National Diabetes Services Scheme Research Articles

Stress Induced Hyperglycemia and the Subsequent Risk of Type 2 Diabetes in Survivors of Critical Illness.

ObjectiveStress induced hyperglycemia occurs in critically ill patients who have normal glucose tolerance following resolution of their acute illness. The objective was to evaluate the association between stress induced hyperglycemia and incident diabetes in survivors of critical illness.DesignRetrospective cohort study.SettingAll adult patients surviving admission to a public hospital intensive care unit (ICU) in South Australia between 2004 and 2011.PatientsStress induced hyperglycemia was defined as a blood glucose ≥ 11.1 mmol/L (200 mg/dL) within 24 hours of ICU admission. Prevalent diabetes was identified through ICD-10 coding or prior registration with the Australian National Diabetes Service Scheme (NDSS). Incident diabetes was identified as NDSS registration beyond 30 days after hospital discharge until July 2015. The predicted risk of developing diabetes was described as sub-hazard ratios using competing risk regression. Survival was assessed using Cox proportional hazards regression.Main ResultsStress induced hyperglycemia was identified in 2,883 (17%) of 17,074 patients without diabetes. The incidence of type 2 diabetes following critical illness was 4.8% (821 of 17,074). The risk of diabetes in patients with stress induced hyperglycemia was approximately double that of those without (HR 1.91 (95% CI 1.62, 2.26), p<0.001) and was sustained regardless of age or severity of illness.ConclusionsStress induced hyperglycemia identifies patients at subsequent risk of incident diabetes.

Age-Specific Trends From 2000-2011 in All-Cause and Cause-Specific Mortality in Type 1 and Type 2 Diabetes: A Cohort Study of More Than One Million People.

To analyze changes by age-group in all-cause and cause-specific mortality rates from 2000-2011 in people with diabetes. A total of 1,189,079 (7.3% with type 1 diabetes) Australians with diabetes registered on the National Diabetes Service Scheme between 2000 and 2011 were linked to the National Death Index. Mortality rates in the total population were age standardized to the 2001 Australian population. Mortality rates were calculated for the following age-groups: 0 to <40 years, ≥ 40 to <60 years, and ≥60 to ≤85 years. Annual mortality rates were fitted using a Poisson regression model including calendar year as a covariate and age and sex where appropriate, with Ptrend reported. For type 1 diabetes, all-cause, cardiovascular disease (CVD), and diabetes age-standardized mortality rates (ASMRs) decreased each year by 0.61, 0.35, and 0.14 per 1,000 person-years (PY), respectively, between 2000 and 2011, Ptrend < 0.05, while cancer mortality remained unchanged. By age, significant decreases in all-cause, CVD, and diabetes mortality rates were observed in all age-groups, excluding diabetes mortality in age-group 0-40 years. For type 2 diabetes, all-cause, CVD, and diabetes ASMRs decreased per year by 0.18, 0.15, and 0.03 per 1,000 PY, respectively, Ptrend < 0.001, while cancer remained unchanged. By age, these decreases were observed in all age-groups, excluding 0-40 years, where significant increases in all-cause and cancer mortality were noted and no change was seen for CVD and diabetes mortality. All-cause, CVD, and diabetes ASMRs in type 1 and type 2 diabetes decreased between 2000 and 2011, while cancer ASMRs remained unchanged. However, younger populations are not benefiting from the same improvements as older populations. In addition, the absence of a decline in cancer mortality warrants urgent attention.

Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes.

