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

Objectives: To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes.

Design: Randomised design with participants either attending training immediately (immediate DAFNE) or acting as waiting list controls and attending “delayed DAFNE” training 6 months later.
Setting: Secondary care diabetes clinics in three English health districts.

Participants: 169 adults with type 1 diabetes and moderate or poor glycaemic control.

Main outcome measures: Glycated haemoglobin (HbA1c), severe hypoglycaemia, impact of diabetes on quality of life (ADDQoL).

Results: At 6 months, HbA1c was significantly better in immediate DAFNE patients (mean 8.4%) than in delayed DAFNE patients (9.4%) (t=6.1, P<0.0001). The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients (t=−5.4, P<0.0001), as was the impact of diabetes on overall quality of life (t=2.9, P<0.01). General wellbeing and treatment satisfaction were also significantly improved, but severe hypoglycaemia, weight, and lipids remained unchanged. Improvements in “present quality of life” did not reach significance at 6 months but were significant by 1 year.

Conclusion: Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk. This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation.

Predicting outcomes in the Dose Adjustment For Normal Eating (DAFNE) trial

Background: In the UK, DAFNE training in flexible intensive insulin therapy significantly reduced the negative impact of diabetes on quality of life (QoL) and improved blood glucose (BG) control without significantly increasing severe hypoglycaemia or body mass index (BMI). Analyses were conducted to predict who would benefit most from the generally highly successful DAFNE training and who might experience undesirable effects (e.g. weight gain).

Methods: Multiple regression was used to predict change in outcomes (6-months post-DAFNE) using baseline data: demographic, biomedical, ADDQoL (measure of the impact of diabetes on QoL), extended DTSQ (Diabetes Treatment Satisfaction Questionnaire), and other psychological measures including diabetes-specific well-being and locus of control.

Findings: Greatest improvement in ADDQoL scores was achieved by those reporting less dietary freedom and less treatment satisfaction at baseline (R2=0.21). BG improvement was predicted by higher baseline BG, lower perceived frequency of hypoglycaemia, greater expectations of DAFNE, and greater BMI (R2=0.30). Increase in BMI was predicted by less dietary freedom, DAFNE training centre, and less ‘satisfaction with insulin’ at baseline (R2=0.23).

Conclusions/Discussion: DAFNE has important benefits to offer. Lifting dietary restrictions had substantial benefits for QoL. BG improvement was predicted by baseline BG but also by expectations (perhaps reflecting greater optimism or determination). Prediction of weight gain was more complex. The influence of training centre will have involved implicit messages conveyed by Educators before and during DAFNE. While DAFNE was successful overall, outcomes are likely to be maximised for individuals if their expectations and personal goals are considered by DAFNE Educators.

Tuning fork: Shopfront

The audience of this performance got to view actions and installations building and evolving over time, and a projected time-lapse video.
In this iteration of Tuning Fork, James Cunningham & Joncli Keane continue the development of their two pronged approach to finding the watering hole of stillness and action, collabora tion and orientation.Originating from a showing in the Bell Tower II series, in the Judy's new Shopfrontspaoe, Tuning Fork will Fuks accentuate the durational aspect of movement through time-lapse video, heighten the trans formative potential of objects using three-metre long carbon rods as instruments of sense, sound and support and alter the space through the numerous tape measures which take on a life of their own. James Cunningham and Jondi Keane inhabit the Shopfront from Friday 7 November, eJqJioring, measuring, filming and projecting, in order to fine tune their interactions for the performance season commencing 19 November.

Promoting "critical awareness" and critiquing "cultural competence" : towards disrupting received professional knowledges

There is a compelling argument that universities should be committed to advancing the Indigenous agenda. With respect to social work, as well as to nursing, psychology, and allied health, this commitment is often translated into a single goal: that graduates should be ‘‘culturally competent’’. While acknowledging that there can be tactical advantages in pursuing this goal the current paper develops a practical critique of the expectation that cultural competence is an unproblematic ‘‘add on’’ to professional education. Using a single case study as an example*how the subject ‘‘individual development’’ is transmitted as a monocultural and unproblematic formation*we argue that it is impossible to learn to work cross-culturally without developing a capacity for reflective self-scrutiny. Less likely to be a flag of convenience than ‘‘cultural competence’’, an allegiance to ‘‘critical awareness’’ prompts the interrogation of received knowledge, for example how human development and personhood is understood, as well stimulating an engagement in the lifelong process of reflecting on one’s own ideological and cultural location.

Transcendental Priority and Deleuzian Normativity. A reply to James Williams

I am grateful that someone whose work I greatly admire could be the philosopher to so eloquently and succinctly cut to the heart of the problem that I posed in the previous issue of Deleuze Studies. James Williams' critical reply leaves me, prima facie, confronted by a stark alternative: either I have misunderstood Deleuze, or I have illustrated problems and lacunae in Deleuze. I will suggest, however, that this is a false alternative, and that Williams' and my divergent accounts of The Logic of Sense – and even Deleuze's oeuvre as a whole – is better understood as a situation of ‘both/and’ rather than ‘either/or’, and hence that my interpretation of Deleuze isn't wrong, but necessarily iconoclastic.

Interview with James Kaiulo

James Kaiulo is a Papua New Guinean who studied at Macquarie University in 1985-1990. He studied on an Australian International Development Assistance Bureau (AIDAB) Scholarship and completed a PhD in Biological Sciences. The interview was conducted in English on 12 February 2015 by Dr. Jonathan Ritchie of Deakin University. This set comprises: an interview recording, and a timed summary.