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2018 ADEA-QLD Branch Conference

 

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Program 20 April
Program 21 April
Speakers
Sponsors

Friday 20 April 2018

 

8.30-9.00am – Registration
9.00-9.15am – Welcome, housekeeping and acknowledgement of country
9.15-10.15am – The Environmental Determinants of Islet Autoimmunity (ENDIA) Study

The ENDIA Study has entered its fifth year of operation to find the causes of type 1 diabetes. This is a national study aiming to recruit 1400 genetically at risk babies and follow them through childhood to determine the triggers and protective factors influencing the development of type 1 diabetes. What makes this study unique internationally is that babies are followed before they are born from the pregnancy. To be eligible to participate, the baby must have a first degree relative with type 1 diabetes (i.e. mum, dad, or sibling). In this presentation, our nurse coordinators based in Brisbane, Emma and Julianne, will provide the rationale for the study, study processes and what participation involves for families. If we can find what causes type 1 diabetes, we can then find ways to prevent it in future generations.

Presentation Here and Here

Julianne Wilson

Emma Brownrigg

 

10.15-11.00am – Diabetic Foot Disease: Sailing by Numbers

Clinicians are able to measure an ever increasing number of parameters relating to clinical care with increasing accuracy.  Diabetic foot disease is no exception.  From improvements in in-shoe pressure measurements, 3D cameras which measure wound size to new wound classification systems and epidemiological evidence our clinical practice exists within sea of numbers.  Scott will explore how we plot our clients course and individualise treatment plans to make gentle or significant course corrections where required.

 Scott Lucado-Wells, Podiatrist
11.00-11.30am MORNING TEA
11.30am-12.15pm – Carbohydrate restriction may improve neuropathy in Type 1 Diabetes

Glycaemic variability – or the intra-day oscillations of blood glucose levels – has recently been found to predict endothelial dysfunction and atherosclerosis independent of HbA1c. Hypoglycaemia and glycaemic variability occur more frequently in people with Type 1 Diabetes (T1DM) than those with Type 2 Diabetes (T2DM), and present significant barriers to optimizing insulin therapy in people with T1DM. We present two cases where intentional carbohydrate restriction significantly improved glycaemic control and reduced the pain associated with peripheral neuropathy. It is unclear if the improvement in neuropathic pain in these cases was due to the improvement in glycaemic variability, reduced insulin requirement or the dietary modification itself.

Presentation Here

Dr Shelia Cook, Endocrinologist
12.15-1.00pm – DESMOND project

In 2016, Diabetes Queensland was the first organisation in Queensland to commence the DESMOND (Diabetes education and self-management for ongoing and newly diagnosed) training and quality development (QD) process for its credentialed diabetes educator and allied health staff. In 2017, funded by the NDSS (National Diabetes Services Scheme), Diabetes Queensland began delivery of the DESMOND program to NDSS registrants in both metropolitan and regional areas of Queensland.

This presentation is an update on what has been achieved in Queensland in 2017.  Twelve months of local evaluation demonstrates the effectiveness of the DESMOND Educator QD process in ensuring consistent, positive outcomes for people living with type 2 diabetes. Program access and service integration highlight the effectiveness and future potential of a state-wide collaborative, cross organisational, approach to DESMOND training and delivery.

Trish Roderick and Linda Uhr, Diabetes
QLD
1.00-2.00pm LUNCH
2.00-2.45pm – Beyond Carbohydrate counting: effects of fat and protein in Type 1 diabetes

Carbohydrate counting is the current gold standard method for determining prandial insulin doses in type 1 diabetes, yet carbohydrate varies in glycemic index (GI) and the method fails to take into account fat and protein, which are also known to affect normal insulin secretion.  Furthermore, meta-analysis reveals carbohydrate counting alone has little or no impact beyond routine care on glycaemic control in type 1 diabetes.