The aim of this work was to estimate the life expectancy (LE) and disability-free life expectancy (DFLE) for adults with and without diabetes. The Chiang method and the adapted Sullivan method were used to estimate LE and DFLE by age and sex. Mortality data in 2011 were available from the National Diabetes Services Scheme for diabetes and from standard national mortality datasets for the general population. Data on prevalence of disability and severe or profound core activity limitation were derived from the 2012 Australian Survey of Disability, Ageing and Carers (SDAC). The definitions of disability used in the SDAC followed the International Classification of Functioning, Disability and Health. Data on diabetes prevalence were derived from the Australian Diabetes, Obesity and Lifestyle study. The estimated LE and DFLE (with 95% uncertainty interval [UI]) at age 50years were 30.2 (30.0, 30.4) and 12.7 (11.5, 13.7) years, respectively, for men with diabetes, and the estimates were 33.9 (33.6, 34.1) and 13.1 (12.3, 13.9) years, respectively, for women with diabetes. The estimated loss of LE associated with diabetes at age 50years was 3.2 (3.0, 3.4) years for men and 3.1 (2.9, 3.4) years for women, as compared with their counterparts without diabetes. The corresponding estimated loss of DFLE was 8.2 (6.7, 9.7) years for men and 9.1 (7.9, 10.4) years for women. Women with diabetes spent a greater number of absolute years and a greater proportion of their life with disability as compared with men with diabetes and women without diabetes. The gains in LE and DFLE across the whole population at age 50years after hypothetically eliminating diagnosed diabetes were 0.6 (0.5, 0.6) years and 1.8 (1.0, 2.8) years. In adults, diabetes results in a modest reduction in LE and a substantial reduction in DFLE. Efforts to identify the specific causes of disability and effective interventions are needed.

Life expectancy of type 1 diabetic patients during 1997-2010: a national Australian registry-based cohort study.

There is limited information about the impact of type 1 diabetes on life expectancy in a contemporary population. We examined the life expectancy of type 1 diabetic patients and explored the contribution of mortality at different ages and of different causes of death to years of life lost (YLL) compared with the general population. We derived mortality rates of Australians with type 1 diabetes listed on the National Diabetes Services Scheme (NDSS) between 1997 and 2010 (n = 85,547) by linking the NDSS to the National Death Index. The Chiang method was used to estimate life expectancy and Arriaga's method was used to estimate the contributions of age-specific and cause-specific mortality to the YLL. A total of 5,981 deaths were identified during the 902,136 person-years of follow up. Type 1 diabetic patients had an estimated life expectancy at birth of 68.6years (95% CI 68.1, 69.1), which was 12.2years (95% CI 11.8, 12.7) less than that in the general population. The improvement in life expectancy at birth in 2004-2010 compared with 1997-2003 was similar for both type 1 diabetic patients (men, 1.9years [95% CI 0.4, 3.3]; women, 1.5years [95% CI 0.0, 3.2]) and the general population (men, 2.2years; women, 1.4years). Deaths at age <60years accounted for 60% of the YLL from type 1 diabetes for men and 45% for women. The major contribution to YLL was mortality from endocrine and metabolic disease at age 10-39years (men, 39-59%; women, 35-50%) and from circulatory disease at age ≥40years (men, 43-75%; women, 34-75%). Data from 1997 to 2010 showed that Australian type 1 diabetic patients had an estimated loss in life expectancy at birth of 12.2years compared with the general population.

Suicidal ideation reported by adults with Type 1 or Type 2 diabetes: results from Diabetes MILES-Australia.

To examine the prevalence and correlates of suicidal ideation (SI) in a community-based sample of adults with Type 1 or Type 2 diabetes. Participants were 3338 adults aged 18-70 years with Type 1 diabetes (n = 1376) or Type 2 diabetes (non-insulin: n = 1238; insulin: n = 724) from a national survey administered to a random sample registered with the National Diabetes Services Scheme. Depression and SI were assessed using the Patient Health Questionnaire, and diabetes-specific distress with the Problem Areas In Diabetes scale. Separate logistic regression analyses by diabetes type/treatment were used to determine relative contribution to SI. Overall, we observed a SI rate of 14% in our sample. Participants with Type 2 diabetes using insulin reported more frequent depressive symptoms, and were more likely to report recent SI (19%) compared with those with either Type 1 diabetes or Type 2 diabetes not using insulin (14 and 12%, respectively). After controlling for depression, there was little difference in the prevalence of SI between diabetes types/treatments, but higher diabetes-specific distress significantly increased the odds of SI. As SI is a significant risk factor for a suicide attempt, the findings have implications for healthcare professionals, pointing to the importance of adequate screening and action plans for appropriate follow-up of those reporting depression. Our findings are also indicative of the psychological toll of diabetes more generally, and the need to integrate physical and mental healthcare for people with diabetes.

Factors associated with early cessation of breastfeeding in women with gestational diabetes mellitus.

