ACBRD team: Prof Jane Speight, Dr Steve Trawley, Virginia Hagger, Dr Christel Hendrieckx, Dianna McDonald and Dr Jessica Browne.
In collaboration with: Renza Scibilia, Jane Cheney (Diabetes Australia - Victoria), Prof Tim Skinner (Charles Darwin University).
Funding: The National Diabetes Services Scheme (NDSS), an initiative of the Australian Government administered by Diabetes Australia.
There are currently more than 15,000 young Australians with type 1 or type 2 diabetes under the age of 24 years. Better understanding of the motivators, behaviours and psychological well-being of young people with diabetes will inform improvement of services and facilities for supporting self management. Building on the strong brand of the Diabetes MILES Study, this survey will investigate five main themes in a self-report internet survey of young NDSS registrants and their parents:
- Management: To identify the extent to which young people with diabetes are actively managing their condition, engaging with recommended treatment strategies and healthcare providers.
- Impact: To explore the full impact of diabetes (including its treatment and complications) on emotional well-being, specifically assessing diabetes-related distress, anxiety and depression; on family relationships, education/employment, hopes/aspirations for the future.
- Longterm Empowerment: To identify the extent to which young people with diabetes (a) feel empowered to manage their condition, (b) perceive that their health professionals are supportive, (c) have access to and have accessed appropriate healthcare resources in the past year.
- Success: To identify aspects of positive mental health associated with successful living with diabetes as well as identifying the health beliefs, values and priorities of individuals that mediate optimal outcomes.
ACBRD team: Prof Jane Speight, Dr Jessica Browne, Dr Adriana Ventura, Elizabeth Holmes-Truscott
Funding: Diabetes Australia Research Program.
In 2011, over 3,300 Australian adults participated in the Diabetes MILES Study, indicating what it is like to live with type 1 or type 2 diabetes. Participants responded to questions about their diabetes self-management, and the physical and psychological impact of the condition. Numerous presentations and publications have been developed from this study.
In 2015, we will be conducting a second Diabetes MILES study. We will be inviting people who previously took part in 2011 to again share their experiences so that we can examine their responses over time. In addition, new participants who have not previously taken part in MILES will also be invited to take the survey.
The results of this study will help us to continue to raise awareness about what it is like to live with diabetes in Australia, and to inform improvements of services and resources for supporting Australian adults with type 1 and type 2 diabetes
Led by: Dr Kylie Mosely (Australian Catholic University, NSW).
ACBRD team: Dr Jessica Browne, Prof Jane Speight
Funding: Diabetes Australia Research Trust (DART)
Regular physical activity (PA) is one of the cornerstones of diabetes management. Research has shown that engaging in regular PA reduces blood glucose levels, thus reducing the risk of diabetes-related complications. Whilst the majority of type 2 diabetes (T2DM) is managed in primary care settings, the recent Diabetes MILES – Australia study indicated that 50% of adults with type 2 diabetes never or only occasionally engage in the recommended amount of PA; and less than half of those advised about PA by their primary care health professional acted upon the advice. As such, the majority of people with type 2 diabetes are not sufficiently active and not acting on the PA advice they receive from health professionals. Using a comprehensive theory of health behaviour change, this project aims to (1) understand the factors affecting the promotion of increased levels of PA among adults with T2DM by primary care health professionals, and (2) determine whether the low levels of PA among Australian adults with type 2 diabetes are due to lack of knowledge about the importance of PA, or lack of support, motivation, or behavioural skills. The project involves a mixed method two-phase process. The two phases will run sequentially. The first phase involves focus groups and interviews with adults with T2DM and primary care practitioners. The second phase involves a large-scale survey of adults with T2DM and primary care practitioners. The findings of the study will assist in designing interventions to promote PA in adults with type 2 diabetes in primary care.
ACBRD team: Dr Jessica Browne, Dr Adriana Ventura, Prof Jane Speight
In collaboration with: Dr Kylie Mosely (Australian Catholic University, NSW).
