Structured education in type 1 diabetes

Abstract

The UK has been slow to promote effective intensive insulin therapy among those with type 1 diabetes. Although many adults use multiple injections, few self-manage their diabetes effectively and maintain tight glucose targets. However, in recent years reports from other countries that high-quality skills training in self- management can improve glycaemic control while lowering rates of hypoglycaemia have changed attitudes. The DAFNE (Dose Adjustment for Normal Eating) trial, which promotes a flexible approach to eating while maintaining tight glucose targets, demonstrated that patients require training to manage their diabetes successfully. Many centres now offer DAFNE, or similar structured education programmes, to adults with type 1 diabetes. Most patients have difficulty in sustaining the approach and the most appropriate ways of continuing support are unclear. A large number of units still provide no structured training depriving their patients of an essential component of their treatment. Formal diabetes education can no longer be regarded as an optional extra. It needs to be seen as essential to treatment as medication and therefore resourced, researched, evaluated and quality assured to a similar standard.