To determine factors associated with early cessation of breastfeeding (≤ 3 months) in women with recent gestational diabetes mellitus (GDM). A cross-sectional online survey of women aged ≥ 18 years, diagnosed with GDM in 2010 and registered with the National Diabetes Services Scheme in Australia. The 59 questions examined breastfeeding duration, intention, attitudes, exclusivity and support. 738 women completed the survey (15% response rate). Data was analysed for 729 eligible respondents. Of these 97% reported 'ever' breastfeeding and 19% had breastfed for ≤ 3 months. Cessation of breastfeeding at or before 3 months was associated with breastfeeding problems at home [adjusted odds ratio 8.01, 95% confidence interval (4.57, 14.05)], return to work prior to three months [OR 3.39 (95% CI 1.53, 7.55)], inadequate breastfeeding support [OR 1.88 (95% CI 1.10, 3.22)], caesarean delivery [OR 1.70 (95% CI 1.04, 2.76)], low socioeconomic status (SEIFA 1 unit increase) [OR 0.89 (95% CI 0.81, 0.97)] and BMI (2 unit increase) [OR 1.08 (95% CI 1.01, 1.57)]. Being married or de facto [OR 0.14 (95% CI 0.03, 0.62)] was a protective against early cessation of breastfeeding. Strategies to improve breastfeeding duration in women with GDM need to address those most at risk of early cessation and provide appropriate postpartum breastfeeding support in this group.

Mortality trends among people with type 1 and type 2 diabetes in Australia: 1997-2010.

With improvements in cardiovascular disease (CVD) rates among people with diabetes, mortality rates may also be changing. However, these trends may be influenced by coding practices of CVD-related deaths on death certificates. We analyzed trends of mortality over 13 years in people with diabetes and quantified the potential misclassification of CVD mortality according to current coding methods. A total of 1,136,617 Australians with diabetes registered on the National Diabetes Services Scheme between 1997 and 2010 were linked to the National Death Index. Excess mortality relative to the Australian population was reported as standardized mortality ratios (SMRs). Potential misclassification of CVD mortality was determined by coding CVD according to underlying cause of death (COD) and then after consideration of both the underlying and other causes listed in part I of the death certificate. For type 1 diabetes, the SMR decreased in males from 4.20 in 1997 to 3.08 in 2010 (Ptrend < 0.001) and from 3.92 to 3.46 in females (Ptrend < 0.01). For type 2 diabetes, the SMR decreased in males from 1.40 to 1.21 (Ptrend < 0.001) and from 1.56 to 1.22 in females (Ptrend < 0.001). CVD deaths decreased from 35.6 to 31.2% and from 31.5 to 27.2% in males and females with type 1 diabetes, respectively (Ptrend < 0.001 for both sexes). For type 2 diabetes, CVD decreased from 44.5 to 29.2% in males and from 45.5 to 31.6% in females (Ptrend < 0.001 for both sexes). Using traditional coding methods, ∼38 and 26% of CVD deaths are underestimated in type 1 diabetes and type 2 diabetes, respectively. All-cause and CVD mortality has decreased in diabetes. However, the total CVD mortality burden is underestimated when only underlying COD is considered. This has important ramifications for understanding mortality patterns in diabetes.

The INSPIRED study: a randomised controlled trial of the Whole Person Model of disease self-management for people with type 2 diabetes.

