Thursday, 22 November 2012
NHS Diabetes: DAFNE and DESMOND
If you show the appalling NHS results (highlighted in the 2 following posts):
to a GP or a HCP they will often reply that the results are due to the patient’s non-compliance or ignorance.
It is then of some interest to examine the results for patients who have received the NHS diabetic education course for Type 1 and Type 2 diabetes.
The structured education programme DAFNE (Dose Adjustment For Normal Eating) is for Type 1 diabetes. A recent publication:
assessed HbA over a 7-year period following such a course. Over the7 year period a reduction in HbA1c from an average of 8.6% to an average of 8.3% was achieved.
The DESMOND Programme (Diabetes Education Self-Management On-going and Newly Diagnosed) is for Type 2 diabetes. A recent publication:
concluded: “a single programme for people with newly diagnosed type 2 diabetes mellitus showed no difference in biomedical or lifestyle outcomes at three years although there were sustained improvements in some illness beliefs.”
Appalling diabetes statistics
Educational programmes bring no significant improvement
The consequences for the future are well known
A recent publication:
Used information from national databases representing over 20 000 patients from 2005 to 2008, Scottish researchers led by Helen Colhoun from the University of Dundee, found that people with type 1 diabetes have 2 to 3 times the risk of heart attacks, strokes, or premature death than the general population and that this increased risk is higher in women than in men. The authors found that in those with type 1 diabetes, the risk (chance) of having a cardiovascular event (heart attack or stroke) for the first time was 2.5 higher in men and 3.2 higher in women, than in the general Scottish population. Furthermore, in those with type 1 diabetes, death rates from any cause were 2.6 higher in men and 2.7 higher in women than in the general Scottish population.
Worryingly, the authors also found that the majority of patients in this Scottish dataset had poorly controlled blood glucose levels, with only 13% having HbA1c levels (a test that measures the blood sugar control over the previous 3 months) in the target range.
They continue: "A striking feature of the data is the very low rate of achievement of glycaemic control targets." The authors add: "Risk factor management should be improved to further reduce risk but better treatment approaches for achieving good glycaemic control are badly needed.”
What better treatment approach for achieving good glycaemic control would you suggest?