Adults with Type 1 Diabetes

DAFNE stands for Dose Adjustment For Normal Eating

DAFNE is a comprehensive diabetes education program for adults with type 1 diabetes. In Australia, we call it OzDAFNE. People attend the program in groups of 6 to 8, and together you learn the skills to calculate how much insulin you need for the amount of carbohydrate in the food you want to eat. The program covers carbohydrate counting and adjusting insulin doses, as well as how to manage exercise, illness and hypoglycaemia. This allows more freedom in your lifestyle at the same time as improving your diabetes control.

What is OzDAFNE?

The OzDAFNE program covers three main areas:

1. Carbohydrate counting

This section teaches you how to estimate the amount of carbohydrate in the food you want to eat and then match this with an appropriate insulin dose. There are practical exercises using real food, photographs of food, food models and food packets that allow you to practice what you have learned. The nutrition topics also include snacks, recipes, eating out, alcohol and sweeteners.

2. Insulin dose adjustment

OzDAFNE teaches you how to check if your basal insulin dose is correct, and how to adjust your bolus insulin dose to match the amount of carbohydrate in the food you want to eat at each meal.

You will be asked to check your glucose levels before each main meal and before bed.

The standard target OzDAFNE glucose levels are:
Before meals Before bed Before driving Before exercise At 3 am	4.0 to 8.0 mmol/L 6.0 to 8.0 mmol/L 5.0 mmol/L or more 7.0 to 10.0 mmol/L 5.0 mmol/L or more

If you have impaired awareness of hypoglycaemia or retinopathy, we may ask you to use the upper end of these targets initially.

3. Other topics

The program also covers other topics like managing hypoglycaemia, exercise, illness, diabetes complications and goal setting. This makes it a truly comprehensive type 1 diabetes self-management program.

To see what the program involves in action, check out the videos below.

Diabetes Victoria OzDAFNE participants
Diabetes UK DAFNE participants

What is involved?

Program formats

OzDAFNE offers separate programs for people using insulin pens and insulin pumps. (Please note, not all formats may be available at all OzDAFNE centres).

OzDAFNE Pens programs

1 week program (in person) – runs Monday to Friday for one week, from 9 am to 5 pm each day.
5×1 program (in person) – runs one day a week for 5 consecutive weeks, from 9 am to 5 pm each day.
OzDAFNE@home – runs over 6 weeks with online lessons and weekly half-day Zoom group meetings.

OzDAFNE Pump programs

1 week program (in person) – runs Monday to Friday for one week, from 9 am to 5 pm each day.

About the program

To get the most out of the OzDAFNE program, you will need to attend all sessions. You may need to take time off work, study, or other commitments. We can give you a letter for your employer that explains the OzDAFNE program and its benefits for your health. This may help you get time off work to attend the program.

The cost to attend an OzDAFNE program varies between locations. This is because there are different funding levels and running costs at each OzDAFNE centre. Please contact your local OzDAFNE centre directly to find out how much their programs cost.

Before the program

Before the program starts, you will need to attend a 1.5-hour appointment with the OzDAFNE Facilitator running the program. At the appointment, we will give you more information and talk about any changes you may need to make before the program begins. You will need to have some blood and urine tests done, fill in a few questionnaires, and answer some questions about your diabetes management and your general health. All information that is collected about you will be kept confidential and securely filed to meet legal requirements. It will only be passed on to your endocrinologist, doctor, or other members of your diabetes care team if you give us permission to do so.

Before the program starts, we will ask your endocrinologist or treating doctor to complete a form giving their approval for you to attend the program. Therefore, it is important that you have talked to them about your interest in OzDAFNE. Your doctor can contact their local OzDAFNE centre or the OzDAFNE Project Officer for more information about the program.

After the program

There are also review sessions for your group after you have finished the OzDAFNE program. Review sessions last for about 3 to 4 hours and are a good way to catch up with your group members. You can talk about any improvements or issues that you have had since the program finished. Review sessions are held at 6 weeks, 6 months, and 12 months after your program. We will look at your diabetes management and general health again at the 12-month review session. By looking at your pre-program and 12-month information, we will be able to see the difference that OzDAFNE has made to your diabetes management.

Is OzDAFNE for me?

