Australian Center for Behavioural Research in Diabetes

Melbourne, Australia

Australian Center for Behavioural Research in Diabetes

Melbourne, Australia

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Little S.A.,Newcastle University | Leelarathna L.,University of Cambridge | Walkinshaw E.,University of Sheffield | Chapple O.,Royal Bournemouth Hospital | And 14 more authors.
Diabetes Care | Year: 2014

OBJECTIVE: To determine whether impaired awareness of hypoglycemia (IAH) can be improved and severe hypoglycemia (SH) prevented in type 1 diabetes, we compared an insulin pump (continuous subcutaneous insulin infusion [CSII]) with multiple daily injections (MDIs) and adjuvant real-time continuous glucose monitoring (RT) with conventional self-monitoring of blood glucose (SMBG). RESEARCH DESIGN AND METHODS: A 24-week 2 × 2 factorial randomized controlled trial in adults with type 1 diabetes and IAH was conducted. All received comparable education, support, and congruent therapeutic targets aimed at rigorous avoidance of biochemical hypogly-cemia without relaxing overall control. Primary end point was between-intervention difference in 24-week hypoglycemia awareness (Gold score). RESULTS: A total of 96 participants (mean diabetes duration 29 years) were randomized. Overall, biochemical hypoglycemia (≤3.0 mmol/L) decreased (53 ± 63 to 24 ± 56 min/24 h; P = 0.004 [t test]) without deterioration in HbA1c. Hypoglycemia awareness improved (5.1 ± 1.1 to 4.1 ± 1.6; P = 0.0001 [t test]) with decreased SH (8.9 ± 13.4 to 0.8 ± 1.8 episodes/patient-year; P = 0.0001 [t test]). At 24 weeks, there was no significant difference in awareness comparing CSII with MDI (4.1 ± 1.6 vs. 4.2 ± 1.7; difference 0.1; 95% CI 20.6to 0.8) and RTwith SMBG (4.3 ± 1.6 vs. 4.0 ± 1.7; difference 20.3; 95% CI 21.0 to 0.4). Between-group analyses demonstrated comparable reductions in SH, fear of hypoglycemia, and insulin doses with equivalent HbA1c. Treatment satisfaction was higher with CSII than MDI (32 ± 3 vs. 29 ± 6; P = 0.0003 [t test]), but comparable with SMBG and RT (30 ± 5 vs. 30 ± 5; P = 0.79 [t test]). CONCLUSIONS: Hypoglycemia awareness can be improved and recurrent SH prevented in longstanding type 1 diabetes without relaxing HbA1c. Similar biomedical outcomes can be attained with conventional MDI and SMBG regimens compared with CSII/RT, although satisfaction was higher with CSII. © 2014 by the American Diabetes Association.


Cooke D.,University of Surrey | Bond R.,University of Sussex | Lawton J.,University of Edinburgh | Rankin D.,University of Edinburgh | And 5 more authors.
Diabetes Care | Year: 2013

OBJECTIVE-To determine whether improvements in glycemic control and diabetes-specific quality of life (QoL) scores reported in research studies for the type 1 diabetes structured education program Dose Adjustment For Normal Eating (DAFNE) are also found when the intervention is delivered within routine U.K. health care. RESEARCH DESIGN AND METHODS-Before and after evaluation of DAFNE to assess impact on glycemic control and QoL among 262 adults with type 1 diabetes. RESULTS-There were significant improvements in HbA1c from baseline to 6 and 12 months (from 9.1 to 8.6 and 8.8%, respectively) in a subgroup with suboptimal control. QoL was significantly improved by 3 months and maintained at both follow-up points. CONCLUSIONS-Longer-term improved glycemic control and QoL is achievable among adults with type 1 diabetes through delivery of structured education in routine care, albeit with smaller effect sizes than reported in trials.© 2013 by the American Diabetes Association.


