ACBRD team: Prof Jane Speight, Dr Christel Hendrieckx, Jennifer Halliday, Lucy Morrish
In collaboration with Prof Peter Colman and Jo Bowden (Royal Melbourne Hospital), Assoc/Prof Alicia Jenkins and Assoc/Prof David O'Neal (St Vincent's Hospital), Dr Neale Cohen (Baker IDI Heart and Diabetes Institute)
Funding: Diabetes Australia - Victoria and Deakin University.
The aim of this study is 1) to conduct a 'snapshot' audit to examine the prevalence of psychological distress, depression, fear of hypoglycaemia and impaired awareness of hypoglycaemia (IAH) among adults with T1DM attending three metropolitan tertiary centres and among adults with T1DM or T2DM in a regional diabetes clinic, and 2) to explore relationships between psychological, clinical and demographic variables.
Despite their clear implications for diabetes management and outcomes (acute and long-term), psychological factors (including diabetes-related distress, depression, fear of hypoglycaemia and IAH) are not routinely monitored in clinical practice. Psychological support is not reimbursable via tertiary referrals and we need local evidence in order to build a strong case for greater psychological support for adults with T1DM or T2DM.
The audit has being conducted across three tertiary clinics (Royal Melbourne Hospital - RMH, Baker IDI, St Vincent's Hospital - SVH) and is still ongoing in one regional diabetes clinic in Werribee. Over an 8-12 week period, all consecutive adult clinic attendees with T1DM or T2DM (only in Werribee clinic) were invited to complete a set of questionnaires and gave permission to access clinical data. The outcomes of this audit will contribute improving psychological outcomes for adults with diabetes as well as for raising awareness of psychological issues in T1DM and T2DM amongst local clinicians. The findings will lead to the design and implementation of easy-to-use monitoring tools for routine clinical practice. Expertise will be built up to train health care providers in identifying psychological distress/disorders and in communicating these outcomes to people with diabetes, offering accurate treatment (by the diabetes team or by referring the patient with diabetes to a specialist)
Led by: Prof Simon Heller (University of Sheffield), UK).
ACBRD team: Prof Jane Speight
Funding: Diabetes UK
There is a lack of robust evidence on the benefits of self-monitoring of blood glucose in adults with newly diagnosed type 2 diabetes. This was investigated in the DESMOND Self Monitoring Study* , a cluster randomised controlled trial comparing the effectiveness of self monitoring of blood glucose and urinalysis in patients attending the DESMOND Newly Diagnosed education course. The study was a multi-site randomised controlled trial run in 8 primary care trusts around England. Study participants attended a DESMOND Newly Diagnosed patient course, which included an additional one hour session on self-monitoring of blood or urine glucose. Just under 300 people with newly diagnosed type 2 diabetes were recruited to the study and collection of follow-up data is complete. The study protocol was published in BMC Family Practice. The trial results were presented at the Diabetes UK Annual Professional Conference (Manchester, 2013) and have been submitted for publication.
* DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) is a comprehensive programme of structured education for people with type 2 diabetes.
Led by: A/Prof Keith McVilly (Deakin University)
ACBRD team: Prof Jane Speight and Lucy Morrish
A systematic review was undertaken of the prevalence of diabetes among people with intellectual disability, and of studies reporting self-management and impact upon well-being. A pilot study (structured interviews) was also undertaken to investigate the experiences, health, and quality of life of people who have diabetes and an intellectual disability. We asked them about how diabetes impacts their lives, any challenges they face in managing their diabetes or general health, and how they feel about living with diabetes. We asked them about the level of care and diabetes-related information provided to them by support people and services such as family, support workers, doctors and other health professionals. The purpose of this small pilot is to inform the design of a larger study of how diabetes affects the lives of people with intellectual disability, so that we can improve diabetes services and increase the support available for this group. The systematic review has been submitted for publication.
ACBRD team: Amelia Lake, Dr Jessica Browne, Prof Jane Speight
In collaboration with Vision 2020 Australia, Diabetes Australia - Victoria, Dr Gwyneth Rees (Centre for Eye Research Australia).
Funding: Vision 2020 Australia
Regular eye examinations are essential in detecting diabetic retinopathy (DR), one of the leading causes of vision loss for people living with diabetes. Maintenance of optimal blood glucose and blood pressure, as well as early detection and treatment of DR via eye screens are key factors in the successful management of the condition. However, as both type 2 diabetes and DR are often asymptomatic in the early stages, people with newly diagnosed T2DM are particularly vulnerable to DR. It is estimated that only half of Australians with diabetes have regular eye exams and one third have never been checked. The Diabetes and Eye Health project aims to raise awareness of the importance of managing the key risk factors for DR, whilst increasing intentions to engage in regular eye examinations. The intended outcome of this project will be the development of evidence-based communication interventions that will increase the intent of Victorian adults diagnosed with type 2 diabetes to seek eye exams and minimise their risk of developing DR.
Click here to read the Diabetes Eye Health evaluation summary.