The impact of dietary fat and protein on glycaemia has been highlighted by those living with type 1 diabetes, who despite accurate carbohydrate counting, have found tight glycaemic control difficult to achieve in practice, especially for foods high in these nutrients.  With the increasing clinical use of continuous glucose monitoring, the impact of these nutrients has become increasingly apparent.

Current research in type 1 diabetes shows fat and protein can significantly alter the postprandial glycaemic response and therefore may require adjusted mealtime insulin doses to improve glycaemic control.  This presentation will examine the current evidence regarding the effects of fat and protein on glycaemia and the insulin dosing strategies currently being investigated. Finally, we will explore how the delegates can translate this research into clinical solutions for people with type 1 diabetes.

Presentation Here

Dr Kirstine Bell, University of
Sydney
2.45 -3.15pm – Digital Hospital

Queensland Hospitals are undergoing rapid digital transformation. We are changing from paper- based hospital work to a digital system. How do we integrate clinical documentation; medical devices and decision support? Does moving to a digital system mean better patient care or is it just moving from paper to a computer?  A thoughtful, data driven approach to digital transformation of care is needed to improve the quality, efficiency and value of the care we provide to our patients.

This presentation will look at the 12 month journey of the impact of the digital world on patient care; issues of digital transparency and hypervigilance translating into transformative and innovative practice to improve patient care.

Presentation Here

Kerry Porter CDE, Princess Alexandra Hospital, Brisbane
3.15-3.45pm AFTERNOON TEA
3.45-4.30pm – Lessons from Paediatric Diabetes

Paediatric diabetes is a diagnostic speciality encompassing type 1, 2 and 3 diabetes though the majority remain Type 1 diabetes. The biggest strides in achieving near perfect control have been made in children and young people in Europe. Australia sadly lags well behind these nations and this results in avoidable morbidity and mortality. Good control is dependent on team messages and targets, judicious use of technology and intensive treatment regimens from diagnosis. However it is only when nationwide evidence-based standards of care are available coupled with universal comparative audit (paediatric and adult) and funding based on outcome does the situation improve.

Presentation Here

Professor
Jerry Wales, Lady Cilento Children’s Hospital, Brisbane
4.30 –5.15pm – Panel discussion: Do the Numbers Matter – Individualising HbA1c, weight, blood glucose levels with a focus on person centred care

Case Study Slides Here

 Shelia Cook (endocrinologist), Bernadette
Heenan (CDE); Kerry Porter (NP); Adnan Gauhar
(pharmacist); Kirstine Bell (Dietitian); Jerry Wales (paediatric
endocrinologist)
Facilitated by: Dr Joanne Ramadge, CEO, ADEA
5.15-5.45pm – Branch Meeting
6.30pm – COCKTAIL RECEPTION

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Saturday 21 April 2018

7.00-8.30am – Flash Glucose Monitoring Workshop and Breakfast – supported by Abbott Diabetes Care

The purpose of this workshop it to give Diabetes Educators the experience of wearing a Flash Glucose Monitoring System to help in understanding this technology. Along with wearing the sensor for up to 14 days, the practical workshop will include how to set up the reader and apply the sensor as well as how to get the best use from the data by the Ambulatory Glucose Profile reports (AGP). The sessions will be held with the support of a Credentialled Diabetes Educator with experience with Flash Glucose Monitors who will share their story.

8.00-8.30am – Registration
8.30-8.45am – Welcome, housekeeping and acknowledgement of country
8.45-9.30am – Economic consequences of diabetes: more than just a health system issue

The cost of diabetes to the health care system is significant and has been well documented. Less well known are the broader economic consequences of diabetes, including the productivity related costs associated with time taken off work, early retirement and premature deaths. These costs are substantial, but typically excluded from economic evaluations of effective diabetes interventions. The result is that funding decisions are often made based on data that underestimates the full spectrum of economic benefits that could be achieved with improvements in patients’ health outcomes. This presentation will provide a brief overview of the health economic approaches that can be applied to estimating the costs of diabetes and summarise the current literature around the economic consequences of diabetes in Australia.