The OzDAFNE program may not be right for all people with type 1 diabetes. Below is a list of criteria that may help you decide if OzDAFNE is right for you. We also suggest that you talk to your endocrinologist or treating doctor about your interest in the program.

To attend OzDAFNE, you need to:

Have type 1 diabetes
Be 18 years or older
Be using multiple daily injections of insulin or an insulin pump
Be willing to check and record your glucose levels at least four or five times a day
Be prepared to adjust your own insulin according to what you eat, your glucose levels, and other factors (for example, exercise)
Be able to attend the complete program
Be able to speak, understand and read English

We will need some information about your current diabetes management and your general health, including:

Your latest HbA1c result, and other blood and urine test results
Any complications you have as a result of your diabetes
Whether you are pregnant or trying to become pregnant
The contact details for your endocrinologist or treating doctor. We will ask them for your medical history, and their consent for you to attend the program.

If you have any questions about whether the OzDAFNE program would be suitable for you or would like to book into a program, please contact your local OzDAFNE centre or the OzDAFNE Project Officer.

Feedback from participants

Over 4000 people have completed an OzDAFNE program in Australia, New Zealand, and Singapore. We collect feedback from all of our participants, as we love to hear what they have to say.

Read some comments from people who have completed the program.

What do participants have to say about OzDAFNE?

We asked Tony some more detailed questions about his experience with OzDAFNE.

Check out what he had to say about the program:

People express their thoughts about OzDAFNE in many different ways.

Andrew wrote us a poem about the difference OzDAFNE has made to his life.

Do you have something to share?

If you are an OzDAFNE graduate who would like to submit your feedback, please contact the OzDAFNE Project Officerwith your comments, poems, songs, whatever!

Frequently Asked Questions

Where is my nearest OzDAFNE centre?

How much does it cost to do an OzDAFNE program?

I have been adjusting my own insulin for years, so what is different about OzDAFNE?

Some people are already adjusting their own insulin doses. However, they may be basing their decisions on their blood glucose levels alone rather than also taking into account what they eat. DAFNE teaches carbohydrate counting skills that take the guesswork out of insulin dose adjustment. This lets you quickly build up the confidence to make changes to your doses as needed.

Confidence in adjusting your insulin is not the only benefit of going to a DAFNE course. There are many other topics covered during the five days including:

How to manage hypoglycaemia.
How to manage illness.
How to adjust insulin for sport and exercise.
Preventing complications.

People who have done the course also say that one of the best things they got out of the program was the chance to meet others with type 1 diabetes and share their experiences.

What happens if I can't get time off work to do the program?

We understand that sometimes it is hard to take five full days off work, study or other commitments. Managing diabetes already takes many hours out of people’s working lives. The DAFNE program may help to reduce this amount of lost work time. For example, DAFNE has been shown to improve blood glucose control, which lowers the risk of long-term complications. It can also decrease the risk of severe hypos. In turn, this means that you should not have to take as much time off work.

Some employers let people have paid leave to go to the course, while other people take annual leave for the five days. We can give you a letter for your employer to help you get the time off. This letter explains the DAFNE program and the benefits that it may have for your diabetes management.

What if OzDAFNE isn't for me?

It is important that you are able to manage your health in a way that you are comfortable with. Some people who have done the course have decided not to keep using the DAFNE approach. However, these people still found the course very useful and they still use some of the principles they learned to help them manage their diabetes.

Why can't I do OzDAFNE by myself? Do I really need to go to a group program?

The DAFNE program has been tested as a five-day group education course. This is the format that has been most successful in trials in Europe. Other ways of delivering the course could be successful for some people, but this hasn’t been proven yet.

The five-day intensive course format means that you can receive diabetes-specific education without the distractions of everyday life. It also lets you talk about your progress each day with ongoing support from experienced health professionals. The group format of the program means that you can meet others with type 1 diabetes, and can share and learn from each other’s experiences during the course. Many DAFNE graduates say that the group sharing was the part of DAFNE that they learned the most from and enjoyed the most!

My glucose control (HbA1c) is already pretty good. Do I still need to do OzDAFNE?

Better blood glucose control is only one of the benefits of DAFNE. Research about the DAFNE program shows us that DAFNE can improve your quality of life. It can also reduce the risk of severe hypoglycaemia by helping you get your hypo symptoms back if you have lost them. DAFNE can give you new ideas to help manage illness, exercise, and hypoglycaemia too.