ACBRD team: Prof Jane Speight
In collaboration with Prof Timothy Skinner (University of Tasmania ), Prof Trisha Dunning (Deakin University), and Dr Jennifer Conn (The University of Melbourne).
The Australian Centre for Behavioural Research and a multidisciplinary working group, was involved in the development of the Diabetes Australia Position Statement: 'A new language for diabetes: improving communication with and about people with diabetes'. The Position Statement highlights the implications of the current language surrounding diabetes in Australia and makes recommendations for modifying this language. Raising awareness of the language commonly used, and how this shapes a person's understanding and experiences of diabetes, creates the opportunity for more effective and positive communications with and about people with diabetes. Click here to download a copy of the position statement or request a copy from: firstname.lastname@example.org
ACBRD team: Prof Jane Speight, Dr Jessica Browne, Elizabeth Truscott-Holmes, Dr Christel Hendrieckx
In collaboration with: Prof Frans Pouwer (Tilburg University, NL), Dr Giesje Nefs (Tilburg University, NL), and Dr Mariska Bot (University of Amsterdam, NL).
Funding for Diabetes MILES - Australia: National Diabetes Services Scheme Strategic Development Grant and unrestricted educational grant from Sanofi Aventis.
Funding for Diabetes MILES - The Netherlands: Prof. dr. J. Terpstra Young Investigator Award 2010 from the Dutch Association for Diabetes Research (Nederlandse Vereniging voor Diabetes Onderzoek)/Lilly Diabetes.
Successful management of diabetes requires attention to the behavioural, psychological and social aspects of the condition. The Diabetes MILES Study an international collaborative that constitutes national surveys of people with diabetes in various countries, with a focus on the psychosocial and behavioural aspects of the condition. Diabetes MILES - Australia was the first to be undertaken and completed in mid 2011. Diabetes MILES - The Netherlands has since also been completed, with preparations underway for Diabetes MILES - Flanders in Belgium. The findings of these surveys has the potential to inform future health policy and service provision so that people with diabetes receive optimal care. You can learn more about the Diabetes MILES Study by visiting www.diabetesMILES.org. You can also read the Diabetes MILES - Australia 2011 Survey Report here. Various analyses have already been published (see publications) or are in active preparation.
Led by: Dr Gwyneth Rees (Centre for Eye Research Australia)
ACBRD team: Prof Jane Speight
The purpose of this pilot project was to assess the impact of different sources of information on people's understanding of their health condition and their motivation to undertake diabetes self-care activities to protect their eye health. People with diabetes attending eye clinics will be randomised to receive an explanation of their retinal imaging results and risk information (including use of the individual's own retinal images) or to receive risk information alone without use of the retinal image. Assessments will be conducted before and after the consultations in both groups and will include: knowledge of DR, perceived risk, beliefs and understanding about DR; motivation levels, generic and diabetes-specific well-being. This is the first randomised controlled trial to examine the impact of retinal images on the awareness, understanding, motivation and well-being of people with diabetic retinopathy. This represents a potential method for enhancing understanding and motivation which could easily be built into clinical practice procedures. The results of this pilot study were published in Diabetic Medicine.
ACBRD team: Dr Jessica Browne, Prof Jane Speight
In collaboration with: Mrs Ann Morris (St John of God Warrnambool Hospital)
International guidelines for diabetes care recommend routine monitoring of wellbeing of people with diabetes, however this rarely occurs in clinical settings. The Australian Centre for Behavioural Research in Diabetes exploring the feasibility and acceptability of monitoring diabetes-related distress as part of routine care in a regional diabetes clinic. All adults with type 1, type 2, or gestational diabetes complete the 20-item Problem Areas In Diabetes (PAID) scale as part of routine care at each visit to the diabetes clinic. Information from the questionnaire is used by the clinician to inform person-centred, psychologically-sensitive care and appropriate referral to mental health services. De-identified data are analysed by the Centre to assess the level of diabetes-related distress in this group, its relationship to HbA1c, and to conduct preliminary validation of the PAID scale in an unselected Australian sample.
ACBRD team: Dr Jessica Browne, Adriana Ventura, Prof Jane Speight
In collaboration with: Dr Kylie Mosely (Australian Catholic University, NSW).
Funding: Deakin University and Diabetes Australia - Vic
Although healthcare professionals and others who do not have diabetes do not always recognise the negative social experience that can result from having diabetes, those with the condition report many concerns, including social embarrassment, feelings of failure and guilt. Other negative experiences that people with diabetes perceive or experience as a result of their condition may include workplace discrimination, negative public attitudes toward needle use and a negative obesity bias across many different social settings and life domains. The effect of this has the potential to impact negatively on the psychological health and physical health of those living with diabetes. The ACBRD has undertaken interviews with adults with type 1 or type 2 diabetes to explore the social experience of living with these conditions. The aims of the interviews are to explore the public perceptions of, and behaviour towards, people living with diabetes and how the consequences of these perceptions and behaviours impact on the lives of those with this condition.