BackgroundThe prevalence of type 2 diabetes has increased dramatically in the last decade, and is continuing to rise. It is a chronic condition, often related to obesity, diet and sedentary lifestyles, and can lead to significant health complications, disability and early death. Diabetes is commonly associated with depression, which can impact significantly on a person’s ability to manage their illness and, consequently, on disease outcomes. Disease self-management is fundamental in diabetes and requires support from multiple health professionals and the active participation of the person, including in maintaining a healthy lifestyle. The Whole Person Model was developed in order to integrate emotional and behavioural aspects into a self-management program for people with type 2 diabetes. Here we describe a study designed to test the efficacy of the Whole Person Model of disease self-management in type 2 diabetes.Methods/DesignIn a parallel-group randomised trial, 180 people with type 2 diabetes of between 2–10 years duration will be recruited via invitation through the Australian National Diabetes Services Scheme. Participants will undergo baseline assessment, followed by randomisation to either intervention or control condition. Control participants will receive fact sheets containing key information about diabetes self-management. The intervention group will receive the INSPIRED (Individual Support & Resources for Diabetes) Manual and be assigned a Health Coach. The INSPIRED Manual consists of six modules that provide key information about diabetes and disease management using the Whole Person Model. Engagement is facilitated by interactive tasks and contact with a Health Coach over seven weeks – an introductory face-to-face session, and six subsequent contacts by phone following each module. Follow-up assessments occur at 13 weeks (post-intervention) and 26 weeks. Primary outcomes include blood glucose management (HbA1c), weight and mood. Secondary outcomes include level of exercise, confidence to manage diabetes, and psychosocial well-being.DiscussionThe Whole Person Model is designed to enable health professionals to address mood disturbance without pathologizing any disorders and, in the context of the chronic illness, empowering behavior change and self-management. If proven effective, this model will strengthen capacity of the healthcare workforce to foster and support effective diabetes self-management.Trial registrationAustralia and New Zealand Clinical Trials Register, ACTRN12613000391774

Gestational diabetes mellitus in Far North Queensland, Australia, 2004 to 2010: midwives' perinatal data most accurate source.

This study examines the accuracy of Gestational Diabetes Mellitus (GDM) case-ascertainment in routinely collected data. Retrospective cohort study analysed routinely collected data from all births at Cairns Base Hospital, Australia, from 1 January 2004 to 31 December 2010 in the Cairns Base Hospital Clinical Coding system (CBHCC) and the Queensland Perinatal Data Collection (QPDC). GDM case ascertainment in the National Diabetes Services Scheme (NDSS) and Cairns Diabetes Centre (CDC) data were compared. From 2004 to 2010, the specificity of GDM case-ascertainment in the QPDC was 99%. In 2010, only 2 of 225 additional cases were identified from the CDC and CBHCC, suggesting QPDC sensitivity is also over 99%. In comparison, the sensitivity of the CBHCC data was 80% during 2004-2010. The sensitivity of CDC data was 74% in 2010. During 2010, 223 births were coded as GDM in the QPDC, and the NDSS registered 247 women with GDM from the same postcodes, suggesting reasonable uptake on the NDSS register. However, the proportion of Aboriginal and Torres Strait Islander women was lower than expected. The accuracy of GDM case-ascertainment in the QPDC appears high, with lower accuracy in routinely collected hospital and local health service data. This limits capacity of local data for planning and evaluation, and developing structured systems to improve post-pregnancy care, and may underestimate resources required. Data linkage should be considered to improve accuracy of routinely collected local health service data. The accuracy of the NDSS for Aboriginal and Torres Strait Islander women requires further evaluation.

Australian women's experiences of living with gestational diabetes

The purpose of this study was to describe Australian women's reflections on the experience of having a pregnancy affected by GDM. Participants were women aged ≥18 years, diagnosed with GDM ≤3 years previously and registered with the National Diabetes Services Scheme. Data was collected from a cross-sectional written postal survey which included the opportunity for women to document their experiences of living with GDM. Thematic framework analysis was undertaken to determine underlying themes. Of 4098 invited eligible women, 1372 consented to participate. Of these, 393 provided feedback on their experiences of living with GDM. Eight key themes emerged from the data (1) shock, fear and anxiety (8.9%), (2) uncertainty and scepticism (9.4%), (3) an opportunity to improve one's health (9.6%), (4) adapting to life with GDM (11.6%), (5) the need for support (17.2%), (6) better awareness (3.5%), (7) abandoned (14.9%), (8) staying healthy and preventing diabetes (13.7%). Women taking insulin were more likely to experience shock, fear or anxiety (p=0.001) and there was a trend towards women who spoke another language also being more likely to report this experience (p=0.061). Those diagnosed with GDM in a previous pregnancy (p=0.034) and younger women (p=0.054) were less likely to view the diagnosis as an opportunity to improve their health. This study provides an insight into the experience of the pregnant woman diagnosed with GDM. It emphasises the importance of health professional support and provides insight into the challenges and opportunities for future diabetes risk reduction.

