Delivery of Dose Adjustment For Normal Eating (DAFNE) in the UK and Ireland 2019-2022

Background To date, evaluations of the structured diabetes education programme, Dose Adjustment for Normal Eating (DAFNE), have focused on improvements in clinical and psychosocial outcomes, however, little is known about implementation and participant attendance across centres. We compared participant profile, course delivery and retention across Irish and UK centres and patterns of course delivery pre and during Covid-19. Methods Data collected annually by DAFNE centres (01.01.2019 to 01.01.2022) were analysed. Multivariable logistic regression assessed the association between demographic (age, gender) and clinical variables (years since diagnosis; DKA requiring admission in past 12 months; severe hypoglycaemic event (hypo) in the last year), course format and country, with non-completion (attended <5 sessions). Results Overall, 6749 people attended DAFNE courses across 91 centres in 3 years. Compared to Ireland, UK-based course attendees were slightly older on average and had diabetes for longer. In 2019 (pre-Covid), 86 centres delivered an average of 10 courses per centre (range: 1 to 30). During Covid (2020) when remote format courses were first offered, 79 centres delivered an average of 5 courses per centre (1 to 15). Overall, 10% of participants did not complete. Younger age, having a severe hypo in the last year, and attending a remote course (vs. standard 5-day face-to-face) were associated with non-completion. Conclusions Course delivery varies widely across centres. This may reflect centre size and resource availability. Although participant non-completion was low, our data do not capture those who withdraw pre-course. Future work should explore barriers and facilitators of course acceptance and retention.