Baker IDI South Australia

The Type 2 diabetes guidelines review and update project 2009-2012

The National Diabetes Strategy has identified, as a key priority, the development and implementation of national evidence based guidelines for the prevention, detection and management of type 2 diabetes guidelines. A consortium of Baker IDI Heart and Diabetes Institute (Baker IDI), The George Institute and Adelaide Health Technology Assessment (AHTA), has been contracted by the Australian Government Department of Health and Ageing (DOHA) to review and update the following four type 2 diabetes guidelines for clinicians and other health professionals:

• Type 2 diabetes guideline on Diagnosis and Management of Hypertension;
• Type 2 diabetes guideline on Prevention and Detection of Macrovascular Diseases;
• Type 2 diabetes guideline on Lipid Control; and
• Type 2 diabetes guideline on Identification and Management of Diabetic Foot Disease.

The project commenced formally in mid June 2009 and will conclude at the end of February 2012.

The objective of this project will be to review and update four type 2 diabetes guidelines for clinicians and other health professionals.

The review of these guidelines has been accepted onto the work program for the NHMRC. This acceptance was necessary to obtain subsequent approval of the guidelines by NHMRC.

The scope of the project is a review and update of existing guidelines and the scope of the original guidelines forms the boundaries of this work. The key items not within scope are:

• Type 1 diabetes
• Other comorbidities or aspects associated with type 2 diabetes
• Type 2 diabetes and comorbidities in children
• Pregnancy or gestational diabetes

For advice regarding type 2 diabetes and associated comorbidities in children, readers will be referred to the paediatric diabetes guidelines. For advice regarding management of diabetes and associated comorbidities during pregnancy, readers will be referred to appropriate guidelines. The project team will liaise closely with the guideline developers for cardiovascular absolute risk to ensure limited overlap and consistency.

Refer to the Type 2 diabetes guideline website http://t2dgr.bakeridi.edu.au/ for further information on this project.

Evidence-based Guideline for Management of Foot Complications in Diabetes

Baker IDI Heart and Diabetes Institute, The George Institute for Global Health and Adelaide Health Technology Assessment have just released for public consultation a new evidence-based guideline on prevention, diagnosis and management of foot complications in diabetes.

The new guideline will update and replace one of a suite of national evidence-based guidelines for the management of type 2 diabetes mellitus. The previous guideline (titled Detection and Prevention of Foot Problems in Type 2 Diabetes) was last issued in 2005. The work has been commissioned by the Commonwealth Department of Health and Ageing and is scheduled for approval by NHMRC in mid 2011.

The new guideline will update the evidence on a broad range of diabetes-related foot complications and include:

• A discussion of foot complications in the context of type 1 and 2 diabetes, the significance of the problem and key issues in diagnosing and treating people with foot complications, and discussion of standard care
• A systematic review of the evidence in relation to assessment of risk of developing foot complications and assessment of severity of foot ulcers
• Prevention of foot complications from diabetes
• The evidence for healing of foot ulcers in relation to therapeutic and educational interventions, as well as to organisation of care
• Areas for future research and development
• Information and resources on Charcot’s neuro-arthropathy, multi-disciplinary foot care services, and other useful information

The consultation on the draft guideline will commence on 25th September, with public submissions invited until 25th October 2010.

An online survey has been developed as an innovation to the usual consultation requirements of NHMRC. The survey will seek views from stakeholder organisations, including all national medical, allied health and nursing groups and all General Practice Networks/Divisions on the guideline recommendations and expert opinions themselves, but also explore the issues of implementation. The implementation of the guidelines is a key focus of the group developing these guidelines.

The project website can be accessed at http://t2dgr.bakeridi.edu.au/. The draft guidelines and full technical report will be available for download via this site. The survey will also be accessible from this site. if you are having trouble downloading a copy of the guidelines you can request a copy to be sent out by contacting Karen Laverty on 08 8462 9707. 

Take Heart

Take Heart is a National Health and Medical Research Council (NHMRC) funded Adelaide-based project, involving screening for depression in people with heart disease to identify links between depression and heart disease. The' Take Heart' project is a cluster randomized controlled trial of a general practitioner focused intervention aimed at reducing depression in patients with heart failure and angina. This project is a collaborative project with the University of Queensland and the University of Adelaide (Dr Geoff Schrader).

