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Behavioural innovation is key to improving the health of one million Australians living with type 2 diabetes

Jane Speight
Med J Aust 2016; 205 (4): 149-151. || doi: 10.5694/mja16.00556

Policy, research and clinical practice need a paradigm shift, focused on human behaviour and psychology

More than 1.1 million Australians have diabetes, about 85% of whom have type 2 diabetes (T2D).1 Just one in four adults with diabetes in primary care has a glycated haemoglobin (HbA1c) value in target range (≤ 7%, 53 mmol/mol), which is important for minimising the risk of devastating long term complications.2 Diabetes costs Australians $14 billion per annum and is likely to cost $30 billion per annum by 2025.1

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  • Jane Speight1,2

  • 1 Deakin University, Geelong, VIC
  • 2 Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC

Correspondence: jspeight@acbrd.org.au

Acknowledgements: 

I am the Foundation Director of the Australian Centre for Behavioural Research in Diabetes, with core funding provided by a collaboration between Diabetes Victoria and Deakin University. The was funded by the National Diabetes Services Scheme, an initiative of the Australian Government administered by Diabetes Australia.

Competing interests:

I am a member of the Accu-Check Advisory Board (Roche Diagnostics Australia). My research group has received unrestricted educational grants from Abbott Diabetes Care, Medtronic and Sanofi Diabetes; sponsorship to host or attend educational meetings from Lilly, Medtronic, MSD, Novo Nordisk, Roche Diagnostics Australia and Sanofi Diabetes; and consultancy income from Abbott Diabetes Care, Roche Diagnostics Australia and Sanofi Diabetes.

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access_time 08:36, 15 August 2016
Ann Morris

What a wonderful article highlighting the importance of psychological issues and barriers to people with diabetes achieving their goals of management. As a CDE with 40 years experience and with a psychologically sensitive approach to delivery of care, anecdotally I have seen the frustration that comes from the "one size fits all" approach and the judgement that occurs from colleagues towards "non compliant" behaviours which often reinforces a sense of failure.
This is powerful messaging that adds to the stigma surrounding diagnosis.
I support Jane in her call for an important paradigm shift away from the dominant medical model that currently dominates.
Ann Morris RN CDE
Winner JDRF "Diabetes Educator of the Year for Impact and Relationships" 2011 &
"CDE Of the Year for Victoria" 2016

Competing Interests: No relevant disclosures

Mrs Ann Morris
RMH and Mayfield

access_time 01:04, 15 August 2016
Timothy Skinner

Prof Speight points out a number of critical issues to making a substantial difference to the burden of diabetes for individuals, society and the health care system. Whilst we agree that there is a need to develop effective and cost effective innovations to support individuals with diabetes, it is also important to note that we have some well established evidence based programs already available to people with diabetes, that are not being widely offered.
For people with type 1 diabetes the DAFNE program has been shown to have substantial benefits for people's quality of life as well as impacting on their blood glucose control. This program, whilst offered in Australia, could be funded to be made more readily available to more people. Other well established programs such as Blood Glucose Awareness Training, and its derivatives, have well established efficacy and cost effectiveness data, but are not offered at all in Australia.
In type 2 diabetes, there are several evidence based self-management education programs showing impacts on quality of life, self-management and metabolic outcomes from Italy, Germany, Israel, USA and the UK. With the exception of the DESMOND program form the UK, none of these programs are available in Australia. Although the DESMOND program is available through Diabetes WA, Diabetes Tasmania, Diabetes Vic and Diabetes NSW & ACT, there is need for the health systems to take a systematic and population wide approach upskilling health professionals and to fund this program, and similar evidence based programs, if the goals of the National Diabetes Strategy are to be realised.
So yes, we need to fund more research, but more urgently we need to fund the implementation of pre-existing, evidence based programs, that comply with national quality standards for self-management education.
We can't wait for outcomes of new research, we need to implement what we already know works.

Competing Interests: I was a co-developer for DESPOND program in the UK, and currently hold an NHMRC grant to explore the acceptability and effectiveness of this program for Aboriginal Australians

Prof Timothy Skinner
Charles Darwin University

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