The impact of patient narratives on self-efficacy and self-care in Australians with type 2 diabetes: stage 1 results of a randomized trial

A randomized-controlled trial (RCT) was conducted from September 2009 to June 2011. National Diabetes Services Scheme registrants diagnosed with type 2 diabetes and aged 30-70 years were invited to participate in a 3-week intervention programme with follow-up at 4 weeks and 6 months. Data were collected using self-report questionnaires in the participant's homes. The intervention group received diabetes factsheets and a DVD comprising patient stories (narratives) of type 2 diabetes management. The control group (CG) received factsheets only. The RCT evaluated the impact of patient narratives on the study outcomes, self-efficacy and self-care, using the Aust/English Diabetes Management Self-efficacy Scale and the Summary Diabetes Self-care Activities measure. Participants were randomly assigned to the intervention or CG using block randomization. The study was not blinded. Six hundred and seventy people enrolled into the study with 335 allocated to each group. At 4 weeks, data were available for 598 participants. t-tests were used to analyse the results. The mean difference between the groups for self-efficacy was 7.2 units (P < 0.001, 95% Confidence Interval (CI) 3.8, 10.7) favouring the intervention group. Change in self-care behaviours during the previous 7 days was also significantly greater for the intervention group: general diet (0.31 days, 95% CI 0.13, 0.48), specific diet (0.26 days, 95% CI 0.05, 0.46), exercise (0.51 days, 95% CI 0.23, 0.80), blood glucose (0.52 days, 95% CI 0.19, 0.85) and foot care (0.38 days, 95% CI 0.06, 0.71). Narrative communication shows promise as a valuable component of type 2 diabetes self-management programmes. ACTRN 12609000210279.

Time spent on health related activity by older Australians with diabetes

There is little information available about what people do to look after their health, or how long people spend on health activities. This study identifies key health related activities and time taken as part of self management by people with diabetes. Management planning often lacks information that this study provides that would help clinicians and patients to create manageable and do-able plans that patients can follow. Data were collected in 2010 using a national survey of people aged 50years the National Diabetes Services Scheme. Respondents provided recall data on time used for personal health care, non-clinical health activity; and health service interactions. Data were analysed using Stata 12 and SPSS 19. While most people with diabetes spend on average less than 30minutes a day on health-related activities (excluding exercise), the highest decile of respondents averaged over 100minutes. Time spent increased with the number of co-existent conditions. Taking medication and sitting in waiting rooms were the most frequently reported activities. The greatest amount of time was spent on daily personal health care activities. The time demands of diabetes for older people can be substantial. Better patient engagement in self management might result from a better match in care planning between the illness demands and the patient time availability, with potential to reduce admissions for hospital care.

Breast and Prostate Cancer Survivors in a Diabetic Cohort: Results from the Living With Diabetes Study

Diabetes is more common in cancer survivors than in the general population. The objective of the present study was to determine cancer frequency in a cohort of patients with diabetes and to examine demographic, clinical, and quality of life differences between cancer survivors and their cancer-free peers to inform better individualized care. Self-reported survey data from 3,466 registrants with type 2 diabetes from Australia's National Diabetes Services Scheme (NDSS) were analyzed to compare relevant variables between cancer survivors and cancer-free patients. Analyses were focused on breast and prostate cancer to reflect the most common cancers in women and men, respectively. Five percent of diabetic women reported a history of breast cancer and 4.2% of men reported a history of prostate cancer. Diabetic patients with a history of breast or prostate cancer were older at time of survey and diabetes diagnosis, less likely to report metformin use (women), and more likely to have two or more comorbidities than their cancer-free peers. More diabetic prostate cancer survivors also reported problems with mobility and performing usual tasks. However, cancer-free diabetic subjects reported a lower diabetes-dependent quality of life than diabetic cancer survivors. There was no association between cancer survivorship and duration of diabetes, indices of glycemic control, obesity, or diabetic complications. Cancer survivors comprise a significant minority of diabetic patients that are particularly vulnerable and may benefit from interventions to increase screening and treatment of other comorbidities and promote a healthy lifestyle.

Time to care? Health of informal older carers and time spent on health related activities: an Australian survey.

