Carbohydrate counting and insulin dose adjustment group sessions for type 1 diabetes: a pilot of their effectiveness at a primary care diabetes centre

It is recommended that a structured group education programme such as DAFNE (Dose Adjustment For Normal Eating) is offered to all adults with type 1 diabetes. Such programmes teach the skills of carbohydrate counting and insulin dose adjustment with the aim of improving glycaemic control (HbAic) without increasing the risk of hypoglycaemia. South West Essex Community Services adult diabetes service was finding that individuals were not accessing the DAFNE programme for various reasons. A diabetes specialist dietitian and nurse decided to pilot the delivery of two 3-hour group sessions to teach some of the basic carbohydrate counting and insulin dose adjustment skills. Changes in HbAIc pre-and post-intervention were reported for 68 subjects. The four different intervention arms compared were: those who attended just the carbohydrate counting session (n=14), those who attended both sessions (n=24), those who had attended one or both sessions and then went on to attend DAFNE (n=1 0), and those who had received no carbohydrate counting education (n=20). Those who had attended one or both of the 3-hour sessions had a mean and absolute reduction in HbAic compared with the group that had not received any education, although this was not statistically significant. The group that had attended one or both of the 3-hour sessions and DAFNE did achieve a statistically significant reduction in HbAic compared with the group that had not received any education. Despite several identified limitations to the pilot, it was felt that the delivery of the two 3-hour carbohydrate counting and insulin dose adjustment sessions demonstrated some clinically (if not statistically) significant improvement in HbAic. Copyright (C) 2013 John Wiley & Sons.