Funding: Diabetes Australia Research Program, Pozible
Over the past few years, the ACBRD has been involved in a novel area of research, exploring the stigma that may surround diabetes. Our literature review and qualitative research studies (in type 1 and type 2 diabetes) have revealed that people experience a negative stigma due to their condition. This stigma has the potential to impact negatively on the psychological health and physical health well-being of those who experience it. However, this phenomenon is under-reported, with no validated measures of stigma developed specifically for completion by people with diabetes. We are currently developing a new measure of diabetes stigma, which will investigate various perceptions and experiences of stigma (such as negative judgement and discrimination) among people with type 1 and type 2 diabetes. It is anticipated that this new measure will help us to quantify the extent to which people with diabetes feel stigmatised by their condition, enable us to understand this phenomenon, and in turn help mitigate its negative effects
ACBRD team: Virginia Hagger, Prof Jane Speight, Dr Christel Hendrieckx
Diabetes-related distress (DRD) refers to the negative emotions and feelings arising from living with diabetes, managing the condition as well as the responses of family, friends and health professionals. In studies of adults with diabetes, DRD is twice as common as clinical depression, and appears to be a stronger predictor of poor diabetes outcomes. Depression and anxiety disorders are more prevalent in adolescents with T1D than those without diabetes, but the prevalence and impact of DRD in adolescents has not been studied extensively. Led by PhD candidate Virginia Hagger, this study aims to investigate the relationship between DRD, anxiety, and depression and the extent to which these constructs predict diabetes outcomes; to evaluate the impact of a group education program for adolescents with T1D on DRD and self-management; and to qualitatively explore adolescents’ perception of DRD after a self-management program.
ACBRD Team: Elizabeth Holmes-Truscott and Prof Jane Speight
In collaboration with the UK NIHR DAFNE Programme and the OzDAFNE advisory group.
Dose Adjustment For Normal Eating (DAFNE) is a group diabetes self-management education program for adults with type 1 diabetes. Over five days, participants learn how to calculate their insulin dose requirements based on the amount of carbohydrate in the food they want to eat, offering less guesswork, more freedom and better health.
OzDAFNE training has been available in Australia since 2005, with 19 centres currently providing DAFNE training. All OzDAFNE participants are asked to complete a short questionnaire before and 12 months after DAFNE training. In addition, medical information such as recent glycated haemoglobin (HbA1c), diabetes-related complications and insulin regimen are collected. Prof Jane Speight is a member of the OzDAFNE advisory group and leading an audit of the de-identified OzDAFNE dataset.
Prof Speight is a member of the UK DAFNE research collaborative and involved in various studies, exploring quality of life, self-management, and cost-effectiveness (see publications).
ACBRD Team: Dr Jessica Browne, Dr Christel Hendrieckx, Adriana Ventura, and Prof Jane Speight
Funding: Deakin University and Diabetes Australia-Vic
Diabetes media campaigns use a variety of strategies with the aim of raising awareness and inspiring health behaviour change at a population level. One strategy that is often employed by such campaigns includes the use of fear appeals, also known as “scare tactics”. In general health communications, evidence as to whether scare tactics actually create behaviour change is contradictory and inconclusive, with extensive evidence indicating that it may have no effect, or even cause unintended negative consequences. Very few diabetes-specific campaigns have been evaluated to determine their effectiveness. The ACBRD is conducting a literature review focusing on fear appeals in health communications to inform effective health messaging in future diabetes campaigns. By informing organisations, like Diabetes Australia-Vic, Diabetes Australia and the International Diabetes Federation (IDF), resources can be better utilised to ensure they have a positive impact on all those exposed to these messages, including people with diabetes and their families, those at risk of developing diabetes, and the general population.
Led by: Prof James Shaw (University of Newcastle, UK).
ACBRD team: Prof Jane Speight, Elizabeth Holmes-Truscott
Funding: Diabetes UK
Severe hypoglycaemia (SH) is one of the most feared complications of type 1 diabetes (T1DM) with a reported prevalence of nearly 40%. In randomized trials of multiple daily injections (MDI) and insulin pump (CSII) therapy, it appears that pumps are beneficial reducing SH. However, individuals with established SH and impaired awareness of hypoglycaemia (IAH) have often been excluded from prospective studies. In published studies investigating the effect of real-time continuous glucose monitoring (RT-CGM), benefit in terms of reduced SH has not yet been demonstrated. The primary objective of this multicentre randomised controlled trial (run in 5 centres in England) is to elucidate whether, in people with T1DM complicated by IAH, rigorous prevention of biochemical hypoglycaemia using optimized existing self-management technology and educational support will restore awareness and reduce risk of recurrent SH. The study protocol was published in BMC Endocrine Disorders. The trial results were presented at the 73rd Scientific Sessions of the American Diabetes Association (Chicago, 2013) and have been submitted for publication.
ACBRD team: Dr Jessica Browne, Laura Smith, Rachel Isaacs, Dr Christel Hendrieckx and Prof Jane Speight
In collaboration with Prof Christopher Gilfillan (Eastern Health).