If my glucose is lower, won't I have more hypos?

We know that 1 or 2 mild hypos a week are not unusual and this is a normal part of living with diabetes. However, research into the Australian DAFNE program (OzDAFNE) has shown that severe hypos happen less often after a person has done a DAFNE course. The program may also bring back your hypo awareness symptoms. This lowers your risk of having a severe hypoglycaemic episode (where you need someone to help you treat the hypo).

Is it dangerous to change my insulin doses?

No. The DAFNE program is delivered over five days with support from experienced Credentialled Diabetes Nurse Educators and Accredited Practising Dietitians. Your endocrinologist or doctor must agree for you to participate, and we keep them informed of any changes that you make during the program.

The DAFNE program teaches you how to make changes to your insulin one step at a time, based on the patterns of your blood glucose results. During the DAFNE course, you will practice adjusting your insulin doses at lunch time with the group and with guidance from the DAFNE health professionals. You will also talk about your experiences at evening meal times. This means that you will have many opportunities to practice adjusting your insulin doses, as well as hearing about the experiences of other members of your group.

I have type 2 diabetes - would OzDAFNE be suitable for me?

The DAFNE program was designed for people with type 1 diabetes. There are major differences between type 1 and type 2 diabetes – lifestyle changes are much more important in type 2 diabetes. It is true that people with type 2 diabetes who use insulin may benefit from the DAFNE principles for insulin adjustment. However, the DAFNE program as a whole would need to be significantly changed to make it suitable for people with type 2. If you have type 2 diabetes, we suggest that you speak to your diabetes care team about education programs that would suit your personal needs.

Is OzDAFNE suitable for children or teenagers with type 1 diabetes?

DAFNE was designed as a program for adults with type 1 diabetes, using adult learning and education principles, and covering adult topics. In this format, it is not suitable for children or teenagers under 18 years old.

However, we do know that some of the DAFNE principles are useful for children and teenagers under 18 years old. In 2012, Diabetes Australia – Vic received an Australian Commonwealth Government grant to design and run a new program for 14 to 18 year olds that is based on the adult DAFNE program. This program is called Teens Empowered to Actively Manage Type 1 Diabetes, or TEAM T1. Read more about TEAM T1.

A short history of OzDAFNE

Beginnings in Germany

A five day structured training program was created in Germany in the 1980s. It was designed by the diabetes team at the Diabetes Centre in Dusseldorf, led by the late Michael Berger. This inpatient program focused on intensive insulin therapy and the self-management of type 1 diabetes (references 1 – 3).

The educational approach is based on the Assal model of “therapeutic education” (4). People learn to match their insulin dose to their food on a meal-by-meal basis. The aim is that they can keep healthy blood glucose control without a higher risk of severe hypoglycaemia. They can then continue this with minimal support from their diabetes team.

Across to the UK

In 1998, the Dose Adjustment For Normal Eating (DAFNE) Project in the UK looked at creating a course based on the Dusseldorf model. The main change was that people would attend the course on an outpatient basis (5). A similar outpatient course was developed in Graz, Austria, led by Thomas Pieber (6). The Austrian course produced equally successful 12-year outcomes to those shown by the Dusseldorf model in Germany (7). This approach has now been widely adapted and developed across Europe.

The UK-based DAFNE Study Group translated the curriculum and carried out a randomised controlled trial of the Dusseldorf approach. The results showed significant improvement in glycaemic control, without increased risk of severe hypoglycaemia. Participants’ quality of life and treatment satisfaction were also significantly improved (5). Over 15,000 people with type 1 in the UK have now done a DAFNE course.

Down under to Australia

Diabetes teams from Victoria, Queensland and Western Australia visited the UK for DAFNE Educator training in November 2004. These teams started to run DAFNE courses in Australia for people with type 1 diabetes in 2005. Over 2000 people have now completed the course in Australia.

In Australia, we call the program OzDAFNE. There are now OzDAFNE courses in most Australian states. OzDAFNE has also spread to nearby countries like New Zealand and Singapore. Click the link to find your nearest OzDAFNE centre.

