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Awareness weeks

Health Awareness Week

World Diabetes Day

14 November 2022

This World Diabetes Day, IDF is calling on policymakers to increase access to diabetes education to help improve the lives of the more than half a billion people living with diabetes worldwide. International Diabetes Federation 

Diabetes Australia best practice guidelines
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UpToDate

Prevention

Diagnosis

Pregnancy

Treatment

UpToDate pathways

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Articles

Aboriginal and Torres Strait Islanders 

Gestational Diabetes

Guidelines

Research

Treatment

Journals

E-books

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Aboriginal and Torres Strait Islanders

Review of diabetes among Aboriginal and Torres Strait Islander people Journal of the Australian Indigenous HealthInfoNet, 26 April 2022
This review focuses primarily on type 2 diabetes among Aboriginal and Torres Strait Islander people, which is responsible for the majority of cases of diabetes in this population. It provides general information on the social and cultural context of diabetes, and the behavioural and biomedical factors that contribute to diabetes among Aboriginal and Torres Strait Islander people.

Improved metabolic parameters of people with diabetes attending an Aboriginal health service in regional Victoria Internal medicine journal 19 June 2022
Aboriginal people living with type 2 diabetes attending this regional Aboriginal health service have comparable glycaemic management to specialist diabetes services in Australia, managed largely by primary care physicians with limited access to specialist care for the past 5 years.

Diabetes and endocrinology 15 May 2022
The burden of diabetes in the remote Aboriginal population of the NT is among the highest in the world. Strengthened systems of care and public health prevention strategies, developed in partnership with Aboriginal communities, are needed.

Yarning about foot care: evaluation of a foot care service for Aboriginal and Torres Strait Islander Peoples Journal of foot and ankle research 4 April 2022
Evaluation of a foot care service for Aboriginal and Torres Strait Islander Peoples embedded in a university-based podiatry program demonstrated that the incorporation of specific service design elements, including yarning circles and group appointments as well as student placements, encouraged ongoing Community engagement with the service. Participants reported improved foot health, greater foot and self-care knowledge, and overall better general health and management as a result of attendance to the clinic. Consideration needs to be given to addressing limited access to transport and flexible operating hours when establishing similar services.

Rates of diabetic retinopathy screening in pregnant patients with type 1 and type 2 diabetes in a predominantly Indigenous Central Australian population Australian and New Zealand journal of obstetrics and gynaecology 9 December 2021
The minority of pregnant women who attend the DANCE clinic at Alice Springs Hospital received DR screening in adherence with national guidelines.

Mixed diabetic retinopathy screening coverage results in Indigenous Australian primary care settings: A nurse-led model of integrated diabetes care Journal of advanced nursing 7 February 2022
A credentialed nurse-educator implemented a model of retinal image-based diabetes education, measured eye screening coverage and adherence to national eye screening guidelines, met the 'acceptable 75% eye screening coverage' benchmark and improved patient eye screening guideline adherence at the one site where the nurse-educator had access to patient recruitment and scheduling. Impact: This novel nurse-led primary care iDEES model of retinal image-based diabetes education can improve the currently low Indigenous diabetes eye screening coverage in Australia. Importantly, the nurse-managed iDEES model of integrated diabetes care is readily adaptable to other settings and populations where access to and/or uptake of eye care is suboptimal.

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Gestational diabetes

Trends and burden of diabetes in pregnancy among Aboriginal and non-Aboriginal mothers in Western Australia, 1998–2015 BMC public health 9 February 2022
There has been a substantial increase in the burden of pre-gestational diabetes (Aboriginal women) and gestational diabetes (Aboriginal and non-Aboriginal) in recent decades. DIP appears to substantially contribute to increasing trends in LGA among Aboriginal babies.

