Jane Overland

Lipohypertrophy: does it matter in daily life? A study using a continuous glucose monitoring system

Aims:  To use continuous glucose monitoring (CGMS) to compare glucose profiles in people with type 1 diabetes following injection of insulin into an area affected by lipohypertrophy vs. an area not affected by lipohypertrophy.

Continuity of care in diabetes: to whom does it matter?

The Australian health care system allows patients to move around to seek medical treatment. This may impact negatively on continuity of care. To determine factors associated with continuity of care for persons with diabetes, the profiles of 479 patients attending the Diabetes Centre, Royal Prince Alfred Hospital, Sydney, Australia, were examined. The majority of patients (87.7%) attended only one general practitioner and had been under the care of the referring doctor for a median of 6.2 years. These patients were older (P=0.02), but were comparable with those attending multiple doctors in terms of their type, duration and treatment of diabetes as well as their clinical and complication profile. There was also a relationship between age and the length of time under the care of the referring doctor (P=0.0002). The HbA(1c), lipid, blood pressure and treatment profiles of patients attending the referring doctor short, medium or long-term were comparable. However, there was an upward trend in the proportion of patients with a history of cerebrovascular disease, ischaemic heart disease or any complication of diabetes with each incremental increase in length of time under the referring doctor. Appropriately, patients seek continuity of care as they age and their health needs become more complex.

The pattern of diabetes care in New South Wales: a five-year analysis using Medicare occasions of service data.

Objective: To use Medicare occasions of service data to establish the pattern and standard of care received by people with diabetes.

Glycemic control and type 1 diabetes: the differential impact of model of care and income

Hatherly K, Smith L, Overland J, Johnston C, Brown‐Singh L, Waller D, Taylor S. Glycemic control and type 1 diabetes: the differential impact of model of care and income.

Glycemic Control and Blood Glucose Monitoring Over Time in a Sample of Young Australians With Type 1 Diabetes The role of personality

OBJECTIVE To determine whether personality traits (conscientiousness, agreeableness, emotional regulation, extraversion, and openness to experience) are associated with glycemic control and blood glucose monitoring behavior, and change or stability of these outcomes over time, in young people with type 1 diabetes. RESEARCH DESIGN AND METHODS A 3-year longitudinal study was conducted using data from 142 individuals with type 1 diabetes, 8–19 years of age. Personality was assessed at baseline using the Five-Factor Personality Inventory for Children. Data relating to glycemic control (HbA1c) and frequency of blood glucose monitoring (based on meter memory) were collected annually. Relationships between personality traits and HbA1c and monitoring frequency were examined using regression models and mixed-design ANOVA. RESULTS Three of the Five-Factor domains were independently associated with glycemic control. Individuals high in conscientiousness and agreeableness had a lower and more stable HbA1c across the 3-year study period. In contrast, the HbA1c of individuals scoring low on these traits was either consistently worse or deteriorated over time. Low or high emotional regulation scores were also associated with worse glycemic control. By the third year, these domains, together with initial HbA1c, accounted for 39% of HbA1c variance. Conscientiousness was the only personality factor associated with blood glucose monitoring behavior. CONCLUSIONS Results of this study underline the importance of personality in contributing to diabetes outcomes. Attention to a young person’s personality, and appropriate tailoring of diabetes management to ensure an individualized approach, may help to optimize diabetes outcomes.

Application of Australian clinical management guidelines : the current state of play in a sample of young people living with Type 1 diabetes in the state of New South Wales and the Australian Capital Territory

AIMS To describe care provided to a sample of young Australians with Type 1 diabetes, and benchmark this against national guidelines. METHODS 158 children and adolescents with Type 1 diabetes, aged 8-19 years, were recruited independent of their source of care as part of a three-year longitudinal study. Data were gathered annually regarding type of health-care services attended, demographic, health-care and self-care information. Participants were also telephoned quarterly to ascertain planned and actual attendance to diabetes services, and current diabetes management. A capillary sample was collected annually for HbA1c determination. RESULTS The mean HbA1c of participants was significantly higher than recommended levels. The annual number of visits to diabetes clinics also fell short of the stipulated 3-4 visits a year and less than 25% of participants received care from all recommended multidisciplinary team members. While the majority of care was provided through the publicly funded system, there was an increasing reliance on privately funded psychologists. CONCLUSION Standards of care received by this group of young Australians and levels of glycaemic control fall short of treatment guidelines, highlighting the need to identify ways to ensure equitable access to specialist multidisciplinary care for all young people affected by diabetes.

Social disadvantage: its impact on the use of Medicare services related to diabetes in NSW.

Objective: To use Medicare data to examine the impact of social disadvantage on the use of health services related to diabetes.

Differential shared care for diabetes: does it provide the optimal partition between primary and specialist care?

Aims  To establish whether a system of differential shared care between general practitioners and specialists is compatible with patients receiving the level of care they require.

The role of pharmacists in the management of Arabic-speaking people with diabetes mellitus: a systematic review

The aim of this review was to explore the literature relating to the role of pharmacists as culturally directed diabetes educators in the Arabic‐speaking community in Australia.

Diabetes Screening and Surveillance Programmes

SummaryAlthough non-insulin-dependent diabetes mellitus is a common and serious disease, it is estimated that about half of the people with the disease are unaware of it, making it a candidate for early detection and screening. To date however, there is no universal agreement regarding the best screening method or the target population. Early treatment should improve long term prognosis but this remains to be proven.During the screening process, many people will be found to have blood glucose levels thought to represent the ‘pre-clinical’ stage of diabetes. Although results of some recent studies are encouraging, there has not been any definitive proof that early detection and intervention can prevent this group from developing overt diabetes. This is currently the subject of a major clinical trial. Therefore, to reduce the burden of diabetes, it is equally important to have programmes supporting early screening and treatment of diabetic complications in patients known to have the disease. Establishing screening programmes to identify patients at high risk of developing complications, and concentrating intervention efforts on this group at an early stage, has great potential to reduce both the personal and economic burden of this chronic disease.