Reference List

1. Mühlhauser, I., Jörgens, V., Berger, M., Graninger, W., Gürtler, W., Hornke, L., Kunz, A., Schernthaner, G., Scholz, V., & Voss, H.E. (1983) Bicentric evaluation of a teaching and treatment programme for type 1 (insulin-dependent) diabetic patients: Improvement of metabolic control and other measures of diabetes care for up to 22 months. Diabetologia 25:470-476.
2. Mühlhauser, I., Bruckner, I., Berger, M., Cheta, D., Jörgens, V., Ionescu-Tîrgoviste, C., Scholz, V., & Mincu, I. (1987) Evaluation of an intensified insulin treatment and teaching programme as routine management of type 1 (insulin-dependent) diabetes. The Bucharest-Düsseldorf Study. Diabetologia 30:681-690.
3. Bott, S., Bott, U., Berger, M., & Mühlhauser, I. (1997) Intensified insulin therapy and the risk of severe hypoglycaemia. Diabetologia 40:926-932.
4. Assal, J.P., Mühlhauser, I., Pernet, A., Gfeller, R., Jörgens, V., & Berger, M. (1985) Patient education as the basis for diabetes care in clinical practice and research. Diabetologia 28:602-613.
5. The DAFNE Study Group. (2002) Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: the dose adjustment for normal eating (DAFNE) randomised control trial. BMJ 325:746.
6. Pieber, T.R., Brunner, G.A., Schnedl, W.J., Schattenberg, S., Kaufmann, P., & Krejs, G.J. (1995) Evaluation of a structured outpatient group education program for intensive insulin therapy. Diabetes Care 18:625-630.
7. Plank, J., Köhler, G., Rakovac, I., Semlitsch, B.M., Horvath, K., Bock, G., Kraly, B., & Pieber, T.R. (2004) Long-term evaluation of a structured outpatient education programme for intensified insulin therapy in patients with type 1 diabetes: a 12 year follow-up. Diabetologia 47:1370-1375.
8. Howorka, K. (1996) Functional insulin treatment. Berlin: Springer.

Does OzDAFNE work?

The DAFNE program has now been evaluated in a number of countries. Participants have seen improvements in a variety of key diabetes management areas. The following benefits have been shown in both Australia and the United Kingdom:

Improved HbA1c (blood glucose control)
Reduced diabetes distress, depression and anxiety symptoms
Increased dietary freedom
No weight gain
No increase in blood fats
No increase in severe hypoglycaemia (In Australian studies of OzDAFNE we have found that severe hypoglycaemia has been reduced).

Below is a brief summary of the findings of some key DAFNE research papers.

DAFNE Study Group.

(2002) 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. BMJ; 325:746.

The DAFNE Study Group set up a randomised controlled trial to evaluate the DAFNE program in the UK. The program was based on the Dusseldorf model of intensive insulin therapy (read more). It was translated to English and run as an outpatient course in three clinics across the UK during the trial.

The trial demonstrated that DAFNE was effective over a short-term (12 month) period. Specifically, the HbA1c of participants significantly decreased from baseline to the 12 month mark (a mean difference of 0.5%). This improvement occurred without a significant increase in severe hypoglycaemia. Cardiovascular risk factors did not worsen despite the increased dietary freedom reported by participants. The trial results also showed significant improvements for participants’ psychological well-being, quality of life, and satisfaction with treatment.

Speight J, Amiel SA, Bradley C, Heller S, Oliver L, Roberts S, Rogers H, Taylor C, Thompson G.
(2010) Long-term biomedical and psychosocial outcomes following DAFNE (Dose Adjustment For Normal Eating) structured education to promote intensive insulin therapy in adults with sub-optimally controlled Type 1 diabetes. Diabetes Research & Clinical Practice; 89:22–29.

This research aimed to assess the long-term outcomes for participants in the original DAFNE trial. Participants provided follow-up data at an average of 44 months after their DAFNE course. The results showed that the improvement in HbA1c reported at 12 months (0.5%) had deteriorated slightly to 0.32% at 44 months but this was still statistically significant.

On the other hand, the positive psychological outcomes reported at the 12 month point were fully sustained at 44 months. These improvements were maintained in areas such as the impact of diabetes on dietary freedom, the impact of diabetes on quality of life, and present quality of life.

