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Training in flexible intensive insulin management improved glycaemic control and quality of life in type 1 diabetes

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QUESTION: Does training in flexible intensive insulin management (combining dietary freedom and insulin adjustment) improve glycaemic control and quality of life in patients with type 1 diabetes?


Randomised (allocation concealed), unblinded, controlled trial with follow up at 6 months (Dose Adjustment for Normal Eating [DAFNE] trial).


3 hospital diabetes clinics in Sheffield, Northumbria, and London, UK.


169 patients >18 years of age with clinical features of type 1 diabetes, moderate or poor glycaemic control (glycated haemoglobin [HbA1c] 7.5–12%), and duration of diabetes >2 years without advanced complications. Exclusion criteria were inability to understand English or identify hypoglycaemia, severe psychiatric illness, and pregnancy. 136 patients (80%) completed baseline and …

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  • Source of funding: Diabetes UK.

  • For correspondence: Dr S Heller, Clinical Sciences Centre, Northern General Hospital, Sheffield, UK. s.heller{at}

  • A modified version of this abstract appears in ACP Journal Club and Evidence-Based Medicine.