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A New Approach to Managing Diabetes

Patients taught to adjust their insulin doses to match the foods they eat

FRIDAY, Oct. 4, 2002 (HealthDayNews) -- With some basic training in math and carbohydrate counting, people with Type I diabetes can follow a more flexible eating plan without losing control of their glucose levels or quality of life.

That's the conclusion of a study appearing in tomorrow's British Medical Journal that tested the Dose Adjustment For Normal Eating (DAFNE) program among patients in the United Kingdom. The regimen was originally developed by clinicians in Germany.

"We know that insulin and food have to be matched, and once you do that you allow the patient to be in the driver's seat to figure out what they want to eat and then how much insulin they need to cover it," says Dr. Francine Kaufman, president of the American Diabetes Association.

"For diabetes to be integrated into somebody's life, then there has to be some flexibility. We can't ask people in our society any more to eat the same thing at the same time every day and expect anybody to do that," Kaufman adds.

About 1.5 million people in the United States suffer from Type I diabetes, which occurs when insulin-producing cells in the pancreas stop working. These people must inject insulin to survive. Without adequate amounts of the hormone, blood glucose levels can soar. Over the long term, this can result in blindness, kidney failure and amputation.

In the new British study, 140 adults with Type I diabetes were randomly split into one of two groups. The first received a five-day training course in the DAFNE program, while the second received "usual care" for six months.

The course taught patients how to adjust their insulin doses to match their food, rather than the other way around -- the traditional treatment for Type I diabetes.

"The essential elements are carbohydrate counting and the skills to adjust your insulin to achieve a near-normal glucose level," says Dr. Simon Heller, co-lead author of the study.

Participants were given the basics of carbohydrate counting on the first day, then told to go home and try it out. Much of the rest of the week was involved with discussing their experiences and fine-tuning the procedures.

"They were given algorithms -- one unit of insulin per carb portion, depending on what their glucose levels were before each meal. And then they had the week to practice their skills," adds Heller, who's with the Clinical Sciences Centre at Northern General Hospital in Sheffield.

After six months, the people who had participated in the DAFNE program had improved glucose control and quality of life, the researchers found.

The high quality-of-life measures were particularly gratifying, Heller says, but they came with a price. To eat more flexibly, most patients had to inject insulin and monitor their blood glucose level more often, procedures that can be cumbersome.

"Despite more shots a day and more monitoring, they had a really positive feeling about their diabetes and felt much more in control. We were very surprised. That was the thing that blew us away," Heller says. "People felt much, much better about having diabetes and more like other people."

Although the short-term results are heartening, it remains to be seen what the long-term outcome will be, Heller says. However, researchers in Dusseldorf, Germany, found that the results were sustained over a period of three years, which, Heller says, "is quite remarkable."

In the British study, some of the patients regressed a bit toward the end of the study as their glucose levels rose slightly. The researchers speculate this may be because they were returning to a system where health-care practitioners weren't familiar with the DAFNE program.

"In retrospect, maybe they needed more back-up," Heller says.

What To Do

To learn more about diabetes, visit the American Diabetes Association or the Joslin Diabetes Center.

SOURCES: Simon Heller, M.D., Clinical Sciences Centre, Northern General Hospital, Sheffield, England; Francine Kaufman, M.D., president, American Diabetes Association, and head, division of endocrinology, Children's Hospital, Los Angeles; Oct. 5, 2002, British Medical Journal
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