Barendse S.,AHP Research | Singh H.,University of Virginia | Frier B.M.,Royal Infirmary | Speight J.,AHP Research | And 2 more authors.
Diabetic Medicine | Year: 2012

As a common side effect of insulin treatment for diabetes, hypoglycaemia is a constant threat and can have far-reaching and potentially devastating consequences, including immediate physical injury as well as more pervasive cognitive, behavioural and emotional effects. Moreover, as a significant limiting factor in achieving optimal glycaemic control, exposure to hypoglycaemia can influence diabetes self-management. Although hypoglycaemia is known to occur in Type 2 diabetes, its morbidity and impact on the individual are not well recognized. The aim of the current review is to examine published evidence to achieve a synthesis of the scope and significance of the potential detriment caused by hypoglycaemia to individuals with Type 2 diabetes. The implications of these observations for treatment and research have also been considered. A narrative review was performed of empirical papers published in English since 1966, reporting the effect of hypoglycaemia on quality of life and related outcomes (including generic and diabetes-specific quality of life, emotional well-being and health utilities) in Type 2 diabetes. Research demonstrates the potential impact of hypoglycaemia on the lives of people with Type2 diabetes, from an association with depressive symptoms and heightened anxiety, to impairment of the ability to drive, work and function in ways that are important for quality of life. Few studies consider hypoglycaemia as an explanatory variable in combination with quality of life or related primary endpoints. As a consequence, there is a pressing need for high-quality research into the overall impact of hypoglycaemia on the lives of people with Type2 diabetes. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.


Leelarathna L.,Institute of Metabolic Science | Little S.A.,Newcastle University | Walkinshaw E.,SheffieldUniversity | Tan H.K.,Derriford Hospital | And 12 more authors.
Diabetes Care | Year: 2013

Objective-Impaired awareness of hypoglycemia (IAH) and defective counterregulation significantly increase severe hypoglycemia risk in type 1 diabetes (T1D). We evaluated restoration of IAH/defective counterregulation by a treatment strategy targeted at hypoglycemia avoidance in adults with T1D with IAH (Gold score ≥4) participating in the U.K.-based multicenter HypoCOMPaSS randomized controlled trial. Research design and methods-Eighteen subjects with T1D and IAH (mean ± SD age 50 ± 9 years, T1D duration 35 ± 10 years, HbA1c 8.1 ± 1.0% [65 ± 10.9 mmol/mol]) underwent stepped hyperinsulinemic-hypoglycemic clamp studies before and after a 6-month intervention. The intervention comprised the HypoCOMPaSS education tool in all and randomized allocation, in a 232 factorial study design, to multiple daily insulin analog injections or continuous subcutaneous insulin infusion therapy and conventional glucose monitoring or real-time continuous glucose monitoring. Symptoms, cognitive function, and counterregulatory hormones were measured at each glucose plateau (5.0, 3.8, 3.4, 2.8, and 2.4 mmol/L), with each step lasting 40 min with subjects kept blinded to their actual glucose value throughout clamp studies. Results-After intervention, glucose concentrations at which subjects first felt hypoglycemic increased (mean ± SE from 2.6 ± 0.1 to 3.1 ± 0.2 mmol/L, P = 0.02), and symptom and plasma metanephrine responses to hypoglycemia were higher (median area under curve for symptoms, 580 [interquartile range {IQR} 420-780] vs. 710 [460-1,260], P = 0.02; metanephrine, 2,412 [-3,026 to 7,279] vs. 5,180 [-771 to 11,513], P = 0.01). Glycemic threshold for deterioration of cognitive function measured by four-choice reaction time was unchanged, while the color-word Stroop test showed a degree of adaptation. Conclusions-Even in long-standing T1D, IAH and defective counterregulation may be improved by a clinical strategy aimed at hypoglycemia avoidance. © 2013 by the American Diabetes Association.


Hendrieckx C.,Australian Center for Behavioural Research in Diabetes | Hendrieckx C.,Deakin University | Halliday J.A.,Australian Center for Behavioural Research in Diabetes | Halliday J.A.,Deakin University | And 7 more authors.
Diabetes Research and Clinical Practice | Year: 2014

Aim: To investigate severe hypoglycaemia (SH) in adults with type 1 diabetes and its associations with impaired awareness of hypoglycaemia (IAH), clinical, psychological and socio-demographic factors. Methods: Attendees of three specialist diabetes clinics in Melbourne, Australia completed questions about frequency of SH in the past six months; impaired awareness of hypoglycaemia (Gold score); and measures of general emotional well-being (WHO-5), diabetes-specific positive well-being (subscale of W-BQ28), diabetes-related distress (PAID) and fear of hypoglycaemia (HFS). Results: Of 422 participants (mean. ±. SD age 37.5. ±. 15.0 years; 54% women), 78 (18.5%) reported at least one SH event and 86 (20.5%) had IAH. SH and IAH frequencies were similar at all clinics. In total, 194 SH events were reported, with 10 people experiencing 40% of events. Compared with those without SH, participants with SH had longer diabetes duration, were younger at diabetes onset and more likely to have IAH (p< 0.01). Those with SH had greater fear of hypoglycaemia and diabetes-related distress, poorer general emotional well-being, and lower diabetes-specific positive well-being, (p< 0.01). There were no associations with age, gender, insulin regimen or HbA1c. Conclusions: This study has identified that SH and IAH in Australian adults with type 1 diabetes exist at similar levels to those reported in US and European research. SH was significantly associated with IAH and fear of hypoglycaemia. Assessment of hypoglycaemia, IAH and psychological well-being as part of a routine diabetes clinic visit was well accepted by attendees and enabled identification of those who may benefit from medical, educational or therapeutic interventions. © 2013 Elsevier Ireland Ltd.