The perspectives of diabetes educators and dietitians on diet and lifestyle management for Gestational Diabetes Mellitus: A qualitative study Journal of diabetes research 21 June 2022
This study explores the knowledge and practice of diabetes educators and dietitians on diet and lifestyle management in women with gestational diabetes mellitus (GDM). Diabetes educators and dietitians were recruited from three maternity hospitals in Adelaide (Australia), through snowball and purposive sampling

Association of pre-pregnancy low-carbohydrate diet with maternal oral glucose tolerance test levels in gestational diabetes BMC pregnancy and childbirth 26 September 2022
The authors observed a relationship between the pre-pregnancy low-carbohydrate (LC) diet and more detrimental oral glucose tolerance test (OGTT) values in patients with gestational diabetes mellitus (GDM). This finding warrants further studies to understand the effect of pre-pregnancy LC diet practice on maternal glucose tolerance.

What is the “cost” of reducing adverse pregnancy outcomes in patients with gestational diabetes mellitus - risk factors for perinatal complications in a retrospective cohort of pregnant women with GDM BMC pregnancy and childbirth 19 August 2022
No differences were found in maternal and foetal outcomes in GDM and non-GDM women except gestational weight gain below Institute of Medicine recommendations. The only “cost” of reducing adverse pregnancy outcomes in GDM patients seems to be lowering gestational weight gain, the future impact of which on GDM pregnant population should be assessed. The maternal abdominal circumference measured before delivery not the severity of carbohydrate intolerance, remained the main predictor for significant perinatal complications.

Fetal echocardiographic parameters in pregnancies complicated by diabetes: a case control study BMC pregnancy and childbirth 18 August 2022
Fetuses of diabetic pregnant females show a significant increase in Myocardial Performance Index (MPI), decrease in E\A ratio and hypertrophic cardiomyopathy (HCM). These alterations in cardiac functions and structure were found to be continuous throughout the period of time between the two visits.

A scoping review of gestational diabetes mellitus healthcare: experiences of care reported by pregnant women internationally BMC pregnancy and childbirth 8 August 2022
This scoping review draws together reported healthcare experiences of pregnant women with GDM from around the world. Commonalities and differences in the global patient experience of GDM healthcare are identified.

Modifiable risk factors and long term risk of type 2 diabetes among individuals with a history of gestational diabetes mellitus: prospective cohort study BMJ 21 September 2022
Among women with a history of gestational diabetes mellitus, each additional optimal modifiable factor was associated with an incrementally lower risk of type 2 diabetes. These associations were seen even among individuals who were overweight/obese or were at greater genetic susceptibility.

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Guidelines

Australian guideline on prevention of foot ulceration: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease Journal of foot and ankle research 6 July 2022
This new Australian evidence-based guideline on prevention of DFU, endorsed by 10 national peak bodies, provides specific recommendations for relevant health professionals and consumers in the Australian context to prevent DFU. Following these recommendations should achieve better DFU prevention outcomes in Australia.

Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines MJA 6 July 2020
Changes in management as a result of the guidelines: Published international guidelines currently exist, but the challenges and specifics to care for children and adolescents with type 2 diabetes which should apply to Australasia have not been addressed to date. These include:

  • recommendations regarding care of children and adolescents from Indigenous backgrounds in Australia and New Zealand including screening and management;
  • tighter diabetes targets (glycated haemoglobin, ≤ 48 mmol/mol [≤ 6.5%]) for all children and adolescents;
  • considering the use of newer medications approved for adults with type 2 diabetes under the guidance of a paediatric endocrinologist; and
  • the need to transition adolescents with type 2 diabetes to a diabetes multidisciplinary care team including an adult endocrinologist for their ongoing care

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Research

Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study The Lancet diabetes and endocrinology 29 September 2022
Despite declining lifetime risk and improvements in life expectancy for those with type 2 diabetes in many high-income jurisdictions, the burden of type 2 diabetes remains substantial. Public health strategies might benefit from tailored approaches to continue to improve health outcomes for people with diabetes.

Novel antihyperglycaemic drugs and prevention of chronic obstructive pulmonary disease exacerbations among patients with type 2 diabetes: population based cohort study BMJ 1 November 2022
In this population based study, GLP-1 receptor agonists and SGLT-2 inhibitors were associated with a reduced risk of severe exacerbations compared with sulfonylureas in patients with chronic obstructive pulmonary disease and type 2 diabetes. DPP-4 inhibitors were not clearly associated with a decreased risk of chronic obstructive pulmonary disease exacerbations.

