile analysis of outcomes in the DAFNEplus trial. Diabet Med. 2026 Mar;43(3):e70203. doi: 10.1111/dme.70203. Epub 2026 Jan 8. PMID: 41507694.
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