Speight J.,Australian Center for Behavioural Research in Diabetes | Speight J.,Deakin University | Speight J.,AHP Research | Browne J.L.,Australian Center for Behavioural Research in Diabetes | And 6 more authors.
BMC Public Health | Year: 2012

Background: Successful management of diabetes requires attention to the behavioural, psychological and social aspects of this progressive condition. The Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Study is an international collaborative. Diabetes MILES - Australia, the first Diabetes MILES initiative to be undertaken, was a national survey of adults living with type 1 or type 2 diabetes in Australia. The aim of this study was to gather data that will provide insights into how Australians manage their diabetes, the support they receive and the impact of diabetes on their lives, as well as to use the data to validate new diabetes outcome measures. Methods/design. The survey was designed to include a core set of self-report measures, as well as modules specific to diabetes type or management regimens. Other measures or items were included in only half of the surveys. Cognitive debriefing interviews with 20 participants ensured the survey content was relevant and easily understood. In July 2011, the survey was posted to 15,000 adults (aged 18-70 years) with type 1 or type 2 diabetes selected randomly from the National Diabetes Services Scheme (NDSS) database. An online version of the survey was advertised nationally. A total of 3,338 eligible Australians took part; most (70.4%) completed the postal survey. Respondents of both diabetes types and genders, and of all ages, were adequately represented in both the postal and online survey sub-samples. More people with type 2 diabetes than type 1 diabetes took part in Diabetes MILES - Australia (58.8% versus 41.2%). Most respondents spoke English as their main language, were married/in a de facto relationship, had at least a high school education, were occupied in paid work, had an annual household income > $AUS40,000, and lived in metropolitan areas. Discussion. A potential limitation of the study is the under-representation of respondents from culturally and linguistically diverse backgrounds (including Aboriginal and Torres Strait Islander origin). Diabetes MILES - Australia represents a major achievement in the study of diabetes in Australia, where for the first time, the focus is on psychosocial and behavioural aspects of this condition at a national level. © 2012 Speight et al; BioMed Central Ltd.


Speight J.,Australian Center for Behavioural Research in Diabetes | Speight J.,Deakin University | Speight J.,AHP Research | Browne J.L.,Australian Center for Behavioural Research in Diabetes | And 2 more authors.
Current Medical Research and Opinion | Year: 2013

Background: There is debate in the literature about the effectiveness of self-monitoring of blood glucose (SMBG) for people with type 2 diabetes (T2DM) who do not use insulin. Several recent systematic reviews and meta-analyses conclude that SMBG does not have any clinical benefit for this group. Objective: We critically appraise the available evidence, and argue whether SMBG is warranted for people with non-insulin-treated T2DM. Results: Considerable heterogeneity exists amongst the literature, and aspects of the methodology of some of these studies confound interpretation of results. Recent evidence demonstrates that when SMBG is 'structured', incorporated as part of a complex intervention, and embedded within education and collaborative care, improvements in average blood glucose levels result. In contrast, studies that do not apply SMBG systematically, or that assess a low frequency SMBG regimen that precludes identification and interpretation of SMBG patterns, are not clinically effective. Psychosocial outcomes, such as self-efficacy and diabetes-related distress, and other clinical outcomes, such as hypoglycaemia detection, should also be considered as important clinical endpoints. Limitations: This is not a systematic literature review. The literature is limited by a lack of studies evaluating a 'structured' approach to SMBG. Conclusions: It is the quality, not quantity, of SMBG that makes a difference to outcomes for people with non-insulin-treated T2DM. The benefits of 'structured' SMBG should be considered as part of a complex intervention when making decisions about policy and practice, and assumptions about the benefits of SMBG for people with non-insulin-treated T2DM should be challenged. © 2013 Informa UK Ltd.


