Wednesday, 24th August Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2016

• Metabolic subtypes and all-cause and cardiovascular mortality in patients with type 1 diabetes (the FinnDiane Study) - Ville-Petteri Makinen
• Therapeutic inertia for glycaemic and blood pressure control in patients with T2DM and the cardiovascular consequences: A Longitudinal study on 1.1 million patients - Sanjoy Ketan Paul
• Dementia risk factors differ by age at onset of type 2 diabetes mellitus: The Fremantle Diabetes Study Phase I - Wendy A Davis
• Proton pump inhibitor use, mortality and endothelial dysfunction in type 2 diabetes: The Fremantle Diabetes Study Phase II - Timothy Davis
• The Prevalence of Diabetes Mellitus and its Association with Stroke Inpatient Outcomes   - Jeremy Lew
• Prevalence of diabetes amongst patients hospitalised with decompensated heart failure and their outcomes - Kaylyn Khoo
• Utilisation of prehospital emergency medical services for hyperglycaemia - Melanie Villani
• Pneumococcal vaccination and incident pneumonia in type 2 diabetes: The Fremantle Diabetes Study Phase II - Timothy Davis

• Pro-oxidant enzyme Nox5 plays a crucial role in diabetic nephropathy - Jay Jha
• Decreased MMP-3 activity is associated with changes in renal morphology in mice with long duration of diabetes.   - Anh Tao
• Targeting the C5a-C5aR1 Signalling Axis in Diabetic Nephropathy - Melinda T Coughlan
• Novel regulation of diabetic cardiomyopathy and cardiac ischaemia-reperfusion injury - Anna C Calkin
• Targeting Connective Tissue Growth Factor (CTGF/CCN2) Protects Against Progressive Non-Alcoholic Steatohepatitis in a Preclinical Model Induced by High-Fat Feeding and Type 2 Diabetes. - Stephen M. Twigg
• Rapid oral uptake and trafficking of AGE modified bovine serum albumin in healthy mice. - Amelia Fotheringham
• Differing effects of two isocaloric exercise programs on metabolic profile and skeletal muscle extracellular matrix in obese mice - Sergio F Martinez Huenchullan
• Preventive role of two exercise programs from high fat diet induced extracellular matrix accumulation in fat depots - Babu Raja Maharjan

• The contribution of glycaemic status to the progression of kidney disease among Indigenous Australians with and without albuminuria– the eGFR follow-up study - Elizabeth LM Barr
• Soluble urokinase plasminogen activator receptor (suPAR) levels and decline in estimated glomerular filtration rate (eGFR) in patients with diabetes - Richard MacIsaac
• Trajectories of eGFR decline over a four year period: the eGFR Follow-up Study - Federica Barzi
• Effect of Empagliflozin on Nephropathy in Subgroups by Age: Results from EMPA-REG OUTCOME - Michael d'Emden
• Tumour Necrosis Factor-alpha Receptor 1 and 2 are Reduced in patients with Type 1 Diabetes and Hyperfiltration - Jas-mine Seah
• Determinants of offloading devices to reduce plantar pressure in the diabetic foot - Jaap J. van Netten
• Annual incidence and risk factors for developing infection in people with diabetes-related foot ulcers - Peter Lazzarini
• Assessment of Microcirculation in the Foot of People with Diabetes with Laser Speckle Contrast Imaging - Jaap J. van Netten

Aim:
Aim: To introduce registered nurse, credentialed diabetes educators (RN-CDEs) to a model of professional practice for supporting General Practitioners (GPs) and Practice Nurses (PNs) in treatment intensification, in particular initiation of insulin, in primary care for people with type 2 diabetes (T2D).

Background and rationale: 

The Stepping Up model of care, based on an enhanced role for the PN supported and mentored by the RN-CDE, has been proven effective, with clinically significant reduction in glycaemic levels without deterioration in quality of life. The session will be a mixture of presentations interspersed with practical role playing for the health professional education aspect, assistance with motivational interviewing skills, therapy options to be considered, and discussion about pathology relating to diabetes care.

The RN-CDE is the only category of CDE managing diabetes exclusively. The expertise this allows can be more widely distributed and utilised if we train, mentor and support primary care health professionals assisting with progression of therapy (including injectables), and practical dietary and exercise management. Integrating the availability of frequent clinic visits to the referring GP with a competent PN (as only a few Medicare funded visits are available to the diabetes educator) will be discussed.

We present this model to assist diabetes specialist trained people (endocrinologists and diabetes educators), to increase primary carers diabetes management knowledge, to enhance the care of the ever expanding number of people with type 2 diabetes.

Overview:
Overview presentation of the Stepping Up Model of Care emphasising the large numbers of people with type 2 diabetes, and the current ratio of specialist diabetes trained people to care for them.

Case Study: Introduce a practice nurse from a busy bulk-billing/private billing clinic and the effect of the training on the people with T2D diabetes at her clinic and how it has translated into routine diabetes management. 

