A new programme launched by Singapore General Hospital (SGH) will change the lives of type 1 diabetes patients and give them the freedom to manage their diabetes rather than let it manage them.
The programme called DAFNE, or Dose Adjustment for Normal Eating, is a five-day course that teaches diabetic patients self management and how to match their insulin to the amount of carbohydrate that they eat. SGH is the only centre in Asia to offer the programme.
Many type 1 diabetics already have multiple injections each day, but they match their food to their insulin. The difference with DAFNE is that patients choose how much insulin to take on a day-to-day and meal-to-meal basis. This means they can eat what they like and, more importantly, when they like. They can even skip or delay a meal if they choose.
Patients are taught to estimate the amount of carbohydrate value of foods they eat using a carbohydrate portion booklet and inject the right dose of insulin according to what they eat. The booklet, specially produced by the SGH team for use in Singapore and SouthEast Asia, has a list of some well-loved local foods such as bubor cha-cha, chapatti, otah bun and yellow noodles.
This is in contrast to what doctors typically advise patients with type 1 diabetes – to eat at about the same times each day and be consistent with the types of food they choose as it prevents blood sugar from becoming extremely high or low.
“The DAFNE programme will change the way diabetes care is delivered as it introduces a new model of care which emphasises self-management and group follow-up,” said Dr Goh Su-Yen, Consultant, Department of Endocrinology and Director, SGH Diabetes Centre.
“Prior to DAFNE, there was no structured programme in Singapore to educate patients with type 1 diabetes on how they can manage their own condition. In fact, many are not used to self-management and still rely on their doctors to help them do so,” said Dr Goh.
The team had also discovered that diabetic patients in Singapore may not need as much insulin as they tend to be more insulin sensitive than previously thought. Some patients even had their insulin dose reduced by 25 to 40 per cent.
Results from the thousands of people with type 1 diabetes who completed DAFNE in the United Kingdom, Republic of Ireland and Australia have shown that they have better blood glucose control, fewer severe hypos and improved quality of life after attending DAFNE. They also have fewer days off work and less chance of diabetes complications that can lead to kidney failure, foot ulceration, deteriorating vision and cardiovascular disease.