Group follow-up compared to individual clinic visits after structured education for type 1 diabetes: A cluster randomised controlled trial

Aim: To compare the effectiveness of group follow-up with individual follow-up after participation in the Dose Adjustment for Normal Eating (DAFNE) structured education programme. Methods: Cluster randomised controlled trial involving 437 adults with type 1 diabetes attending hospital diabetes clinics in Ireland. All participants received DAFNE at baseline. Intervention arm participants received 2 group education sessions post-DAFNE and did not attend clinics. Control arm participants received 2 one-to-one clinic visits post-DAFNE. Results: We observed no significant difference in the primary outcome (change in HbA_1c) at 18 months follow-up (mean difference 0.14%; 95% CI -0.33 to 0.61; p=0.47). Secondary outcomes, including rates of severe hypoglycaemia, anxiety, depression, the burden of living with diabetes and quality of life did not differ between groups. Mean level of HbA_1c for the entire sample (regardless of treatment arm) did not change between baseline and 18 month follow-up (p=0.09), but rates of severe hypoglycaemia, diabetes related hospital attendance, levels of anxiety, depression, the burden of living with diabetes, quality of life and treatment satisfaction all significantly improved. Conclusions: Our data suggest that group follow-up as the sole means of follow-up after structured education for individuals with type 1 diabetes is as effective as a return to one-to-one clinic visits.