Key principle 1: MI
Brief overview of motivational interviewing followed by practical application, with division into pairs, with varied scenarios to be discussed, with the participants in the role of person with diabetes or GP/DE/PN. Gather to brainstorm results. 

Key principle 2: The range of glycaemic therapeutic options facing GPs, PNs and people with T2D
Ensure DEs feel comfortable with the large choices of oral and injectable hypoglycaemic therapy currently available. Safety aspects, various appropriate titration algorithms for titration, and essential knowledge needed by the HPs and PWD.
Hands on manipulation of various injectable devices (insulins, GLP1s), available after the session for interested participants.

Key principle 3: Monitoring
Discuss both useful blood glucose monitoring for change of therapy management, and the pathology routinely done for people with diabetes, and alert levels relating to different oral and injectable medications, including appropriate communication with the treating GP for any safety concerns or discussion of progression of therapy. Include in this section the importance of pathology showing improvement, as one aspect demonstrating the value of the DE working with the clinic GP and nurses. 

Conclusion:
Lessons from the implementation of Stepping Up. Give emphasis to the uptake being greater in lower socio-economic areas where patients are reluctant/cannot afford to pay for a health service.

Learning Objectives:

• To understand the rationale for a reoriented professional practice model in primary care
• To become familiar with the principles of a model of professional practice based on a RN-CDE mentoring role for GPs and PNs in implementing treatment intensification for people with T2D in primary care

• New role for the RN-CDE, expanding health professional care of people with type 2 diabetes in primary care - Louise Ginnivan and Jo-Anne Manski-Nankervis

*NB: The entrance to Central Room B is via the Exhibition Hall

If you wish to attend this masterclass, please ensure you arrive on time as places are limited

The aims of the workshop are to:

• Outline the social, emotional, nursing and medical issues that need to be considered when planning care for/with older people with diabetes.
• Involve workshop participants in discussing key aspects of care using a case study approach.
• Challenge, provoke and engage the audience.

Overview of the symposium content

Professor Trisha Dunning - Who are older people?

Ms Nicole Duggan - Caring for older people with diabetes: nursing perspective

Dr Mark Kennedy - Caring for older people with diabetes: a medical perspective

Questions to the speakers and interactive case discussion

Learning outcomes

At the end of the symposium, participants will be able to:

• Understand that each older person is highly individual and that care must be personalised to suit their functional status, life expectancy, risk profile and personal goals.
• Outline the key social, emotional/psychological, nursing and medical issues that need to be considered when planning care for/with older people with diabetes and their families.
• Understand the importance of adopting a proactive strategy for identifying and managing associated risks such as pain, falls, and medicine-related errors and adverse events.
• Understand the effect of changing functional status on care and education needs, quality of life and self-care capacity.
• Understand the importance of regular comprehensive assessments and medicine reviews to safety and proactive, preventative care planning.

• Caring for older people with diabetes: issues, challenges and shared solutions - Trisha Dunning, Nicole Duggan and Mark Kennedy

• Investigating adipose tissue lipid metabolism as a key regulator of whole-body glucose tolerance - Marin E Healy
• Lipid Droplet Proteome Reveals Role of Key Proteins in the Pathogenesis of Hepatic Insulin Resistance - Shilpa Nagarajan
• Association Between Gut Specific G-Coupled Protein Receptors and Resistance to Diet-Induced Obesity in C57BL6/J MICE. - Barbara C Fam
• Molecular markers of beta-cell mortality - Ryan J Farr
• Angiotensin II causes β-cell dysfunction through endoplasmic reticulum stress induced inflammation - Stanley MH Chan
• UBL-5 is essential for sustaining pancreatic β-cell function and mass in mice - Christian S Haralambous
• GLT25D1 regulates the secretion of HMW adiponectin and lipid accumulation - Julie Webster

• Investigating the role of the System-L amino acid transporter LAT1 in the development of pancreatic beta-cell dysfunction and type 2 diabetes - Terence P Herbert
• Beta-Cell Regeneration in Zebrafish; Metformin and Consequences for Alpha and Delta Cells - Kathryn Aston-Mourney
• Heparan sulfate (HS) loss in Type 2 diabetes (T2D)-prone db/db beta cells increases susceptibility to oxidative stress - Sarita Dhounchak
• Insulin secretion impairment in Sirt6 knockout pancreatic β cells is mediated by suppression of the FoxO1-Pdx1-Glut2 pathway - Byung-Hyun Park
• BPA and Octylphenol induced endoplasmic reticulum stress by modulating calcium homeostasis in mouse pancreas - Eui-Bae Jeung

• French maritime pine bark extract-based supplement suppress hepatic inflammation and improve insulin sensitivity - Kristine C McGrath
• Role of c-Cbl in muscle energy metabolism in relation to obesity - Wala Alzahrani
• Matrine eliminates hepatosteatosis and glucose intolerance in high fructose-fed mice by suppressing ER stress associated de novo lipogenesis in the liver - Ali Mahzari
• Calbindin-D9k and ER Stress in Hypoxia-Induced Diabetes Mellitus like Model - Eui-Bae Jeung
• Comparative genotypic and phenotypic analysis of surrogate monocytic-like cell lines and human peripheral blood monocytes - Darren M Riddy

