Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial

The DAFNE study (1) was not a fair clinical trial, because there was
no control intervention in the control (waiting) group. I wonder what
would have happened to the HbA1c level of the control patients if they,
too, had enjoyed a five- day teaching and treatment course to improve
their current insulin regime, liberalize their diet, reinforce their
knowledge and strengthen their motivation. Simply being recruited for a
waiting cohort may include patients who were sent to jail while on the
list (which happened during one of the former Düsseldorf-Bucharest studies
in former communist Roumania as I was told). Reinforcemend of a given
diabetic treatment improves HbA1c, as does lifestyle intervention (2).

Dietary freedom, i.e. freedom from unfounded outmoded dietary
prescriptions (3) may also be provided with more conventional insulin
regiments. Thus, DAFNE may be good for some people, but other approaches
may be good as well for other people. There are many ways leading to Rome.

1) DAFNE Study Group. Training in flexible, intensive insulin management
to enable dietary freedom in people with type 1 diabetes: dose adjustment
for normal eating (DAFNE) randomized controlled trial. Br.Med.J.2002;
325:746-9

2) Perry TL, Mann JI, Lewis-Barned NJ et al. Lifestyle intervention in
people with insulin dependent diabetes mellitus (IDDM). Eur J Clin Nutr
1997; 51:757-63

3) Diabetes and Nutrition Study Group (DNSG) of the European Association
for the Study of Diabetes (EASD) 2000: Recommendations for the nutritional
management of patients with diabetes mellitus. Eur J Clin Nutr 2000; 54:
353 - 55