Funding: Building The Evidence grant from the Department of Health and Ageing.
The Integrated Diabetes Education and Assessment Service (IDEAS) is a community health-based clinic for people with type 2 diabetes. The IDEAS clinics offer collaborative, multidisciplinary care for people with type 2 diabetes in a community setting. This differs from the traditional acute clinics which are based on a typical medical model, where various services (e.g. diabetes education, podiatry) cannot usually be accessed at the same time and same place. In contrast, the IDEAS clinics offer half-day appointments, giving people the opportunity for tailored, multidisciplinary care at the one location during the one appointment. While evidence from systematic reviews indicates that integrated care for chronic conditions has positive effects on functional health status and quality of care, the impact of this approach on other patient reported outcomes, particularly psychosocial outcomes, is unclear. Many other evaluation studies of collaborative care models for chronic conditions such as diabetes have focussed on biomedical or economic outcomes alone. The Centre, in collaboration with Eastern Health is conducting a randomised controlled study to evaluate the IDEAS model of diabetes, particularly with regard to the impact of diabetes care received at the IDEAS clinics on patient-reported psychosocial outcomes. This evaluation study is funded primarily by Whitehorse Community Health, who received a Building The Evidence grant from the Department of Health and Ageing to undertake this evaluation study.
ACBRD team: Prof Jane Speight, Jennifer Halliday, Dr Christel Hendrieckx, Dr Linda Beeney, Dr Jessica Browne and Dr Adriana Ventura
Funding: the National Diabetes Service Scheme (NDSS), an initiative of the Australian Government administered by Diabetes Australia.
International guidelines consistently recommend monitoring the psychological well-being of people with diabetes but it is not yet part of routine diabetes care. Guidelines typically convey broad recommendations without offering practical strategies for implementation. Thus, routine assessment of mental health in diabetes care is often impeded by barriers (e.g. time, resources, skills, confidence, attitudes). Peer support is valuable for assisting people with diabetes to initiate and sustain a complex and unrelenting self-management regimen, overcome feelings of isolation and improve mental health and well-being. In Australia, there is a strong need for:
practical, diabetes-specific, mental health resources and training for diabetes healthcare professionals
diabetes-specific resources and interventions for people with diabetes, which build upon existing programs and services
This NDSS national development program is addressing these unmet needs by developing:
a practical handbook for health professionals: describing mental health problems associated with diabetes, how to monitor them, how to address them during consultations, when and how to refer people with diabetes to mental health specialists, communicating about mental health in diabetes care
training for healthcare professionals to enable development of skills and strengthen confidence in discussing mental health issues
a National Diabetes and Mental Health Professional Network: to support interdisciplinary collaborative practice across Australia's primary mental health care and diabetes care sectors
resources for people with diabetes to facilitate conversations with their healthcare professionals and peers about their emotions, concerns, and diabetes-related distress e.g. online diabetes-related distress intervention and peer support model
ACBRD team: Elizabeth Holmes-Truscott and Prof Jane Speight
Approximately a quarter of people with type 2 diabetes (T2D) are unwilling to begin insulin therapy despite it being almost inevitable for the effective management of this progressive condition. This negative appraisal of insulin is known as 'Psychological Insulin Resistance'. Health professionals may also hold negative appraisals of insulin therapy, which can influence how insulin is regarded by people with T2D. Led by PhD candidate Elizabeth Holmes-Truscott, this research aims to quantify the level, and the determinants, of psychological insulin resistance in a national Australian context as well as investigate interventions to improve receptiveness to insulin among adults with T2D. This body of work will highlight barriers to insulin initiation for Australian adults with T2D as well as understanding what facilitates change in insulin appraisals.
Led by Dr Steven Trawley
ACBRD team: Dr Steven Trawley, Virginia Hagger, Prof Jane Speight
This project will develop an Australian version of the DiabetesDriving.com intervention, a low-cost educational program specifically aimed towards at-risk drivers with type 1 diabetes. The DiabetesDriving-Australia (DDA) project will consist of an online educational component combined with a small tool-kit that is kept in the car. The tool-kit contains: a pre-drive checklist, rapid-acting and long-acting glucose sources, blood glucose driving benchmark keychain and stickers, and a blood glucose meter. The DDA will be evaluated in a pilot randomised controlled trial.
Led by Dr David O'Neal (St Vincent's Hospital Melbourne / University of Melbourne) with the JDRF Overnight Closed Loop Study Group.
