Issue 125 Item 14 Counting Carbs Improves Glycemic Control

Fitting diabetes into their lives, rather than their lives into diabetes” could allow more people with diabetes to adopt intensive insulin treatment A week-long course (DAFNE) that teaches diabetics to adjust their insulin intake to match their normal food consumption improves glycemic control and reduces the impact of the disease on their lives, British researchers said on Friday.

The technique "provides patients with the ability to fit diabetes into their lives, rather than their lives into diabetes" and could allow more people with type I diabetes to adopt intensive insulin treatment, according to Dr. Simon Heller, from Northern General Hospital in Sheffield, and colleagues.

The researchers studied 140 type I diabetics who had moderate or poor glycemic control. Half were immediately assigned to a 5-day "dose adjustment for normal eating" (DAFNE) course that taught the skills to replace insulin by matching it to desired carbohydrate intake on a meal-by-meal basis.

The other half of the group continued as usual for 6 months before taking the training course.

After 6 months, glycated hemoglobin levels were significantly better in the immediate DAFNE group (mean 8.4%) than in the delayed group (9.4%, p < 0.0001), the researchers report in the British Medical Journal for October 5.

Questionnaires revealed that people who took the course reported feeling a significant improvement in the impact of diabetes on their dietary freedom and quality of life. They also told researchers their overall well-being was higher than did those who had not yet taken the course.

Not everyone with type I diabetes will want to undertake intensive insulin treatment, and some will prefer a simpler routine with fewer injections, the researchers note.

"Nevertheless, as the only way of reducing microvascular disease is by maintaining tight glycemic control, we need better ways of enabling patients to intensify their insulin treatment," they write.

The DAFNE approach has the potential to reduce the incidence of complications and improve quality of life for people with type I diabetes, and deserves further investigation, they conclude. BMJ 2002;325:746-749