Presentation Here

Dr Hannah Carter,
Queensland University of Technology
9.30 –10.15am – Diabetic Management in the Frail Older Patient

The number of older persons with diabetes is increasing as a consequence of population ageing, increased rates of obesity and increasing life expectancy.  Diabetic management in patients with physical and cognitive frailty poses unique challenges and a different therapeutic approach to the general cares offered the younger diabetic patient. While tight glycemic targets and the prevention of long term complications is desirable in the younger diabetic it has been shown that these targets are not appropriate in the care of the elderly patient.

This paper will focus on the causes of frailty and the potential for harm in the older patient.  The interactions between treatment targets and possible adverse events in the older patient will be discussed.  Changes in treatment goals and the approach taken by geriatric medicine in managing older diabetic patients will be explored.  A discussion on potential side effects of oral agents and insulin and the special problems of care in a residential care environment and in patients undergoing rehabilitation will also be covered.

Presentation Here

Associate Professor Paul Varghese, Princess Alexandra Hospital
10.45-11.30amConcurrent sessions

  • Being a CDE In Private Practice

Lynne looks into why you would go into private practice versus public the public sector, what are the benefits and what are the negatives.Where and how do you start a business? Let’s look at what nurses know about business and then how we can find the information needed. Who is there to support you?Is it all about numbers – sure is! How do you get referrals? What else can you do? Setting goals – what do you want to achieve and when?How do you make private practice work with out going insane and how do you make it profitable?How do the people in your team contribute to the success of a private practice? Who do you need in your team and what tools can you use to choose the right team member?How do you keep the ball rolling? Is it really worth it!

Presentation Here

  • Puberty and diabetes

Puberty is the period of sexual development marking the transition from childhood to adulthood. It is a time which is associated with significant changes particularly for the adolescent with Type 1 diabetes.  The hormonal changes at puberty affect blood glucose control, often making it more difficult to manage. It is a time when the effectiveness of insulin declines by about 30% to 50%.  This insulin resistance is due to the surge in growth hormone and other sexual hormones. For the majority of adolescents with diabetes, their doses of insulin must constantly be adjusted to maintain blood glucose control. At the same time, puberty is also a time of great psychological and social change for the adolescent. Common consequences are that the young person does not wish to be seen as different to their peers and adherence to diabetes management becomes a major challenge.  In addition, at least 30% of young people with a chronic disease develop overt depression.

Concurrent sessions

  • Being a CDE in private practice – Lynne McCleary(CDE, Toowoomba)

 

 

 

 

 

 

 

  • Puberty and diabetes – Eunice Lang, CDE
11.30am-12.15pm – Long-term effects of diabetes in pregnancy: the role of epigenetic changes

With the rise of overweight and obesity in the obstetric population, the incidence of gestational diabetes and type 2 diabetes are increasing. It is well-known that diabetes in pregnancy has long-term adverse effects on mother and baby with increased risks of obesity, metabolic disease and cardiovascular disease. The mechanism for these long-term effects is thought to be through epigenetic changes. Epigenetic markers alter the accessibility of DNA and changes to these markers can increase or decrease the expression of genes and thereby protein amount and function. Epigenetic markers such as DNA methylation and histone modifications can be stable over longer periods of time.

In this presentation, I will review the current evidence of the role of epigenetic changes in changing long-term outcomes in mother and baby affected by diabetes in pregnancy.

Dr Marloes Dekker Nitert, University of QLD
12.15-1.15pm  LUNCH
1.15-2.00pm – Diabetes education in rural and remote areas and with Indigenous clients

In this presentation, Bernadette Heenan, 2018 Jan Baldwin National CDE of the Year, will discuss how she uses the seven step to diabetes self-management program with her Indigenous clients. She will also discuss how diabetes educators working with their multidisciplinary team to personalise these steps and make them more meaningful and useful for their client in managing their health outcomes.