Led by Dr John Furler at the University of Melbourne.
ACBRD team: Prof Jane Speight and Elizabeth Holmes-Truscott
Funding: National Health and Medical Research Council (NHMRC)
'Stepping Up' is a cluster randomised controlled trial of an intervention to facilitate insulin initiation in primary care for people with non-insulin-treated T2DM and suboptimal HbA1c. The intervention aims to facilitate timely and evidence-based initiation and up-titration of insulin through two key elements: a) supportive education for the general practitioner (GP) and practice nurse (PN), addressing inter-professional culture and clarifying roles and; b) practice systems change, tailored to meet the local practice and funding context and the needs of patients. The primary outcomes of Stepping Up are change in glycated haemoglobin (HbA1c) and proportion of participants who successfully initiate insulin, with various psychosocial outcomes also being examined. The trial protocol has been registered on the Australian and New Zealand Clinical trials registry (ACTRN12612001028897). Further information about the Stepping Up study is available online.
Led by: Prof Jane Overland (University of Sydney) and Prof Christopher Gilfillan (Eastern Health)
ACBRD team: Prof Jane Speight
Funding: Roche Diagnostics Australia
There are a number of reasons why people with type 1 diabetes check their blood glucose less frequently than recommended by their healthcare professionals. Various barriers have been identified, e.g. forgetfulness, difficulties with handling and disposing of blood glucose test strips, embarrassment about monitoring in public, lack of time, lack of understanding of results, not knowing what action to take, not wanting to see 'bad numbers'. The Accu-Chek Mobile® incorporates a number of key features, which eliminate the need to handle test strips or single lancets before and after use, giving the user more freedom and flexibility when monitoring, as well as allowing more discrete monitoring. The Accu-Chek Mobile® also allows the user to set up to 10 reminder times - at each set time a beep sounds and the reminder time is displayed. This randomised controlled cross-over study was designed to determine whether adults with type 1 diabetes are more likely to monitor their diabetes as recommended using the Mobile® monitoring system compared to the Optium Xceed®, a system commonly used by people with type 1 diabetes living in Australia. The study also assessed the effect of the two monitoring systems on peoples' glycaemic control, diabetes treatment satisfaction, confidence in treating diabetes and diabetes distress. Preliminary results were presented at the ADS-ADEA (Sydney, 2013) and IDF World Diabetes Congress (Melbourne, 2013) (see Presentations).
Led by: Prof Helena Teede and Dr Katherine Kibbey (Monash University)
ACBRD team: Prof Jane Speight and Laura Smith
Funding: Novo Nordisk Regional Diabetes Support Scheme
Young adults with type 1 diabetes are a high risk group who typically experience poorer diabetes outcomes compared to older adults and are at a high risk of being lost to healthcare services during the transition between paediatric and adult services. A structured transition program involving a multidisciplinary team is known to improve both clinic attendance and diabetes outcomes. To inform the development of appropriate service provision suited to the needs of this group, we conducted a survey to determine the barriers to and enablers of engaging with specialist diabetes care in young adults from a low socio-economic, multicultural region. The results of this study were published in Diabetic Medicine.
ACBRD team: Prof Jane Speight, Dianna McDonald, Virginia Hagger
In collaboration with: Jane Chenny (Diabetes Australia)
Funding: National Diabetes Services Scheme an initiative of the Australian Government administered by Diabetes Australia.
The ACBRD is currently conducting two national research projects specifically looking at transition. The need for effective support and facilitation is important during the transition phase as it is widely acknowledged that a significant proportion of young people struggle during this period and many cease to maintain engagement with their healthcare teams. This disengagement can result in complications going unchecked and may eventually lead to poorer health outcomes. A better understanding of the type of support and information needed by parents and young people at this stage will assist to develop ways to help young adults engage with their new adult healthcare team and hopefully maintain regular contact into their adulthood.
The Youth Transition Pack (funded by the Federal Government's National Diabetes Services Scheme (NDSS)) provides regular information to parents and young adults as they approach the age of moving from paediatric to adult diabetes healthcare services. The NDSS transition pack consists of: a birthday card sent directly to young people, aged 12 to 20 years, who are registered on the NDSS. a letter sent to their parents (until the child is 18 years) outlining age-related issues relevant to the management of diabetes. The letter also prompts parents to start thinking about their child's transition from paediatric to adult healthcare services. The ACBRD is conducting an evaluation of the transition pack to assess the perceived usefulness of the information provided, how it is used by parents and/or young people, and how it could be improved. The survey will also gather information on the 'readiness' for transition and asks about the transition experiences of those who have recently moved to adult healthcare. This project is a quantitative research project and will use an online survey methodology.
Qualitative research to explore experiences of transition. The qualitative project involves conducting indepth interviews with young people who have recently experienced transition. We will explore what worked well and what could have been better. We will also look at the planning that occurred before the move (if any) and how the move from supported /facilitated by healthcare professionals. As well as interviewing young people who have recently transitioned the study will interview parents and diabetes health professionals working in this area.