For further information: Professor Simon Stewart 08 8462 9700

Lift For Life

The Lift for Life program is an evidence-based strength training program for older Australians with Type 2 diabetes. It is being developed in partnership with the Adelaide-based company EFM gyms. The program was developed based on research conducted by the International Diabetes Institute (now merged within Baker IDI). The research showed that in just three months, blood glucose control had improved by 7%. After six months, the improvement was 14%- a result which matched and sometimes exceeds that typically produced by conventional drug treatment.

For further information please call 1300 733 143 or find your local Lift for Life provider 

VIPER-BP Study

The Valsartan Intensified Primary carE Reduction of Blood Pressure Study (VIPER-BP Study) is a Phase IV clinical trial of intensified blood pressure management in primary care using valsartan alone and as combination anti-hypertensive therapy.

The primary objective of the study is to evaluate the efficacy of an intensive blood pressure (BP) management strategy relative to usual care in a primary care setting, using a number of currently available forms of valsartan therapy (single and in combination with a thiazide diuretic or calcium channel blocker), to achieve BP control at 26 weeks of active management in patients who have a sub-optimal BP (with or without current antihypertensive treatment) relative to the current National Heart Foundation of Australia expert guidelines.

For further information: Professor Simon Stewart or Trial Manager 08 8462 9700

The WHICH? Study

The WHICH? Study of consumer-friendly and cost-saving heart failure management -Which Heart Failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care.

Chronic heart failure (CHF) is a costly, debilitating and deadly condition that has reached near epidemic proportions in Australia. In the absence of a permanent cure for CHF, the number of people affected by CHF has risen beyond 350,000 and is expected to increase by 20-30% in the next 20 years.

This study is a randomised, head-to-head study of a home versus clinic-based CHF-MP, in 1000 recently hospitalised CHF patients recruited from SA, NSW and QLD. The study follows previous research on the benefits of applying nurse-led, CHF management programs (CHF-MPs) to typically old and fragile patients, in whom recurrent hospital admissions and a premature death are common. The results of pioneering Australian research show that CHF-MPs dramatically improve health outcomes in CHF. CHF-MPs now form part of the recommended "gold-standard" management of CHF. However, there is also evidence that only a small proportion of patients are exposed to a CHF-MP in Australia. Residual issues such as consumer preference and the cost of applying these programs are hindering their wide-spread application. The WHICH? Study addresses this "road block" to implementing a potentially valuable health care service by tackling a number of critical issues: which form of CHF-MP (home or specialist clinic-based follow-up), will produce the best health outcomes, save the most money and meet the needs of consumers at the same time?

The results of this vitally important study will provide clinicians, health administrators and governments with a clear "economic blueprint" for the cost-effective management of CHF tailored to the needs of consumers. This study has the potential to improve the health care and associated outcomes in more than 25,000 CHF patients per year and save the health care system hundreds of millions of dollars in the process.

For further information: Professor Simon Stewart 08 8462 9700

Collaborating with Baker IDI

Baker IDI is keen to further collaborate with existing health and medical researchers and organisations in South Australia. We believe there is great opportunity for partnerships around workplace interventions, indigenous health and public education programs with the aim of reducing the incidence of diabetes and heart disease, as well as identifying those already at risk of these diseases.

Contact the Baker IDI General Manager for South Australia, Ms Kathy Mott on 08 8462 9720

Diabetes Co-ordinated Care – A Policy Analysis Project

Baker IDI, in collaboration with the Australian Diabetes Educators Association has been successful in a grant from the Australian Primary Health Care Research Institute (ANU) to undertake an analysis of the proposed co-rinated care program for people with diabetes. The project, titled, "Will voluntary patient registration, performance incentives plus capitated payments to general practice for care for people with diabetes result in improved access, coordination and outcomes?" has two objectives:

1. to identify which patient groups will be advantaged and which patient groups will be disadvantaged by the proposed diabetes coordinated care program; and 
2. to identify and model some options to augment the existing policy to improve the benefits and reduce the risks within the proposed budget.

This project brings together allied health providers, GPs, specialist doctors, policy makers, consumers and researchers to explore the implications of a new policy initiative, prior to it being fully implemented. The processes proposed will enable a range of perspectives to be included in any deliberations and forums for exchange of views will be created throughout the project period.

The project builds on evidence of the relationship between diabetes patients, the provision and financing of their care and their health outcomes.

Chief Investigators:
Professor Peter Clifton
Dr Peter Sexton
Associate Professor Jonathan Shaw
Ms Clair Matthews

Researchers:
Brita Pekarsky
Tony Lawson

The project period is December 2010 to December 2011.