Bernadette Heenan, RN, 2017
CDE of the Year
2.00-2.45pm – Oral Abstracts
2.45-3.30pm – Juvenile Diabetes Research Foundation

Pauline Hanrahan

Clinical trials allow treatments and therapies to reach patients sooner, and healthcare professionals are a vital link connecting patients to ongoing research. Dr Hanrahan will discuss what opportunities, services and support that JDRF can provide to healthcare professionals caring for people living with type 1 diabetes.

JDRF is the leading global organisation funding type 1 diabetes (T1D) research. Our mission is to accelerate life-changing breakthroughs to cure, prevent and treat T1D and its complications. JDRF research focusses on all aspects of the disease, including preventative therapies, understanding the immune response, glucose control, complications, encapsulation and beta cell therapies.

In order to address the gap in clinical type 1 diabetes research in Australia, JDRF advocated for funding for a clinical research network.

The Australian Type 1 Diabetes Clinical Research Network (T1DCRN) is a collaborative initiative dedicated to positively impacting the life of people with type 1 diabetes through accelerating clinical research for the cure, treatment and prevention of type 1 diabetes. The T1DCRN is led by JDRF Australia and is funded through a Special Research Initiative of the Australian Research Council. The T1DCRN is funding ongoing clinical trials, a registry, a large world-first cohort study, career development and innovative research.

Kirsti Gale

This presentation will cover all aspects of JDRF and the CRN particularly in relation to Health Care Professionals working in the area of Type 1 Diabetes.

JDRF provides a range of services and programs to assist and support health care professionals working with the type 1 diabetes community. Our aim is to update health care professionals on existing and new resources and programs that will assist in the education and support of their patients. We value the important role HCP’s play in the frontline management and education of Type 1 Diabetes.

Presentation Here

Dr Pauline Hanrahan, Senior Manager Clinical Operations

 

 

 

 

 

 

 

 

 

 

 