The authors concluded that DAFNE “offers major long-term benefits for quality of life outcomes and treatment satisfaction and more modest long-term benefits for glycaemic control”.

McIntyre HD, Knight BA, Harvey DM, Noud MN, Hagger VL, Gilshenan KS.
(2010) Dose Adjustment for Normal Eating (DAFNE) – an audit of outcomes in Australia. Medical Journal of Australia; 192(11):637–640.

The aim of this research was to assess the short-term outcomes for participants in the DAFNE program in Australia. At 12 months post-course, the mean HbA1c of participants had fallen from 8.2% to 7.8% (a decrease of 0.4%). Overall, the decrease in HbA1c was found to be greater for those participants whose baseline HbA1c was the highest pre-course. The incidence of severe hypoglycaemic episodes decreased in Australian DAFNE participants. This is different to the earlier UK DAFNE studies, which showed no change in severe hypoglycaemia post-course. The Australian DAFNE audit also showed improvements in diabetes-related distress, and anxiety and depression symptoms.

Current DAFNE research

The DAFNE Collaborative is strongly committed to research and development to improve the DAFNE program. The DAFNE Research Group is currently working on a number of studies and research programs. Some of these are listed below. You can read more about further studies by visiting the UK DAFNE website.

Australian research & projects

TEAM T1 – Teens Empowered to Actively Manage Type 1 Diabetes

TEAM T1 is a five-day group education program designed for teenagers aged 14 to 18 years with type 1 diabetes. It has been adapted for adolescents from the DAFNE program for adults with type 1 diabetes.

A pilot version of the TEAM T1 program was run at three Australian locations in 2009 and 2010, with 19 teenagers. Results showed that the program was acceptable and helpful for teenagers and their parents. Most participants had improved HbA1c levels 3 months after the program. They also reported improved confidence to manage their diabetes and less diabetes-related distress.

Another 5 years of funding for TEAM T1 was received from the Australian Government under the Chronic Disease Prevention and Service Improvement Fund. However unfortunately this program funding has now expired and there are currently no centres in Australia running TEAM T1 programs.

UK research & projects

Trial of 5-day vs 5-week DAFNE format

Research has shown that delivering DAFNE over a consecutive 5-day period is very effective. However, some people are unable to attend a full week program, and so miss out on doing a DAFNE program altogether. DAFNE in the UK responded to these requests by trialling an “intermittent” delivery format. These programs were delivered one day per week over five weeks (5-week DAFNE).

This research showed that there were no significant differences in outcomes for people who attended the standard 5-day programs compared with the 5-week programs. Both groups had similar improvements across all biomedical and psychosocial areas included in the study. The team concluded that both program formats should be made available.

As a result of these research findings, a number of Australian OzDAFNE centres introduced the 5-week format. Check directly with your preferred centre to see if they are offering this format.

REPOSE: Relative Effectiveness of Pumps Over MDI and Structured Education

Insulin pumps are sometimes seen as the ‘gold star’ method of delivering insulin to people with type 1 diabetes. This research looked at the effectiveness of pumps in comparison to multiple daily injections of insulin. One study group received the standard DAFNE program for people using MDI therapy. The second study group received DAFNE education that was adapted for people using pump therapy.

This study showed that both groups had improvements in their diabetes management, and that pump treatment was not significantly better than multiple daily injections when DAFNE training was used. Read the full article explaining the results here.

Irish research & projects

Ongoing care post-DAFNE

Research has shown that ongoing support assists with improving outcomes from education programs. The Irish DAFNE Study Group looked at two different methods of follow-up care after a DAFNE course. Their research also looked at economic concerns and the qualitative experiences of participants in both study groups. For more information about the results and outcomes of this research, please see the list of published articles and abstracts, or contact Professor Sean Dinneen.

OzDAFNE graduates

In this section there is information on:

The OzDAFNE ketone and illness guidelines
How to order a replacement OzDAFNE Tracker (Diary) or Carbohydrate Portion List
Get involved in OzDAFNE!

We are always looking for new ideas. Please let us know if you have any thoughts on topics you would like to see in the OzDAFNE graduate section of this website.

