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2018 ADEA-WA Branch Conference



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Program 5 April
Program 6 April

Thursday 5 April 2018

6.00-7.30pm – Flash Glucose Monitoring Workshop sponsored by Abbott Diabetes Care

Friday 6 April 2018

8.00-9.30am – Registration 
8.30-8.35am – Welcome by Branch Chair
 8.35-9.20am – Closed Loop Therapy for Type 1 Diabetes: Update 

Most patients with Type 1 Diabetes do not achieve acceptable glycaemic control especially the young, all are at risk of hypoglycaemia and for many, the burden of care is high and results in significant stress for both the patient and family. Advances in technology have offered promise to address these problems through automated insulin delivery.  The artificial or mechanical pancreas uses a combination of continuous glucose sensing, an insulin pump and a control algorithm to keep blood glucose levels at a target level. Rapid progress has been made over the last 10 years and these systems have proven safe and effective in hospital studies and early outpatient trials. These trials have demonstrated reduced hypoglycaemia and more time spent in an optimal glucose range. Early models have been “hybrid” that is they still require a bolus to be given for food intake. In 2016 the first commercial device was approved by the FDA and will be released in 2017 in the USA. Other systems are in development. There remain challenges such as food and exercise and it is not yet known how patients will manage these devices in the real world but despite the challenges it is likely that diabetes treatment will be revolutionised over the next decade.

Professor Timothy Jones, University of Western Australia
 9.20-10.05am –  Counting the Fat, Protein and Carbs – Translating the Evidence into Clinical Practice 

At present, individuals with type 1 diabetes typically calculate the meal-time insulin dose using an individualised insulin-to-carbohydrate ratio. However, there is increasing evidence that the glycaemic impact of dietary fat and protein should be considered when determining the meal-time insulin dose and how it is delivered. Protein and fat have been shown to independently and additively cause postprandial hyperglycaemia in children and adults using intensive insulin therapy. Large quantities of protein eaten alone results in significantly delayed and sustained postprandial glycaemic excursions.  The addition of protein to a carbohydrate meal decreases the early postprandial glucose level and then increases late postprandial glucose in a dose dependent manner. Currently, there are no published clinical guidelines describing the optimal timing and split of the insulin bolus to account for the fat and protein content. A recent study by our group found a combination bolus with at least 60% of the dose upfront was required to control the initial postprandial rise, with additional insulin of up to 30% needed in the extended bolus to prevent delayed hyperglycaemia. Novel mealtime insulin dosing algorithms have been developed to account for the glycaemic impact of meal fat and protein content. However, significant inter-individual variation in insulin requirements for fat and protein means an individualized approach to insulin dosing is advised. Diabetes education will remain the key to the successful translation of new methods of insulin dosing into the daily lives of people living with type 1 diabetes.

 Dr Carmel Smart, John Hunter Children’s Hospital, Newcastle
10.35-11.20 – Concurrent Sessions

Technology and Diabetes (via video conference)

There is no doubt that technology and innovation continue to have a growing impact on diabetes care and offer us solutions that are transformative in the way self-management care is delivered. With the growing adoption of e-Health solutions, there is a real potential for accelerated change in diabetes healthcare and opportunities to overcome barriers of the past. For people with diabetes, the use of technology can translate to fewer clinic and emergency visits, reduced episodes, and duration of hospitalisations, decreased travel time and expense and increased service access particularly for the aged, disabled and living in rural areas. For clinicians, using technology can lead to enhanced clinical outcomes, more informed decision making, greater efficiency and the expansion of outreach services. However, the integration of newer technologies poses challenges to the traditional models of service delivery and demands that our industry evolve to meet the varying needs of people living with diabetes. To not only survive but to thrive in delivering better services, we need to be aware of what technology tools are available to us as healthcare professionals and understand and integrate technologies into our work and do this in a way that directly draws on the needs of the individual living with diabetes. This session will be fun and interactive and explore real-world opportunities for the use of technology in diabetes self-management and care through case studies and audience discussion.

Link to presentation

The Impact and Importance of Vascular Calcification in Patients with Diabetes Mellitus

Vascular calcification is a poorly understood disease process involving hardening of the arteries. Worsening vascular calcification leads to poorer elasticity of the arteries and may precipitate hypertension, cardiac hypertrophy or even heart failure. There is a very strong association between the severity of coronary artery calcification and the likelihood of suffering a myocardial infarction. People with diabetes mellitus suffer a more severe form of vascular calcification. There is no current treatment for vascular calcification and such a treatment may be beneficial in reducing the risk of cardiovascular disease in people with diabetes mellitus.