BackgroundLittle is known about the time spent on specific health related activities by older adult informal carers who assist people with chronic illness. Research has not yet addressed the association between carer health status and their care demands. Such information could inform policy and health system efforts to manage chronic illness.MethodsWe conducted an Australia wide survey using recall questionnaires to record time use. The study asked how much time is spent on “most days” for the most common activities like taking medication, self-treatment and testing, and how much time in the last month on less common activities like attending a physician or shopping associated with health needs. The survey was mailed to 5,000 members of National Seniors Australia; 2,500 registrants on the National Diabetes Services Scheme; and 3,100 members of the Australian Lung Foundation. A total of 2519 people responded, including 313 people who identified as informal carers. Statistical analysis was undertaken using Stata 11. Standard errors and confidence intervals were derived using bootstrapping techniques within Stata 11.ResultsMost carers (96.2%) had chronic illness themselves, and those with greater numbers of chronic illnesses were those who faced the greatest overall time demands. The top decile of carers devoted between 8.5 and 10 hours a day to personal and caring health related activities. Informal carers with chronic illness spent more time managing their own health than people with chronic illness who were not informal carers. These carers spent more time on caring for others than on caring for their own health. High levels of caring responsibility were associated with poorer reported carer health.ConclusionsPolicy and health care services will need to adapt to recognise and reduce the time burden on carers who themselves have chronic illness. More carefully targeted investment in the social infrastructure of formal care would free up carers for other activities (including their own care) and holds the potential to improve the quality of life as well as the health outcomes of this population.

Does the shortage of diabetes specialists in regional and rural Australia matter? Results from Diabetes MILES—Australia

AimTo investigate differences in access to services and health outcomes between people living with Type 1 (T1DM) and Type 2 (T2DM) diabetes in rural/regional and metropolitan areas. MethodsDiabetes MILES—Australia was a national postal/online survey of persons registered with the National Diabetes Services Scheme. Selected variables, including utilisation of health care services and self-care indicators, were analysed for 3338 respondents with T1DM (41%) or T2DM (59%). ResultsRespondents from rural/regional (n=1574, 48%) and metropolitan areas were represented equally (n=1700, 52%). After adjusting for diabetes duration, demographic and socioeconomic variables, rural/regional respondents with T1DM (RR 0.90, 95% CI 0.83–0.97) and T2DM (RR 0.69, 95% CI 0.59–0.81) were less likely to report consulting an endocrinologist during the past 12 months. Rural/regional respondents with T1DM were more than twice as likely to have accessed a community/practice nurse for diabetes care (RR 2.22, 95% CI 1.25–3.93) while those with T2DM were more likely to have accessed a diabetes educator (RR 1.21, 95% CI 1.07–1.36) or dietician (RR 1.17, 95% CI 1.07–1.36). For the T1DM and T2DM groups were no differences between rural/regional and metropolitan respondents in self-reported hypoglycaemic events during past week and the majority of self-care indicators. ConclusionsDespite a lack of access to medical specialists, respondents with T1DM and T2DM living in rural/regional areas did not report worse health or self-care indicators. The results suggest that multidisciplinary primary services in rural areas may be providing additional care for people with diabetes, compensating for poor access to specialists.

Time's up. descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey.

Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5–16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.

Type 2 diabetes prevalence varies by socio-economic status within and between migrant groups: analysis and implications for Australia.

BackgroundEthnic diversity is increasing through migration in many developed countries. Evidence indicates that type 2 diabetes mellitus (T2DM) prevalence varies by ethnicity and socio-economic status (SES), and that in many settings, migrants experience a disproportionate burden of disease compared with locally-born groups. Given Australia’s multicultural demography, we sought to identify groups at high risk of T2DM in Victoria, Australia.MethodsUsing population data from the Australian National Census and diabetes data from the National Diabetes Services Scheme, prevalence of T2DM among immigrant groups in Victoria in January 2010 was investigated, and prevalence odds versus Australian-born residents estimated. Distribution of T2DM by SES was also examined.ResultsPrevalence of diagnosed T2DM in Victoria was 4.1% (n = 98671) in men and 3.5% (n = 87608) in women. Of those with T2DM, over 1 in 5 born in Oceania and in Southern and Central Asia were aged under 50 years. For both men and women, odds of T2DM were higher for all migrant groups than the Australian-born reference population, including, after adjusting for age and SES, 6.3 and 7.2 times higher for men and women born in the Pacific Islands, respectively, and 5.2 and 5.0 times higher for men and women born in Southern and Central Asia, respectively. Effects of SES varied by region of birth.ConclusionsLarge socio-cultural differences exist in the distribution of T2DM. Across all socio-economic strata, all migrant groups have higher prevalence of T2DM than the Australian-born population. With increasing migration, this health gap potentially has implications for health service planning and delivery, policy and preventive efforts in Australia.