OzDAFNE ketone and illness guidelines

Follow the OzDAFNE ketone and illness guidelines:

At the first sign of feeling unwell, even if your BGLs are in target
When your blood ketones are 0.6 mmol/L or more, even if you feel well
When your BGL is 15.0 mmol/L or more for over 6 hours, even if you feel well

The OzDAFNE ketone and illness guidelines must be used whether it is day or night.

The OzDAFNE ketone and illness guidelines are based on ketone checking. If you are not able to check your ketones, you must get medical help so that ketones can be checked for you and treatment given as needed.

Make sure that you always have in-date blood ketone test strips.

Click the link to download the latest OzDAFNE ketone and illness guidelines (December 2019)(PDF).

You can also download an extended OzDAFNE Tracker page to help you record the extra BGL and ketone checks (PDF).

Need more help?

If you are feeling too unwell to follow these guidelines or you are not sure what to do then contact your doctor or diabetes educator, or call the Emergency Department of your nearest hospital to ask their advice.

Contact your OzDAFNE Facilitators if you would like to talk about the OzDAFNE ketone and illness guidelines, or another aspect of OzDAFNE and your diabetes management. You can contact your local OzDAFNE centre directly or fill in the Contact Us form with your location and we will put you in touch with a Facilitator near you.

The NDSS Helpline (1800 637 700) is also available if you want to talk to a health professional about any aspect of managing your diabetes.

OzDAFNE resource ordering

OzDAFNE provides graduates with extra copies of the OzDAFNE Tracker (Diary) for free. Each Tracker lasts for about 6 months.

There are a number of options to order extra copies of the Tracker.

Contact your local OzDAFNE centre. They sometimes have copies that they can give to you.
Click here to place an order.

If you have any questions or problems with ordering, please contact the OzDAFNE Project Officer.

Get involved with OzDAFNE

We are always looking for graduates who are happy to tell us about their OzDAFNE experiences. We want to make the OzDAFNE program as great as it can possibly be. This feedback helps us make changes to improve the course and the experiences of people who attend the program. It gives us the opportunity to promote the OzDAFNE program to people with diabetes and health professionals. It also helps us approach various funding bodies with an aim to make the program available to as many people as possible.

There are a number of ways that you can get involved in helping us. You could:

Be interviewed about your OzDAFNE experience (either on video or in written format)
Write a page or paragraph or blog about OzDAFNE that we can use on this website, in newsletters or in funding applications.
Tell health professionals about your experience at one of our health professional workshops.
Be a mentor to people who are thinking about doing OzDAFNE, or other graduates who may need some support.
Be a ‘case study’ – letting our OzDAFNE Facilitators follow your progress and report on this at conferences in Australia and overseas.
Simply help spread the word. Tell people about your experience with OzDAFNE.

If you are happy to volunteer some time to get involved in the OzDAFNE community, then please let us know! Feel free to contact your OzDAFNE centre or contact the OzDAFNE Project Officer for any current opportunities in your area.

TEAM T1 program for teens with T1 diabetes

Please note: there are currently no centres in Australia running TEAM T1

What is TEAM T1?

TEAM T1 stands for Teens Empowered to Actively Manage Type 1 Diabetes.

TEAM T1 was designed for teenagers aged 14 to 18 years old, and was based on the adult DAFNE program. The program was run over 5 days (10am to 3pm) in a small group of 6 to 8 people. It was run by a diabetes educator and dietitian trained in type 1 diabetes management.

TEAM T1 taught young people the skills to work out how much insulin they needed for the amount of carbohydrate in the food they wanted to eat. It also taught them how to manage hypos, how to manage above-target blood glucose levels, and how to adjust food and insulin for exercise.

The emphasis of the program was on self-management, problem-solving, and building confidence to help prepare young people to manage their diabetes as they leave school and move to work, study, and adult diabetes care.

There was also a two day parent support program for parents of young people who were participating in a TEAM T1 program, which was held on the Monday and Friday of the TEAM T1 program. The parent program included information about insulin adjustment, carbohydrate counting, hypoglycaemia, exercise and sick day management and how to support their teenager with diabetes as they transitioned to adulthood.

The TEAM T1 program was originally funded by the Australian Government under the Chronic Disease Prevention and Service Improvement Fund. The initial TEAM T1 project funding lasted for 5 years.

Unfortunately the project funding has now expired and there are currently no centres in Australia running the TEAM T1 program.

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