Research in the Community Reduces Diabetes Burden

It costs the health system $2.7 billion a year in treatment, nearly $135 million of which could be prevented through better management of blood sugar levels in individuals.

Sydney Health Partners has funded three projects to reduce the lifelong risk of diabetes-related complications - or prevent patients from developing diabetes in the first place.

Professor Maria Craig, Paediatric Endocrinologist at the Children's Hospital at Westmead, is looking at ways to reduce the burden of variable blood sugar - generating new clinical evidence to assess the viability of new technologies.

She is measuring the clinical and economic outcomes of treating type 1 diabetes (T1D) patients with a new technology known as a hybrid closed-loop insulin pump and comparing the outcomes with those of traditional multiple daily injection therapies.

Unlike conventional insulin pumps, hybrid closed loop systems automatically vary the supply of insulin in response to continuous blood glucose monitoring, helping patients maintain their blood-glucose levels throughout the day.

Principal Co-investigator, Associate Professor Jane Holmes Walker, says that this is the first study into whether the health and lifestyle benefits of the pumps outweigh the costs.

"Because hybrid closed-loop insulin pumps are not currently available to public health patients, it is important to research their health and economic impacts," she said.

"We're attempting to put a dollar value on the quality of life improvements that may result from use of the new technology."

Helping young adults better manage their type 2 diabetes (T2D) is the focus of Dr Timothy Middleton, Endocrinologist at the Royal Prince Alfred Diabetes Centre and the University of Sydney.

"Diabetes is a lifelong condition, and young adults are going to have extended exposure to risk factors," he said.  "But these people are busy studying, starting families - they have other commitments and worry about other aspects of their lives, over their diabetes."

To combat this, he and his co-investigators, Professors Jencia Wong and Professor Clara Chow, have developed a program that sends supportive messages and appointment reminders to patients via SMS, so they remain engaged with the treatment and management of their disease, and attend their quarterly clinic appointments. The TEXT2U project compares the new SMS program against current standard of care with promising results thus far.

Interim analysis of participants 6 months into the program has found that 81 percent maintained a perfect clinic attendance record compared to the 47 percent of individuals who are receiving the current standard of care.

"Ultimately we want to help these young people develop good habits," said Dr Middleton. "The risk is that if they miss clinic appointments, we miss out on opportunities to identify and address problem areas with them; this will result in poorer health outcomes and impaired quality of life in the long term."

In another project, Professor N Wah Cheung, Director of Diabetes and Endocrinology at Westmead, is also engaging with patients via SMS - attempting to reduce the risk of pregnant women with gestational diabetes developing type 2 diabetes after their pregnancy.

"International data suggest that women who have had gestational diabetes have a 50% risk of developing diabetes in the next 25 years, but studies we've done around western Sydney show that it's much higher here - around 60% risk of getting diabetes or pre-diabetes within 5 years," said Professor Cheung.

As part of an SHP-funded trial, women with recent gestational diabetes will wear activity monitoring devices and be sent personalised SMS tips and reminders to eat healthily and stay active based on their activity data.

"We know from diabetes prevention studies that if you're active, if you eat healthy and you manage your weight, your risk for diabetes is lower. We want to know if simple technology can be used to help women modify their lifestyle and reduce their long-term risk," he said.