Partial meal replacement for people with type 2 diabetes: 2-year outcomes from an Australian general practice Australian journal of primary health 2 November 2022
Patients with T2DM who were able to follow a partial meal replacement plan for 3 months with advice from a general practitioner achieved significant weight loss over 24 months. A multicentre randomised controlled trial to confirm these findings is required as this could significantly change the management of T2DM in primary care.

Empowerment-based support program for vulnerable populations living with diabetes, obesity or high blood pressure: a scoping review BMC public health 9 November 2022
This review of the literature shows that support for people with chronic diseases such as diabetes, obesity or high blood pressure is based on three pillars: empowerment, peer mediation and holistic and tailor-made support for the individual. The empowerment approach, which considers the capacities and resources of individuals and whose goal is to strengthen their ability to act on their health, appears to be entirely suited to the support of these chronic diseases. This review underlines the importance of moving away from a biomedical approach to a holistic approach truly focused on the person, their capacities and their needs.
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Treatment

Management of type 2 diabetes in young adults aged 18–30 years: ADS/ADEA/APEG consensus statement MJA 17 April 2022
Changes in management as a result of this statement
Management recommendations for young adults, which differ from those for adults, include:

  • screening for diabetes in young adults with overweight or obesity and additional risk factors, including in utero exposure to type 2 diabetes or gestational diabetes mellitus;
  • more stringent glucose targets (glycated haemoglobin ≤ 6.5% [≤ 48 mmol/mol]);
  • in the context of obesity or higher cardio-renal risk, glucagon-like peptide 1 receptor agonists and sodium–glucose cotransporter 2 inhibitors are preferred second line agents;
  • β-cell decline is more rapid, so frequent review, early treatment intensification and avoidance of therapeutic inertia are indicated;
  • a blood pressure target of < 130/80 mmHg, as the adult target of ≤ 140/90 mmHg is too high;
  • absolute cardiovascular disease risk calculators are not likely to be accurate in this age group; early statin use should therefore be considered; and
  • a multidisciplinary model of care including an endocrinologist and a certified diabetes educator.

Advances in type 2 diabetes therapy: a focus on cardiovascular and renal outcomes MJA 17 February 2022
Summary

  • Treatment options for type 2 diabetes have expanded. While metformin remains the first line treatment in most cases, choices for second line treatment now extend beyond sulfonylureas and include the sodium–glucose cotransporter 2 (SGLT2) inhibitors, glucagon‐like peptide 1 (GLP1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors. SGLT2 inhibitors are recommended for people with atherosclerotic cardiovascular disease, heart failure or kidney disease. Diabetic ketoacidosis is an uncommon but important side effect; its occurrence can be minimised with appropriate patient education and management, especially during perioperative periods and times of illness.
  • GLP1 receptor agonists are recommended for people with atherosclerotic cardiovascular disease. Gastrointestinal side effects are common but are less prominent with the longer acting agents and can be minimised with slow titration of the shorter acting agents.
  • DPP4 inhibitors are generally well tolerated, but alogliptin and saxagliptin should be used with caution in people with risk factors for heart failure.
  • To optimise the management of type 2 diabetes, clinicians need to be aware of the pharmacological characteristics of each class of blood glucose‐lowering medications and of the effect on cardiovascular health and renal function, balanced by potential adverse effects.
  • Medications that have cardiovascular or renal benefits should be prescribed for patients with these comorbidities, and this is reflected in recent international guidelines.

Multicenter, randomized trial of a Bionic Pancreas in Type 1 Diabetes NEJM 29 September 2022
In this 13-week, randomized trial involving adults and children with type 1 diabetes, use of a bionic pancreas was associated with a greater reduction than standard care in the glycated hemoglobin level. 

 

 

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Journals

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E-books

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Previous Awareness Weeks

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