Clinical Diabetes Research

Diabetes is a chronic multi-organ disease with a worldwide prevalence that has tripled since 2000. Diabetes care requires regular reviews by multidisciplinary teams as well as lifelong commitment and self-management by patients. Similar to many chronic diseases, main challenges in delivering diabetes care are lack of patient engagement, poor communication, limited consultation time and resources. Ineffective or inadequate clinical consults result in higher rates of adverse outcomes including hospitalisations in addition to increased time and economic burden on the health system.

Use of technology including mobile apps has revolutionised diabetes management. Research has demonstrated the potential of mobile apps to improve diabetes outcomes by facilitating patient participation in care. Through a structured evidence-based approach, we aim to co-design a novel app to optimise value-based diabetes care delivery. This app is predicted to reduce failure to attend rates for diabetes consultations, improve patient engagement, and increase patient and clinician satisfaction, ultimately leading to improved clinical and economic outcomes.

Team: Dr Negar Naderpoor, Mrs Susanne Baker, Dr Ashley Ng, Dr Sandy Reeder, Dr Ayesha Barmare

Pregnancy can be a challenging time for women with Type 1 Diabetes (T1D), as they face higher risks of complications. Maintaining optimal glucose control is essential, but is difficult during pregnancy due to physiological changes. This project aims to explore the potential of an innovative technology called the hybrid closed-loop (HCL) insulin delivery system, also known as the artificial pancreas. In non-pregnant individuals with T1D, this technology has shown promise in improving glucose control and quality of life. However, HCL systems are not yet approved for use during pregnancy in most countries, including Australia, and there is limited knowledge about their effectiveness and safety in this context. This project aims to assess the acceptability and feasibility of supervised HCL system use in pregnant women with T1D. It will compare the effectiveness of HCL systems with sensor-augmented pump therapy or multiple daily insulin injections. Additionally, it will evaluate patient satisfaction and diabetes-related stress. The findings will provide crucial evidence to support the implementation of HCL systems in selected pregnancies, leading to improved maternal and neonatal outcomes.

Team: Dr Negar Naderpoor, Dr Helena Teede, Dr Rebecca Goldstein, Dr Ashley Ng, Dr Sandy Reeder, Dr Alysha Wanigaratne, Monash Health Diabetes Unit

Diabetes Ketoacidosis (DKA), Hyperosmolar Hyperglycaemic State (HHS) and severe hypoglycaemia are life-threatening emergencies, requiring presentation to the Emergency Department (ED), and often result in subsequent ICU admissions. In 2020-2021, there were 19,100 ED presentations with diabetes as the principal diagnosis across Australia, costing $18.9 million in public hospital EDs, with 76% of these cases resulting in hospital admissions, and 40% from DKA alone. Previous research showed a 12-20% readmission rate within a month.

Reducing readmissions as a health service priority is an important indicator of care quality and a crucial factor to reduce healthcare costs. This project will use the Consolidated Framework for Implementation Research (CFIR) and Learning Health System (LHS) framework to generate knowledge and resources to support clinical practice in reducing hospital readmissions for people with diabetes. We plan to co-design a new model of care including behavioural interventions, education and access to devices for this group, in order to improve glycaemic management and reduce diabetes-related readmissions. A health economic assessment will be the final phase of this project.

Team: Dr Negar Naderpoor, Prof Helena Teede, Dr Ashley Ng, Monash Health Diabetes Unit

Young adults with diabetes have higher glycated haemoglobin (HbA1c) compared to the broader population of adults with diabetes and higher incidence of psychological distress and disordered  eating. All three factors place this group at higher risk of the development of diabetes-related complications. Attendance by young adults at diabetes care appointments is generally low, and associated with sub-optimal glycaemic control, though causality is unclear.

In the last decade, diabetes care for Young Adults has evolved significantly due to advanced diabetes technologies, COVID, and a move towards a focus on person-centred care.   A recent systematic review of transition models of care for Type 1 Diabetes identified that models did not report on implementation outcomes including acceptability, adoption and appropriateness among clinicians, calling on future models to address these gaps. For this reason, there is a need to evaluate the current YADS service to report on implementation outcomes for patients and clinicians, and identify patient acceptability, and barriers and facilitators within the service that impacts patient engagement and diabetes health.

This project aims to assess patient and clinicians acceptability and barriers and facilitators in the YADS service at Monash Health.

Team: Dr Rebecca Goldstein, Dr Ashley Ng, Dr Negar Naderpoor, Dr Katherine Kibbey, Prof Helena Teede, Monash Health Diabetes Unit