ACBRD team: Prof Jane Speight, Dr Christel Hendrieckx and Dr Steve Trawley
Funding: JDRF International
Type 1 diabetes requires lifelong administration of exogenous insulin via multiple daily injections or insulin pump. Today the decisions about insulin requirements are made by the person with diabetes, taking into account their blood glucose levels, food intake, physical activity, stress and illness. Mismatches between an individual’s insulin requirements and insulin delivery can result in acute and chronic diabetes-related complications. An 'artificial pancreas' or 'Closed Loop' system has the potential to overcome these mismatches and its consequences. This new technology determines insulin requirements based on a computerised algorithm reviewing continuous glucose information. The overall aim of this clinical trial is to evaluate the use of overnight 'closed loop’ in comparison for the first time in the home setting. A range of outcomes will be assessed. In particular, the ACBRD's contribution will be:
- Exploratory interviews with study participants about their expectations and experiences with the 'Closed Loop', compared to their current treatment
- Assessing the effect of the overnight 'Closed Loop’ on daytime cognitive performance. The study begins in January 2014.
ACBRD team: Dr Jessica Browne and Prof Jane Speight
In collaboration with Dr Alan Barclay, Dr Gary Deed, and Dr Hilton Shapiro.
Funding: Roche Diagnostics Australia.
STeP IT UP (which stands for Structured Testing Program Implementation Trial – Updated Protocol) is is a six-month, multi-site trial of a comprehensive doctor/patient intervention that uses a highly structured and systematic self-monitoring of blood glucose (SMBG) regimen for the purposes of optimising blood glucose management. The study is being conducted in primary care settings. Participants and their general practitioners will be trained in how to conduct structured SMBG, and how to interpret and respond to the results. STeP IT UP is building on the evidence from the initial STeP study (conducted in the USA) by exploring the feasibility of implementation in an Australian primary care setting, and by a wider range of clinical and psychosocial outcomes.
Led by: Dr Jennifer Conn (Royal Melbourne Hospital, Parkville)
ACBRD team: Dr Christel Hendrieckx , Prof Jane Speight
Funding: The National Diabetes Services Scheme (NDSS), an initiative of the Australian Government administered by Diabetes Australia.
Health professionals play a vital role in supporting people with type 1 diabetes in the management of this chronic condition and in optimising their mental health. Although diabetes care professionals recognise the impact of diabetes on the emotional well-being, they feel less confident and skilled in having a conversation with their patients about emotional and psychological problems they may experience. This education resource is developed to enhance the consultation skills of trainees in adult endocrinology. It addresses a large range of emotional and psychological problems resulting from or complicating the life of people with type 1 diabetes.
This project is a collaboration of mental health professionals, communication experts, diabetes health professionals and endocrinology trainees, as well as adults with type 1 diabetes.
This resource will be launched early 2014
ACBRD team: Virginia Hagger, Prof Jane Speight, and Dr Christel Hendrieckx
In collaboration with Diabetes Australia-Victoria and Mater Children’s Hospital, Brisbane.
Funding: This project is supported by funding from the Department of Health and Ageing (DOHA) Chronic Disease Service improvement Fund.
TEAM T1 is a five day interactive group education program for adolescents with type 1 diabetes aged 14–18 years. It was adapted for adolescents from the adult DAFNE program. TEAM T1 teaches adolescents to effectively self-manage their diabetes as they transition to adulthood, and to feel more confident and in control of their diabetes. Funding by the Department of Health and Ageing is enabling a nationwide rollout (with the TEAM T1 program to be offered in 11 centres nationally between 2012 and 2015) with evaluation of real-world implementation. ACBRD is leading the evaluation study of TEAM T1 which will assess the impact of the TEAM T1 program on a range of psychological, behavioural and clinical outcomes. Qualitative methods will also be used to explore the perceived experiences of adolescents who have attended the TEAM T1 program, and barriers to implementing changes after the program.
Led by: Prof Brian Oldenburg (Monash University).
ACBRD team: Prof Jane Speight
Funding: NHMRC Partnership grant
For many people with type 2 diabetes, daily management demands can seem overwhelming. The Telephone-Linked Care (TLC) Diabetes Program is a sophisticated interactive telephone system designed to support people with type 2 diabetes in the comfort of their home and at no cost. The TLC system is designed to complement the care already provided by the healthcare team by further monitoring, educating and coaching individuals with type 2 diabetes. TLC has been trialled in Queensland and shown to improve diabetes outcomes (see results published in BMC Public Health). This NHMRC Partnership grant (starting January 2014) will enable further development of the TLC program and evaluation of its real world implementation as a service provided by Diabetes Australia in Queensland, Victoria and WA.