THE DI­A­BETES EPI­DEMIC

Pro­gram to man­age a di­a­betes epi­demic in Syd­ney, Aus­tralia

Great Health Guide - - CONTENTS - Prof Glen Maberly

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.

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