The effectiveness of a "4-step" education programme on HbA _1c', weight, hypoglycaemia awareness and quality of life

Diabetes self-management education is now widely recognised as a critical element of care for all people with diabetes and is considered necessary in order to improve patient outcomes. Following the success of the DAFNE (Dose Adjustment for Normal Eating) programme, which teaches carbohydrate counting and insulin dose adjustment, many centres have developed their own programmes, including Aintree University Hospital, where the authors of this article run the "4-step" programme. Diabetes UK (2003) recommends evaluating the effects of education programmes on HbA_1c, BMI, quality of life and hypoglycaemia awareness. In accordance with those recommendations and in an effort to inform future service delivery, this article evaluates the impact of the authors' "4-step" programme.