The needs, concerns, and characteristics of younger Australian adults with Type 2 diabetes

The mean age of onset of Type 2 diabetes mellitus is decreasing in Australia and internationally. We conducted an internet-based survey to improve our understanding of the emotional well-being and unmet needs of younger adults with Type 2 diabetes, and to inform service provision for this group. A random sample of National Diabetes Services Scheme registrants (n = 1,417) with Type 2 diabetes, aged 18-39 years, living in the Australian state of Victoria received an invitation to complete the online survey. The study was also advertised state-wide. The survey included validated scales (PAID-5: diabetes-related distress; WHO-5: general emotional well-being) and study-specific items. A total of 149 eligible respondents participated. Almost two-thirds (63%) of respondents reported severe-diabetes related distress; more than a quarter (27%) had impaired general emotional well-being. Most (82%) were overweight or obese (BMI ≥ 25); most (77%) had at least one other co-morbidity. Lack of motivation, feeling burned out, and being time-poor were identified as top barriers to self-management. More than half (59%) of respondents had not participated in structured diabetes education. Respondents perceived that younger adults with Type 2 diabetes had different health-care needs than their older counterparts (68%), and that most Type 2 diabetes information/services were aimed at older adults (62%). Of a range of potential new services, respondents indicated greatest interest in an online forum specifically for younger adults with Type 2 diabetes. Younger adults with Type 2 diabetes have impaired emotional well-being and physical health. Population-based research is needed to confirm the current findings, to further inform service delivery and optimise outcomes for this group.

Mental health issues decrease diabetes-specific quality of life independent of glycaemic control and complications: findings from Australia’s living with diabetes cohort study

BackgroundWhile factors associated with health-related quality of life for people with chronic diseases including diabetes are well researched, far fewer studies have investigated measures of disease-specific quality of life. The purpose of this study is to assess the impact of complications and comorbidities on diabetes-specific quality of life in a large population-based cohort of type 2 diabetic patients.MethodsThe Living with Diabetes Study recruited participants from the National Diabetes Services Scheme in Australia. Data were collected via a mailed self-report questionnaire. Diabetes-specific quality of life was measured using the Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire. The analyses are for 3609 patients with type 2 diabetes. Regression models with adjustment for control variables investigated the association of complications and comorbidities with diabetes-specific quality of life. Next, the most parsimonious model for diabetes-specific quality of life after controlling for important covariates was examined.ResultsThe expected associations with better diabetes-specific quality of life were evident, such as increased income, not on insulin, better glycaemic control and older age. However, being single and having been diagnosed with cancer were also associated with better ADDQoL. Additionally, poorer diabetes-specific quality of life was strongly sensitive to the presence of diabetes complications and mental health conditions such as depression, anxiety and schizophrenia. These relationships persisted after adjustment for gender, age, duration of diabetes, treatment regimen, sampling region and other treatment and socio-demographic variables.ConclusionsA greater appreciation of the complexities of diabetes-specific quality of life can help tailor disease management and self-care messages given to patients. Attention to mental health issues may be as important as focusing on glycaemic control and complications. Therefore clinicians’ ability to identify and mange mental health issues and/or refer patients is critical to improving patients’ diabetes-specific quality of life.

Reduction in the incidence of diabetes lower extremity amputations in Queensland: 2005‐2010

Methods Data on all Queensland diabetes-related lower extremity amputation admissions from 2005-2010 was obtained using diabetes amputation-related ICD-10-AM (hospital discharge) codes. Queensland diabetes amputation incidences were calculated for both general and diabetes populations using population data from the Australian Bureau of Statistics and National Diabetes Services Scheme respectively. Chi-squared tests were used to assess changes in amputation incidence over time.