Barriers to Uptake of Diabetes Education (BUD1E) study

People living with type 1 diabetes need to self-care on an almost hourly basis to allow them to achieve tight glycaemic control and reduce risk of diabetes related complications. Structured education transfers skills from the healthcare professional to the person living with a long-term condition. NICE recommends attendance at structured education, particularly recognising Dose Adjustment For Normal Eating (DAFNE) as meeting all of the quality standards. DAFNE is provided across south London by most CCGs, and is usually taught over 5 days by a diabetes specialist nurse and dietitian. Despite incentivising attendance by adding it to quality and outcomes framework, National Audit Data have shown continued low uptake.

Barriers to Uptake of Diabetes Education (BUD1E) study is a three-year project part funded by HIN and CLAHRC South London. It is investigating reasons for low attendance at structured education for adults with type 1 diabetes living in Southwark and Lambeth. The project is now completed, having captured the voices of over 550 people living or working in Southwark and Lambeth with type 1 diabetes or working within the NHS.

The BUDiE study has identified key social and economic factors associated with non-attendance at DAFNE, including male gender and lower educational attainment/numeracy. The most novel findings are the identification of four types with specific characteristics preventing their attendance at DAFNE. These characteristics offer potential for targeted intervention to encourage greater access and engagement with the course.

The findings have influenced the successful bid for NHS England transformation funding to improve uptake to diabetes education courses locally. Additionally 2 other projects have been implemented. Firstly, the co-creation of, a website bringing quality assured resources into one easy to find place, to empower people with type 1 diabetes to find the information they require to self-manage their condition. Secondly, marketing strategies are being deployed to encourage attendance using the patient voice; DAFNE champions are being set up to talk to peers about their experiences of the course and allay any fears.

If you would like more information about this project, please contact Sophie Harris, Innovation Fellow at