Issue 126 Item 11 Flexible Insulin Management Improves Quality of Life in Diabet

The only way of reducing microvascular disease currently is by maintaining tight glycemic control, flexible insulin management is one way to achieve it. Training diabetic patients in flexible, intensive insulin management allows greater dietary freedom in people with type 1 diabetes, according to results of the Dose Adjustment For Normal Eating (DAFNE) randomized trial reported in the Oct. 3 issue of the British Medical Journal.

"Skills training promoting dietary freedom improved quality of life and glycemic control in people with type 1 diabetes without worsening severe hypoglycemia or cardiovascular risk," write S. Heller, from the Northern General Hospital in Sheffield, U.K., and colleagues from the DAFNE Study Group. "This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation."

In this study, which took place at hospital clinics in the U.K., 169 adults with type 1 diabetes and moderate or poor glycemic control received a five-day training course immediately upon enrollment or six months later. The course trained patients to adjust their insulin doses to match their food choices, rather than restricting favorite foods and taking insulin according to a prescribed schedule.

At six months, the group given DAFNE training immediately did significantly better than the delayed training group in mean glycosylated hemoglobin ( 8.4% vs. 9.4%; P<.0001), impact of diabetes on dietary freedom (P<.0001), impact of diabetes on overall quality of life (P<.01), and general well-being and satisfaction with treatment. Severe hypoglycemia, weight, and lipid levels did not differ between groups.

At one year, the immediate training group also had significant improvements in "present quality of life" despite an increase in the number of daily insulin injections and in blood glucose monitoring. Although patients were not restricted to healthy food choices, there was no apparent deterioration in cardiovascular risk factors.

"Not everyone with type 1 diabetes will wish to undertake intensive insulin treatment, even without dietary restrictions; some will prefer a simpler regimen with routine meal timing and fewer injections," the authors write. "Such options will still be needed. Nevertheless, as the only way of reducing microvascular disease currently is by maintaining tight glycemic control, we need better ways of enabling patients to intensify their insulin treatment." BMJ. 2002;325:746-749