2018 ADEA-QLD Branch Conference
|Program 20 April|
|Program 21 April|
|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.
|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|
|11.30am-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.
|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
|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.
|Dr Kirstine Bell, University of
|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.
|Kerry Porter CDE, Princess Alexandra Hospital, Brisbane|
|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.
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|| Shelia Cook (endocrinologist), Bernadette
Heenan (CDE); Kerry Porter (NP); Adnan Gauhar
(pharmacist); Kirstine Bell (Dietitian); Jerry Wales (paediatric
Facilitated by: Dr Joanne Ramadge, CEO, ADEA
|5.15-5.45pm – Branch Meeting|
|6.30pm – COCKTAIL RECEPTION|
|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.
|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.
|Associate Professor Paul Varghese, Princess Alexandra Hospital|
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!
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.
|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|
|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
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.
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.
|Dr Pauline Hanrahan, Senior Manager Clinical Operations
Kristi Gale, Community Programs
|3.30-3.45pm – Evaluation and Close|