Natalie Wischer,  National Association of Diabetes Centres





Dr Jamie Bellinge, Department of Health, WA

 11.20am-12.05pm – Diabetes in Pregnancy: NDSS Initiatives to Support Women Before, During and After Pregnancy

The National Diabetes Strategy states that approximately 12-14% of pregnant women in Australia are diagnosed with gestational diabetes1, while the AIHW reports that 10 in 1000 births are to women with pre-existing type 1 or type 2 diabetes2. Evidence indicates that the number of women with all forms of diabetes in pregnancy is increasing3, with the prevalence of GDM now reported to be as high as 30% in some regions of Australia4. Women with diabetes require additional support during pregnancy. However, the planning, management and postnatal care needs of pregnant women differ depending on the type of diabetes. Diabetes in pregnancy is a priority area for the National Diabetes Services Scheme (NDSS). This presentation will summarise the latest NDSS data on gestational diabetes, as well as key findings from the NDSS Contraception, Pregnancy & Women’s Health Survey (2015) which gathered information on preconception counselling and care provided to Australian women with pre-existing diabetes. NDSS initiatives to support women before, during and after pregnancy, will be presented.


Dr Melinda Morrison, Diabetes NSW
 12.05-1.00pm – Lunch and Poster Presentations
1.00-1.45pm – Oral Abstracts

Oral Stream A  (Clinical Research/ Research into Practice)

  • Carbohydrate manipulation: an evidence informed strategy to manage blood glucose levels for physical activity in type 1 diabetes (t1d), but is it popular? – Marian Brennan
  • User experiences with sensor augmented pump therapy in the management of type 1 diabetes during a randomised controlled trial – Jennifer Nicholas
  • Carbohydrate restriction by women with gestational diabetes at Fiona Stanley hospital – Cathy Latino

Oral Stream B   (Rural/ Telehealth/ Education)

  • Delivering close to home/cost effective diabetes care in a Telehealth setting for rural women – Marina Mickleson
  • “It is not the program content but rather how it is delivered that is important”: what do DESMOND (diabetes education and self-management for the ongoing and newly diagnosed) QD (quality development) assessors observe as common challenges for educators delivering a structured person-centred program? – Kylie Mahony
  • Building Capacity in Regional and Remote Areas to Improve Chronic Disease Outcomes – Kelly Harris
1.45-2.30pm – The Long Term Impact of Diabetes in Pregnancy

The proportion of women with pregnancy complicated by either gestational or pregestational diabetes is increasing. This relates both to recent changes in the diagnostic criteria for gestational diabetes and to lifestyle factors contributing to increasing prevalence of obesity.  In addition the incidence of type 1 diabetes is increasing. This talk will explore implications of diabetes in pregnancy on maternal long term health and on health of the offspring. Epigenetic chromosomal changes which mediate many of these effects can hopefully be at least partially avoided by good pre-pregnancy and pregnancy care optimising glycemic control and avoiding excess maternal weight gain in pregnancy.


Dr Dorothy Graham, Obstetric Physician
3.00-3.45pm – CDE Panel : Wish We Knew Then What We Know Now

(Chaired by Glenn Cardwell, APD)


Jaimee Paniora, Annette Hart, Nicole Frayne and Andrea Gilbey
3.45 -3.55pm – Awards Presentation
3.55-4.00pm- Conference wrap up, evaluation and close
4.00-4.45pm – ADEA-WA Branch Meeting
5.00-6.30pm – Meet and Greet Cocktail Function (included in ticket cost). No specific theme. Smart casual dress code.

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Glenn Cardwell is an Advanced Accredited Practising Dietitian with 38 years of experience in clinical and public health nutrition. He advises the public, the fresh produce industry, and lectures to health professionals and university students. He is currently working closely with farmers to promote the nutrition and health benefits of mushrooms, cherries, bananas and asparagus, while being engaged in mushroom research at Curtin University. He has written four books, including one that has been translated into Russian and Mandarin.
Dr Tim Jones is Head of the Department of Diabetes and Endocrinology, Princess Margaret Hospital for Children, Perth and Clinical Professor at Telethon Kids Institute, University of Western Australia.

Dr Jones received his paediatric training in Australia and in the UK, and his postdoctoral training at Yale University, USA. Dr Jones has a strong clinical research interest in diabetes, in particular, hypoglycaemia, insulin therapy, exercise, technology and complications, is director of the NHMRC/JDRF funded Centre for Research Excellence in diabetes translational research, and leads a research team based at the Telethon Kids Institute and Princess Margaret Hospital for Children.

  Dr Carmel Smart is a Paediatric Endocrine Dietitian at the John Hunter Children’s Hospital, Newcastle and holds a Conjoint Senior Lecturer position with the University of Newcastle. In 2016, she was awarded a Clinical Research Fellowship. Carmel’s major research interests are in the impact of the different macronutrients on postprandial blood glucose levels. She is the lead author of the international guidelines for the dietary management of children and adolescents with type 1 diabetes and is on the expert faculty of the JDRF Type 1 Performance in Exercise and Knowledge Group. Carmel co-supervises a clinically focused group of researchers whose aim is to improve the lives of children with diabetes.
Natalie Wischer is the Chief Executive Officer of the National Association of Diabetes Centres (NADC) and the Executive Director of Diabetes Online Services. She also works in management, education and clinical roles across acute, aged care and community health settings.

