THE DIABETES EPIDEMIC
Program to manage a diabetes epidemic in Sydney, Australia
Diabetes is now one of the biggest challenges confronting Australia’s health system. Approximately 1.7 million Australians have diabetes, including all types of diagnosed diabetes with 1.2 million known, as well as silent, undiagnosed type 2 diabetes, estimated to be up to 500,000. The diabetes epidemic in Western Sydney typifies this massive problem. Western Sydney is a diabetes hotspot with disease rates higher than the New South Wales (NSW) average. People in Western Sydney are living in a ‘diabetogenic’ environment where the population, community, local economy and built environment make it difficult for the residents to engage in a healthy lifestyle. There is an urgent need to change the environments in which people live, work and play, to address the social determinants of health in Western Sydney.
WHAT IS THE WESTERN SYDNEY DIABETES INITIATIVE?
At Western Sydney Diabetics (WSD), we want to increase the proportion of the healthy population, slow the community’s progression towards being at risk of diabetes and reduce the size of the atrisk population. It is estimated that over 200,000 people, which is a quarter of the Western Sydney population, are likely to be affected by diabetes or pre-diabetes. The WSD initiative, recognises that diabetes is everybody’s business. Partnerships between community health services, general practice, hospitals, specialist practices and allied health need to be improved so that people with
diabetes or at risk of diabetes have access to more integrated and comprehensive diabetes services. Only then can we reduce the burden on the health system, reduce the number of people with diabetes and pre-diabetes symptoms and slow the diabetes epidemic.
COLLABORATIVE DIABETES CARE.
One of our initiatives introduced in 2014, was aimed at encouraging a much more collaborative approach to diabetes care, involving the person with diabetes and all key members of their healthcare professional team for one joint appointment – called the Joint
Specialist Case Conference (JSCC). At each appointment, the person living with diabetes meets with their GP and specialists, which may include their endocrinologist, practice nurse, resident medical staff, diabetes nurse educator and pharmacist, in the GP setting. This meeting allows all aspects of diabetes care to be discussed in an open forum involving the person living with diabetes and their team and provides an opportunity to share learnings and experiences. It also allows for immediate decisions on care plans for patients, covering diagnosis, treatments and interventions in one consultation. These discussions include everything from medication review, cholesterol and blood sugar testing (HbA1c), diet and lifestyle review and for those people injecting their diabetes medication, a review of their injection technique. We have found that review and education on correct injection technique by a trained healthcare professional, can lead to significant improvements in the patients’ health and encourage people to follow the five golden rules of injection technique.
THE FIVE GOLDEN RULES OF INJECTION TECHNIQUE FROM MAYO CLINIC:
1. Always inject into the healthy fatty layer under your skin. 2. A 4mm length pen/needle, inserted at 90 degrees is recommended for all adults and children. 3. Inject diabetes medication into areas on the abdomen, thighs and buttocks.
4. Check injection sites for lumps and bumps. 5. Rotate injection sites properly.
WHAT IMPACT HAS OUR APPROACH HAD?
Since WSD created the JSCC, we have been gathering feedback from GPs and patients and the overall impact on practice diabetes management.
The key outcomes of the program, Effectiveness of joint specialist case conferences for building general practice capacity to enhance diabetes care: A pilot study in Western Sydney, Australia, include: 1. Engaging 1,200 patients, 165 GPs, across 57 different practices in Western Sydney. 2. Key improvement in key clinical measures in three years following JSCC include: • An average of 2.30 kilograms in weight loss • A decrease of 0.93% in HbA1c (sugar levels) • A decrease of 4.61% in diastolic blood pressure • Almost half report increased GP confidence in managing diabetes • Ninety percentage of patients have reported that JSCC were useful.
CONCLUSIONS: 1. Diabetes is an epidemic in Australia and the Western world.
Everyone has a role to play in reducing the risk of developing diabetes and managing it effectively if diagnosed - we continue to find that diabetes is more prevalent than we thought.
2. Involve people in their role to manage diabetes.
Encouraging people with diabetes to play a central role in their diabetes care management has been very successful for us in Western Sydney. Regular blood sugar testing, small weight loss and education on diabetes medication and injection technique can lead to better diabetes management.
3. Lose weight.
Any weight loss is good for reducing the risk of developing diabetes, 30% of those with pre-diabetes who lose 2 kilograms, won’t go on to develop diabetes.
4. Get tested.
If you have any doubts or have been diagnosed with pre-diabetes, get tested regularly for diabetes. Professor Glen Maberly, Senior Endocrinologist and Program Lead, Western Sydney Diabetes. He is the driving force behind the Western Sydney Diabetes initiative. The Western Sydney Local Health District (WSLHD) is a diabetes hot-spot and has built a program with numerous partners in all sectors to beat diabetes. Throughout his career, Glen has focused on bringing public health evidence-based research findings to large scale implementation.