Study Results

On this page you will find the study results from the DAWN™ study. You can quick-navigate the page by using the "table-of-contents" menu on the right side of the page

1. Study Background
The DAWN™ Programme was created because more than half of people with diabetes do not achieve good health and quality of life, despite the availability of effective medical treatments.

Filling knowledge gaps
Although a considerable amount of psychosocial research had been carried out which pointed to psychosocial issues as the reason for poor outcomes, there were no large, truly global studies to map the problem.
Important gaps in knowledge existed, particularly concerning data which would (a) allow for international comparisons of management approaches to diabetes, (b) examine the complex relationships between the stakeholders – people with diabetes and their families, the physicians, the nurses and their support teams, and (c) enable policy makers and other stakeholders to recommend changes where needed.

The DAWN™ (Diabetes Attitudes Wishes and Needs) study in 2001 was a massive collaborative undertaking involving Novo Nordisk, the International Diabetes Federation and an international expert advisory board – the largest diabetes study of its kind ever conducted.

2. Study objectives
The objectives of the DAWN™ Study were:

• To increase the understanding of patient perceptions surrounding diabetes
• To develop insights into the attitudes and responsibilities of policy makers and caregivers
• To identify areas for improvement in the psychosocial management of diabetes
• To identify the most important psychosocial barriers and solutions to more effective self-management of the disease across the world
• To provide doctors, nurses and policy makers with information to help decision-making and the development of national diabetes care programmes
• To identify areas where it is critically important to improve collaborations between the parties involved in diabetes management

3. Facts & figures
The DAWN™ study 2001 is to date the largest global psychosocial diabetes study of its kind, addressing the perceptions and attitudes of more than 5,000 people with diabetes and 3,000 healthcare diabetes professionals in a total of thirteen countries.

To ensure the highest possible scientific quality of the DAWN™ Study, an international scientific advisory panel was convened under the chairmanship of Professor Sir George Alberti, then president of the International Diabetes Federation (IDF).

The study involved:

• 5,426 adults with diabetes
• 2,194 primary care physicians
• 556 specialists (endocrinologists, diabetologists)
• 1,122 nurses (specialist and general)
• The people with diabetes interviewed were self-classified as 50% Type 1 and 50% Type 2.
• The 13 countries involved were: Australia, Denmark, France, Germany, India, Japan, The Netherlands, Norway, Poland, Sweden, Spain, UK and USA.

The research consisted of face-to-face or telephone interviews depending on the country, the culture and telephone penetration rate. Interviews were on average 30-50 minutes in length.

The study was conducted at a single point of time in mid-2001, and is qualitative rather than epidemiological, helping healthcare professionals and policy makers to set priorities for further research.

4. Summary key findings
The DAWN™ study provided a wealth of information which is being used for teaching and training purposes around the world. It confirmed the importance of the following factors for improving health and life quality for people with diabetes (Practical Diabetes International 2004):

• Enhance communications between people with diabetes and healthcare providers
• Promote team-based diabetes care
• Promote active self-management
• Overcome emotional barriers to effective therapy
• Enable better psychological care for people with diabetes

5. Enhance communications
The DAWN™ study showed that healthcare providers:

• Feel they have insufficient time for dialogue with their patients
• Often perceive the difficulties of managing diabetes very differently to patients
• Were interested (>60% response) in improving communication with their patients

(DAWN™ study 2001, Data on File, Novo Nordisk)

6. Promote active self-management
The DAWN™ study showed that:

• Most of the people with diabetes who were questioned said they did not follow all the treatment recommendations given by their healthcare professional.
• Many patients think their diabetes is demanding and prevent them from doing what they want.
• Healthcare providers recognize that psychosocial issues strongly influence how well patients manage their diabetes.

(DAWN™ study 2001, Data on File, Novo Nordisk)

7. Team-based care
The DAWN™ study showed that:

• Less than half of people with diabetes in the study believe that their problems are discussed between members of the healthcare team.
• Healthcare professionals generally recognize that more communication is needed within the diabetes team.
• Nurses could play a key role in increasing the active involvement of the patient in the care process.

(DAWN™ study 2001, Data on File, Novo Nordisk)

8. Barriers to treatment
The DAWN™ study showed that:

• More than half of people with Type 2 diabetes are worried about starting insulin.
• Half of them believe that starting insulin means they have failed to manage their diabetes.
• Only one of out five believe insulin would help them manage their diabetes better.
• A third of physicians postpone insulin until "absolutely essential".

References:

• Geelhoed-Duijvestijn, P. et al "Physician Resistance to Prescribing Insulin: An International Study." Diabetologia, 2003.
• Peyrot, M. et al "An International Study of Psychological Resistance to Insulin Use among Persons with Diabetes." Diabetologia, 2003.

9. Enable better psychological care for patients with diabetes
The DAWN™ study and related data showed that:

• Of those reporting, more than two in five people with diabetes report poor psychological well-being.
• Many patients experience emotional stress related to their diabetes.
• More than a third of healthcare providers do not feel equipped to adequately address patients' psychological needs.

(DAWN™ study 2001, Data on File, Novo Nordisk)

10. From study to action
The DAWN™ study provided a blueprint of what it means to live with diabetes and what challenges healthcare providers are facing in their efforts to help their patients control and manage their condition effectively. With these conclusive insights about critical needs and gaps, the DAWN™ study has proven itself an important platform for dialogue and partnerships and as a decision making tool to improve outcomes of diabetes care.

Novo Nordisk has so far organized four large international DAWN™ Summits, in 2002, 2003, 2006 and 2008, to set the stage for concerted advocacy and action.

Through the DAWN™ programme, Novo Nordisk promotes new partnerships to truly translate DAWN™ into action.