Having worked in the area of diabetes for over 20 years, including 3 years in remote Aboriginal communities, she has a passion for technologies including apps, telehealth and social media in support of people living with diabetes. She shares her in-depth knowledge of these areas through regular articles in numerous publications as well as through presentations nationally and internationally. Natalie also has extensive experience as a Quality and Risk Manager and has a strong commitment to quality and consumer-focused care which underpins all of the work.

  Dr Melinda Morrison is the NDSS Diabetes in Pregnancy Priority Area and Service Pathway Leader. Melinda is a CDE who completed her PhD in the area of gestational diabetes. She has worked for Diabetes NSW ACT since 1999 and from 2013-16 was employed as the program leader for the NDSS Diabetes in Pregnancy National Development Program which focused on initiatives to support women with type 1 and type 2 diabetes to plan and prepare for pregnancy. Her current role includes developing nationally consistent NDSS pathways for women with GDM.
 Dr Jamie Bellinge (MBBS) is a medical doctor and young investigator in the field of cardiovascular disease prevention. He is a Doctor of Philosophy (PhD) candidate at the University of Western Australia. Currently, he is working on a randomised controlled trial of Vitamin K and Colchicine for the treatment of Vascular Calcification in people with diabetes mellitus. This trial is expected to finish by mid-2018 and if successful, will prove the first ever therapy for treating calcification (“hardening”) of the arteries.
  Dr Dorothy Graham studied medicine at the University of Western Australia, graduating in 1984. She trained in general medicine at Royal Perth Hospital, then did a PhD in Preeclampsia at the University of Western Australia under Professor Lawrence Beilin. The next 2 years was spent at Women and Infant’s Hospital in Providence, Rhode Island doing a Fellowship in Obstetric Medicine. Since returning to Perth she has worked at King Edward Memorial Hospital and in private practice as a consultant physician in obstetric medicine. Special interests are diabetes and hypertension in pregnancy as well as all aspects of medical problems in pregnancy.
  Andrea Gilbey is an accredited practicing dietitian and credentialed diabetes educator.  She worked in the department of diabetes and endocrinology at PMH as a dietitian, diabetes educator and clinical coordinator for 15 years.  After PMH she ran a private practice with her main focus in diabetes education and nutrition. Andrea is currently working part time as a Dietitian Diabetes Educator and as the WA Account Manager for BD Diabetes Care. Andrea enjoys keeping fit with running and cross training. She loves cooking and experimenting with recipes with make them healthier for her husband and three children.  She feels strongly about providing people with diabetes practical ways to stay motivated and self manage.
  Nicole Frayne completed her Bachelor of Pharmacy in 1996 at CURTIN University WA. Her pharmacy experience includes hospital, community pharmacy and roles in teaching. To continue to provide and expand  patient care with a strong focus on Quality Use of medicines, Nicole gained accreditation with the Australian Association of Consultant Pharmacy. This experience was valuable when working for the National Prescribing Service providing educational visits to general practitioners and allied health. 2017 marked 10 years as an accredited pharmacist. Nicole is currently employed at GP Down South as project co-ordinator for diabetes service provision in the south west. Primary provision of service is within general practice . To enable to expand this service Nicole became a credentialed diabetes educator. The experience and knowledge gained as a diabetes educator has been invaluable in the HMR (Home Medicine Reviews) and RMMR’s (Residential Medication Management Reviews) that Nicole provides as a consultant pharmacist. Recently Nicole has been employed by St John of God Hospital Bunbury providing inpatient diabetes care. The combination of primary care, acute care and working in a team environment with health professionals is a rewarding combination.
  Jaimee Paniora is the 2017 Western Australia CDE of the Year. She started out as an Accredited Exercise Physiologist and went on to postgraduate studies in diabetes education as well as further study in nursing. Her passion is lifestyle related disease. Her goal is to promote a non-judgmental, supportive and empowering environment for all people living with diabetes. She works at the Princess Margaret Hospital for Children.
  Annette S. Hart, Nurse Practitioner, Midwife, CDE. Originally trained in Edinburgh, Scotland then gained Diploma in Diabetes in London 2004, before relocating to WA in 2007.  Since arriving in Perth Annette has gained wide-ranging diabetes experience across life’s continuum having worked as specialist midwife and labour ward coordinator at King Edward Memorial Hospital, building on her extensive knowledge of diabetes in women of childbearing age from pre-conception, antenatal, intrapartum to the postnatal period.  Annette has also worked at Princess Margaret Hospital for Children where her interest in child and adolescent health was nurtured and built upon. Here she gained exemplary experience in caring for families and children diagnosed with type 1 diabetes, insulin pump therapy and continuous glucose monitoring and associated technologies.  Currently, Annette has developed a nurse-led diabetes education service as Clinical Nurse Consultant at a secondary hospital in Perth and is now entering the realms of private practice as Endorsed Diabetes Nurse Practitioner specialising in insulin pump therapy, CGMS and all things insulin.  Annette is a PhD candidate at Edith Cowan University.

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