Singh H.,Virginia Polytechnic Institute and State University | Murphy H.R.,Addenbrookes Hospital | Hendrieckx C.,Australian Center for Behavioural Research in Diabetes | Hendrieckx C.,Deakin University | And 4 more authors.
Current Diabetes Reports | Year: 2013

Ineffective management of blood glucose levels during preconception and pregnancy has been associated with severe maternal and fetal complications in women with pre-existing diabetes. Studies have demonstrated that preconception counseling and pre-pregnancy care can dramatically reduce these risks. However, pregnancy-related outcomes in women with diabetes continue to be less than ideal. This review highlights and discusses a variety of patient, provider, and organizational factors that can contribute to these suboptimal outcomes. Based on the findings of studies reviewed and authors' clinical and research experiences, recommendations have been proposed focusing on various aspects of care provided, including improved accessibility to effective preconception and pregnancy-related care and better organized clinic consultations that are sensitive to women's diabetes and pregnancy needs. © 2013 Springer Science+Business Media New York.


Browne J.L.,Australian Center for Behavioural Research in Diabetes | Browne J.L.,Deakin University | Ventura A.,Australian Center for Behavioural Research in Diabetes | Ventura A.,Deakin University | And 4 more authors.
BMJ Open | Year: 2014

Objectives: While health-related stigma has been the subject of considerable research in other conditions (eg, HIV/AIDS, obesity), it has not received substantial attention in diabetes. Our aim was to explore perceptions and experiences of diabetes-related stigma from the perspective of adults with type 1 diabetes mellitus (T1DM). Design: A qualitative study using semistructured interviews, which were audio recorded, transcribed and subject to thematic analysis. Setting: All interviews were conducted in non-clinical settings in metropolitan areas of Victoria, Australia. Participants: Adults aged ≥18 years with T1DM living in Victoria were eligible to take part. Participants were recruited primarily through the state consumer organisation representing people with diabetes. A total of 27 adults with T1DM took part: 15 (56%) were women; median IQR age was 42 (23) years and diabetes duration was 15 (20) years). Results: Australian adults with T1DM perceive and experience T1DM-specific stigma as well as stigma-by-association with type 2 diabetes. Such stigma is characterised by blame, negative social judgement, stereotyping, exclusion, rejection and discrimination. Participants identified the media, family and friends, healthcare professionals and school teachers as sources of stigma. The negative consequences of this stigma span numerous life domains, including impact on relationships and social identity, emotional well-being and behavioural management of T1DM. This stigma also led to reluctance to disclose the condition in various environments. Adults with T1DM can be both the target and the source of diabetes-related stigma. Conclusions: Stigmatisation is part of the social experience of living with T1DM for Australian adults. Strategies and interventions to address and mitigate this diabetes-related stigma need to be developed and evaluated.


Browne J.L.,Australian Center for Behavioural Research in Diabetes | Browne J.L.,Deakin University | Ventura A.,Australian Center for Behavioural Research in Diabetes | Ventura A.,Deakin University | And 4 more authors.
BMJ Open | Year: 2013

Objectives: While health-related stigma has been the subject of considerable research in other conditions (obesity and HIV/AIDS), it has not received substantial attention in diabetes. The aim of the current study was to explore the social experiences of Australian adults living with type 2 diabetes mellitus (T2DM), with a particular focus on the perception and experience of diabetes-related stigma. Design: A qualitative study using semistructured interviews, which were audio recorded, transcribed and subject to thematic analysis. Setting: This study was conducted in non-clinical settings in metropolitan and regional areas in the Australian state of Victoria. Participants were recruited primarily through the state consumer organisation representing people with diabetes. Participants: All adults aged ≥18 years with T2DM living in Victoria were eligible to take part. Twenty-five adults with T2DM participated (12 women; median age 61 years; median diabetes duration 5 years). Results: A total of 21 (84%) participants indicated that they believed T2DM was stigmatised, or reported evidence of stigmatisation. Specific themes about the experience of stigma were feeling blamed by others for causing their own condition, being subject to negative stereotyping, being discriminated against or having restricted opportunities in life. Other themes focused on sources of stigma, which included the media, healthcare professionals, friends, family and colleagues. Themes relating to the consequences of this stigma were also evident, including participants' unwillingness to disclose their condition to others and psychological distress. Participants believed that people with type 1 diabetes do not experience similar stigmatisation. Conclusions: Our study found evidence of people with T2DM experiencing and perceiving diabetesrelated social stigma. Further research is needed to explore ways to measure and minimise diabetes-related stigma at the individual and societal levels, and also to explore perceptions and experiences of stigma in people with type 1 diabetes.

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