Health professionals

Health professionals must complete training to become an accredited OzDAFNE Facilitator. This training is known as the OzDAFNE Accreditation Training (OAT). To be eligible for OAT, you must:

• Be a Registered Nurse and Credentialled Diabetes Educator (RN-CDE) or an Accredited Practising Dietitian (APD), or the equivalent in your country if outside Australia
• Have clinical experience working with people with type 1 diabetes
• Be committed to the philosophy of self-management and freedom to eat
• Be committed to the principles of OzDAFNE
• Be an effective communicator
• Preferably have had experience in facilitating group programs
• Work at an existing OzDAFNE centre or work in a diabetes service that meets the criteria for becoming a new OzDAFNE Centre

In order to become and to remain an accredited OzDAFNE Centre, your diabetes service must:

• Have strong management support to introduce and run OzDAFNE. This includes assigning sufficient staff time, resources and funding for:
  • The 5-day OzDAFNE in person programs and/ or OzDAFNE@home programs
  • Pre-program appointments for participants
  • Half-day follow-up sessions 
  • Administration
• Identify at least one Registered Nurse – Credentialled Diabetes Educator to complete the OAT
• Identify at least one Accredited Practising Dietitian to complete the OAT
• Ideally, you will also have a diabetes specialist or doctor who supports OzDAFNE in your service
• Pay the fee for initial training and resources
• Pay the yearly OzDAFNE Collaborative membership fee ($200 in 2024)
• Abide by the OzDAFNE Collaborative guidelines regarding ownership of intellectual property and the use of OzDAFNE resources
• Ensure that your OzDAFNE Facilitators complete the OzDAFNE Quality Assurance Program requirements. This includes:
  • Delivering the curriculum to a high standard
  • Completing a yearly internal peer review
  • Running the minimum number of courses per year as required

The OAT is a four-part structured training course. It enables trainees to become accredited OzDAFNE Facilitators. A short description of each part of the OAT is below.

STEP 1 – Observation of a 5-day in-person OzDAFNE program

Trainees observe a full 5-day OzDAFNE program in person. Experienced OzDAFNE Facilitators deliver the program. Trainees complete several exercises during the observation.

STEP 2 – Online learning

Trainees complete online lessons covering OzDAFNE principles including insulin dose adjustment, use of corrections, hypoglycaemia, ketone and illness guidelines and prevention of complications. Nutrition sessions include carbohydrate identification and counting, label reading eating out, physical activity, managing alcohol and group facilitation.

STEP 3 – Live workshop

Following completion of online learning sessions, trainees attend a live 1 day workshop. The workshop reviews the OzDAFNE principles, discusses how to deliver the OzDAFNE curriculum, and how to run the program in a diabetes service. Workshops are held in Melbourne or online as needed.

STEP 4 – Delivery of a 5-day in-person OzDAFNE program and Peer Review

Trainees deliver their first 5-day OzDAFNE program at their service. They receive peer support from an experienced OzDAFNE Facilitator.

The competency of the trainees is assessed by an experienced OzDAFNE Facilitator during delivery of their first program. 

The trainee is accredited as an OzDAFNE Facilitator once they finish the OAT. Each OzDAFNE Facilitator must then complete all quality assurance requirements each year to remain accredited.

Please contact the OzDAFNE Project Officer if you or your diabetes service is interested in training. We can give you more information about becoming an OzDAFNE Facilitator or OzDAFNE centre. Otherwise, you can come along to one of our OzDAFNE Health Professional Workshops. These workshops provide details about the training process and OzDAFNE in general.

You can also download our detailed Training Guidebook here.

The OzDAFNE program teaches participants to estimate the carbohydrate content of the food they wish to eat. They then match this with the appropriate bolus insulin dose. The nutrition topics are designed to teach participants how to estimate the carbohydrate content of meals using practical exercises. These include exercises with real food, photographs of food, food models and food packets. The benefits of healthy eating are also discussed in one of the sessions.

Topics covered within the nutrition section of the course include:

• The Carbohydrate Portion (CP)
• Snacking
• Estimating carbohydrates in recipes and nutritional information panels
• Eating out
• Alcohol

The Carbohydrate Portion is one of the central principles of OzDAFNE. The program works on the basis that 1 CP equals 10 g of carbohydrate. Insulin doses are then adjusted to match the number of CPs eaten on a ratio basis.

The OzDAFNE insulin regimen is based on a basal/bolus regimen, with food covered by bolus insulin. Glucose monitoring is performed before each main meal and before bed. Using standard algorithms as a starting point, the following items are considered when calculating the appropriate insulin dose:

• Current glucose result
• The results of previous glucose measurements
• Individual insulin-to-CP ratios at that meal time
• The quantity of the proposed intake of carbohydrate (number of CPs)

Participants who have retinopathy or impaired awareness of hypoglycaemia may be advised to use the higher end of these targets initially.

Participants are encouraged to keep their glucose values within the target range at the specified times. Above target pre-meal and pre-bed glucose levels can be corrected by taking extra bolus insulin. Below target pre-meal and pre-bed glucose levels can be corrected by taking less bolus insulin or eating extra carbohydrate.

The emphasis of the program is on active participation amongst the participants. The meal times of all the participants, at lunchtime while at the program for in person sessions, and at home, are used as exercises to work through using the OzDAFNE Stepwise Approach. The aim is that participants learn from their own and others’ experiences of dose adjustment during the program.

The OzDAFNE program also covers various other aspects of daily diabetes management. Participants are given advice on how to best manage hypoglycaemia. Participants are provided with sick day guidelines to enable them to manage illness safely and effectively. There are also discussions regarding how to handle physical activity, pregnancy, and future complications.

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

Please note: There are times when we may need more information before deciding if a person can attend an OzDAFNE program. Some examples are if a person has an HbA1c of greater than 12%, is pregnant, or has severe complications from their diabetes.

There are multiple papers demonstrating the effectiveness of DAFNE/OzDAFNE programs. The following are some seminal papers which provide the evidence of the effectiveness of the program. If you would like further references, please contact us via email. 

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.

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.

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.