Managing diabetes and preventing complications: what makes the difference?

Jane Speight
Med J Aust 2013; 198 (1): 16-17. || doi: 10.5694/mja12.11489

Greater emphasis is needed on behavioural and psychosocial aspects in research and clinical practice

Wednesday 14 November marks World Diabetes Day, the birthday of Sir Frederick Banting, whose research led to the discovery of insulin in 1922. In the 90 years since, there have been other significant landmarks. The Diabetes Control and Complications Trial (DCCT)1 and United Kingdom Prospective Diabetes Study (UKPDS)2 showed that the devastating complications of diabetes can be prevented or delayed with intensive glycaemic management. However, this has proven virtually impossible to achieve and maintain in clinical practice. In Australia, the mean glycated haemoglobin (HbA1c) level of people with diabetes remains well above DCCT and UKPDS targets.3 This is unsurprising given the considerable challenges of managing diabetes on a daily basis: healthy eating, being physically active, taking medications as recommended, self-monitoring of blood glucose levels, all underpinned by healthy coping, problem solving, risk awareness and risk reduction. So, what makes the difference?

Please login with your free MJA account to view this article in full

  • Jane Speight

  • The Australian Centre for Behavioural Research in Diabetes, Melbourne, VIC.



The Australian Centre for Behavioural Research in Diabetes is a partnership for better health between Diabetes Australia – Victoria and Deakin University.

Competing interests:

No relevant disclosures.

  • 1. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 683-689.
  • 2. UK Prospective Diabetes Study Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with Type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837-853.
  • 3. National Association of Diabetes Centres. Australian national diabetes information audit and benchmarking (ANDIAB) 2009: final report. Canberra: Australian Government Department of Health and Ageing, 2009. (accessed Nov 2012).
  • 4. World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: WHO, 2003.
  • 5. Speight J, Browne JL, Holmes-Truscott E, et al. Diabetes MILES — Australia 2011 survey report. Canberra: Diabetes Australia, 2011. http://www.diabetesmiles (accessed Nov 2012).
  • 6. Ali S, Stone MA, Peters JL, et al. The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabet Med 2006; 23: 1165-1173.
  • 7. Barnard K, Skinner T, Peveler R. The prevalence of co-morbid depression in adults with Type 1 diabetes: systematic literature review. Diabet Med 2006; 23: 445-448.
  • 8. Fisher L, Mullan JT, Arean P, et al. Diabetes distress but not clinical depression or depressive symptoms is associated with glycemic control in both cross-sectional and longitudinal analyses. Diabetes Care 2010; 33: 23-28.
  • 9. Therapy deficit [editorial]. Nature 2012; 489: 473-474.
  • 10. Pouwer F, Beekman ATF, Lubach C, Snoek FJ. Nurses’ recognition and registration of depression, anxiety and diabetes-specific emotional problems in outpatients with diabetes mellitus. Patient Educ Couns 2006; 60: 235-240.
  • 11. Levinson W, Gorawara-Bhat R, Lamb J. A study of patient clues and physician responses in primary care and surgical settings. JAMA 2000; 284: 1021-1027.
  • 12. Speight J, Conn JJ, Dunning T, Skinner TC. Diabetes Australia position statement. A new language for diabetes: improving communications with and about people with diabetes. Diabetes Res Clin Pract 2012; 97: 425-531.
  • 13. Fisher L, Hessler D, Naranjo D, Polonsky W. AASAP: a program to increase recruitment and retention in clinical trials. Patient Educ Couns 2012; 86: 372-377.
  • 14. Gale E. The Hawthorne studies – a fable for our times? QJM 2004; 97: 439-449.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.