Kristi Gale, Community Programs

3.30-3.45pm – Evaluation and Close

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Speakers

   Emma Brownrigg is a Paediatric Nurse specialising in Oncology/Haematology with over 20 years’ experience. In 2015 she completed Graduate Certificate in Transfusion Nursing working as the Transfusion Nurse at Lady Cilento Children’s Hospital for 2 years. Whilst working alongside Diabetes Educators at the Mater Children’s she observed an increase in incidence of Juvenile Diabetes and became interested in the reasons for the increase. Emma is one of the study coordinators for the ENDIA Study: a pregnancy to early life cohort study in children at risk of type one diabetes. Emma has a Border Collie named Banjo with Type One Diabetes and manages his insulin and glucose curves at home.
   Julianne Wilson completed her general nursing training at Royal Brisbane Hospital and her Midwifery at Mater Mothers Hospital. She has worked as a research nurse for over 25 years in Phase 1 ,2 & 3 trials at Qpharm Clinical Trials facility. She has also worked at Princess Alexandra Hospital with patients experiencing liver disease. Julianne has been working in the field of diabetes since 2012 when she started on the AdDIT study (Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial). Julianne has recently become a grandmother to a beautiful baby girl.
  Dr Kirstine Bell is an Accredited Practising Dietitian and Credentialled Diabetes Educator with a PhD in the optimisation of insulin dosing in type 1 diabetes from the University of Sydney, Australia. Following her PhD, Kirstie undertook short-term post-doc research positions with the Joslin Diabetes Center & Harvard Medical School in Boston, USA and the Hunter Medical Research Institute, Newcastle to continue her research. Kirstie is currently an NHMRC Early Career Research Fellow at the Charles Perkins Centre, University of Sydney.  She is the recipient of the DAA Joan Woodhill Prize for Excellence in Research and her work has been incorporated into International Diabetes guidelines including the American Diabetes Associations’ Standards of Medical Care.  She is the National Diabetes Interest Group Convenor for the Dietitians Association of Australia and serves as the clinical co-chair for the ADEA Program Organising Committee for the Australasian Diabetes Congress.
   Dr Hannah Carter  is a health economist at the Australian Centre for Health Services Innovation (AusHSI), based at the Queensland University of Technology in Brisbane. Her current role involves providing advice, guidance and support on health services evaluation, including research project design, methodology and cost-effectiveness analysis. She also has specialist knowledge in health system modelling, and an interest in estimating the economic consequences of disease. Her doctoral thesis explored the productivity related costs associated with premature mortality in Australia.
   Dr Marloes Dekker Nitert is a Senior Research Fellow at The University of Queensland. Marloes is a biomedical researcher with a PhD from Lund University in Sweden. Her research focuses on the role of metabolism in complications of pregnancy. She currently heads a laboratory research group at the UQ Centre for Clinical Research studying the role of the gut microbiome in pregnancy, the role of food additives on placental function and placental gene expression and epigenetic markers in pregnancy complications. Marloes works closely together with clinician-scientists and clinicians at the Royal Brisbane and Women’s Hospital. She is part of the SPRING RCT team which assesses if probiotics can prevent gestational diabetes mellitus in overweight and obese women. Marloes is a scientific representative on the SOMANZ council.
   Kerry Porter has over 20 years experience working in diabetes and other chronic diseases. She is an endorsed Nurse Practitioner, credentialled diabetes educator and a midwife. Kerry is currently the Nurse Lead / Nurse Practitioner at the Princess Alexandra Hospital. She also runs a private practice. Kerry’s background includes working in primary health, community health, private practice, and hospital settings both in rural and urban environments. She has vast experience in working with children and adults with type 1, type 2, insulin pump therapy and diabetes in pregnancy. Kerry is passionate about helping people live the best lives they can.
   Associate Professor Paul Varghese is the current Director of Geriatric Medicine at the Princess Alexandra Hospital.  He studied at University of Queensland and trained as a General Physician before completing his fellowship in Geriatric Medicine in 1992.  He practices in clinical geriatric medicine with clinical interests in the areas of amputees, dementia, falls and the acute care of the elderly.  He is actively involved in undergraduate and post graduate teaching and holds the clinical title of Associate Professor with the University of Queensland.  He is Stream leader for the Metro South Aged care and Rehabilitation stream and sits on a number of clinical reference groups at both a State and Federal level.  His research interests include falls, clinical database design, tele-geriatrics and the management of patients with dementia.
 Lynne McCleary has been a Registered Nurse for over 44 years and has been a CDE on and off for over 20 years. She has worked in both the public sector and private sector as a Registered Nurse and a CDE. She inaugurated and was the coordinator of the diabetes clinic in Narrabri NSW and is happy to say that it is still operational.  In 2015 after the closure of the diabetes clinic she managed in Toowoomba, she decided that she would start a Diabetes Clinic called AH Diabetes in Toowoomba. She was lucky enough that the team she worked with also decided to come with her and it has now grown into thriving business.
   Scott Lucadou-Wells graduated from QUT Podiatry in 1996 and has worked predominantly in the public sector in both hospital and community-based settings.  Scott found his passion for high risk foot problems in 2002 working at the Caboolture Community Health Centre within a multi-disciplinary Diabetes Service and has since spent most of his clinical time working with this challenging condition.  In 2007 Scott commenced as a Team Leader of a Multi-disciplinary team which instilled a strong drive for efficiency and efficacy in clinical practice and a love of quality and service improvement.  Scott has since held leadership roles in the Podiatry professional group in Metro North Hospital and Health Service (MNHHS) where he leads service-wide clinical audits.  Scott is currently the Advanced Clinical Podiatrist for the MNHHS Diabetes Service and for the Australian Wound Innovation Centre.  Scott’s key areas of clinical interest are assessment of peripheral vascular disease and offloading for wound healing.
Dr Hanrahan trained as a Nurse and went on to complete a PhD in Public Health. She has over 20 years of experience in Melanoma Research, having managed over 40 clinical trials across all phases including first in-human studies. In 2016 she joined JDRF as the Senior Manager Clinical Operations. In this role she manages the research portfolio of the Australian Type 1 Diabetes Clinical Research Network (T1DCRN) with the Research Team. She works closely with funded clinical trials to ensure they run to time and budget. She regularly meets with HCPs across Australia to increase awareness of T1DCRN-funded research.  
Kristi Gale is a Channel and Relationship manager with over 20 years corporate experience in various industries. In 2015 she joined JDRF in the Community Programs team. In this role she manages various programs including the Federal Government Insulin Pump program, Heath Care Professional program and T1d Connect support groups, while also assisting with KIDSAC and Peer Support Program. She works closely with our research team and regularly meets with HCPs across Australia to increase awareness of T1DCRN-funded research. Kristi has also lived with Type 1 Diabetes for the last 33 years.
Professor Jerry Wales is Director for Endocrinology in Brisbane, Australia. He is coChairman of the Queensland State Diabetes Network. He is a member of council of APEG and also serves on the APEG Diabetes sub-committee. He trained at Oxford University then was a paediatric endocrinologist at Sheffield Children’s Hospital in the UK from 1991-2013. He was Chairman of the BSPED 1997-2001 and Chairman of the United Kingdom National Institute for Health and Clinical Excellence (NICE) review of Diabetes Care for Children and Young People, published in 2015. He has widely published in the field of paediatric endocrinology & diabetes.
Bernadette Heenan was the 2017 Jan Baldwin CDE of the Year. Bernadette works for the Apunipima Cape York Health Council in North Queensland. She works with remote clients who have  a range of different languages. She has developed many resources to assist Indigenous clients in understanding their diabetes and uses the latest technologies to help clients “see” what effect glucose is having on their bodies.
Trish Roderick is a credentialed diabetes educator and accredited DESMOND Educator who has worked across a broad range of services over the 17 years she has been involved in diabetes education. Coming originally from general practice Trish has worked for the last 8 years at Diabetes Queensland. In her current role as Health Services Delivery Manager she has been actively working to establish sustainable evidence based group education programs in the community setting.

Linda Uhr is an accredited practicing dietitian. Currently she works in both the areas of prevention and management of diabetes for Diabetes Queensland. She project manages the state government funded high school cooking program ‘Need for Feed’ as well as working in the health team to deliver both consumer and health professional education. Trained as a DESMOND Educator she has recently begun her Graduate Certificate of Diabetes Education at the University of Technology in Sydney.

  Dr Sheila Cook is the Director of Diabetes and Endocrinology at Toowoomba Hospital.  After completing her endocrinology and obstetric medicine training in Brisbane in 2006, she became the first endocrinologist west of Brisbane. In Toowoomba, she established the Diabetes and Endocrinology Unit, the Obstetric Medicine Service, the Acute Medical Unit and the Physician in the Practice Clinic where she has regularly visited 25 general practices to see her patients with their GPs.  Sheila is passionate about holistic care and learning from her patients.  As a mother of four, she is obsessed with the metabolic impact of sleep deprivation and sugar.
Eunice Lang is a trained Paediatric Registered Nurse and Credentialled Diabetes Educator (CDE) and has worked in the field of Diabetes and Endocrinology for the past 25 years. The majority of her career was spent as the Clinical Nurse Consultant to the Department of Endocrinology and Diabetes at the Royal Children’s Hospital, Brisbane. During that time Eunice was involved in many state-wide and national programs developing guidelines and resources for health professionals as well as young people and their families. Eunice also worked at the Mater Children’s Hospital developing the Sweet Diabetes Transition Program. Originally this program was designed for the transition of young people in Queensland from paediatric to adult diabetes care. However, the principles of this program have been included in the National Evidence Based Clinical Guidelines for Type 1 Diabetes in Children, Adolescents and Adults. Eunice now works in her own private practice called Diabetes Central and has a special interest in continuous glucose monitoring (CGM).

 

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