• Effect of skeletal muscle-specific knockout of the lysine acetyltransferase, GCN5, on skeletal muscle insulin sensitivity - Simon Schenk

• How can registries and data improve the trajectory of care for young people with type 1 diabetes? - Maria E Craig
• Mind the gap- building transition services for youth with diabetes - Jane Holmes-Walker
• Driving and Diabetes - Stephen M. Twigg
• Engaging women and clinicians with pre-pregnancy care - Helen Murphy

• Long non coding RNAs in human pancreatic beta-cells - Jorge Ferrer
• Overlap in genetic susceptibility to type 1 and type 2 - lessons from mouse models - Christopher Nolan
• Finding Novel beta cell genes using the Collaborative Cross - Sof Andrikopoulos
• Supersized: epigenetics in very large mammal models - Katherine Samaras

• Quantifying and Predicting Mean A1C Reductions for Exenatide QW and BID: Importance of Baseline A1C and Other Patient Characteristics - Jonathan Shaw
• Addition or Switch to Insulin Therapy in Patients Treated with GLP-1 Receptor Agonists: A Real World Study in 66,583 Patients - Olga Montvida
• Hypoglycaemia in Elderly Patients with Type 2 Diabetes in Subacute Hospital Care is Associated with increased Mortality - Chia Pei Chong
• Audit of Diabetes Management Guidelines for the Cancer Centre during the Pilot Phase - Peter G Colman
• Effect of Empagliflozin on Cardiovascular Death in Subgroups by Age: Results from EMPA-REG OUTCOME - Michael d'Emden
• Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial outcomes - Richard Simpson
• Effects of linagliptin on glycemic control and albuminuria in type 2 diabetes - the MARLINA–T2D™ trial - Per-Henrik Groop
• Fenofibrate Reduces Uric Acid Levels and Gout Events in Type 2 Diabetes: Results from the Field Study - Boris Waldman

• Obesity without Muscle Insulin Resistance in High-Starch Diet Mice - Amanda E Brandon
• Role of the hepatoportal system in the reversal of insulin resistance in rats - Holly M Johnson
• The role of lipid droplet protein, Perilipin 5, in glucose and lipid metabolism - Stacey N Keenan
• The free fatty acid receptor GPR84: a new player in glucose tolerance and mitochondrial function? - Magdalene K Montgomery
• Antagonism of peripheral Y1 receptor ameliorates diet-induced obesity and improves glucose tolerance - Yan-Chuan Shi
• Osmotic mini-pump delivered streptozotocin allows targeted and consistent induction of type 2 diabetes in rats. - Dino Premilovac
• Screening for Small Molecules to Treat Type 2 Diabetes, Based on Disruption of the Interaction between Protein Kinase C epsilon and RACK2 - Carsten Schmitz-Peiffer
• Dynamics of blood DNA methylation changes associated with Type 2 Diabetes Mellitus: a longitudinal study - Pierre-Antoine Dugué

Content Outline:

The introduction of the National Disability Insurance Scheme across Australia in the near future will not include any funding for diabetes care. This will place an increased need for health services to be accessible to people with a disability and to provide customised services to address their unique needs. To support diabetes services to improve their ability to provide high quality diabetes care to people with ID, Professor Gary Wittert and Credentialled Diabetes Educators Jayne Lehmann and Anne Marks will share their clinical expertise in the care of diabetes in people with ID.  This symposium will include presentations that draw on the available research and clinical experience and resources used by the presenters to provide high quality diabetes care services to people with ID. Case studies will explore the issues related to diabetes care of people with Prader-Willi and Down Syndromes.
Co-morbidities like obesity, poor nutrition, limitations on exercise capacity, use of anti-psychotics, syndrome associated conditions and sleep-disordered breathing will be explored. The challenges involved with the use of non health professional support workers in the delivery of diabetes care will be explored. A range of resources designed for the specific education and support needs of people with diabetes and ID will be presented to inspire participants to increase their confidence and capacity to address the unique needs of this high risk target group.

Session Outline:

Presentation by Prof Gary Wittert

• Overview of current data on the standard of health of people with ID to set the scene for why this is important to address
• Overview of risk factors for diabetes e.g. obesity, poor nutrition, limitations on exercise capacity, use of anti-psychotics, syndrome associated conditions and sleep-disordered
• Overview of issues compounding the risks e.g. supported care, lack of healthy cooking skills and recipe support for support workers, ill-equipped health and community systems to support preventive and acute care/early diagnosis etc

Group Interactive exercise

Presentation by Jayne Lehmann

• The NDIS and its implications for the healthcare sector
  
• Barriers to access by people with ID within a diabetes or health service
  
• Resources and strategies to assist
  

Group Interactive exercise

Presentation by Anne Marks

• The challenges of intensive insulin therapy for people with type 1 diabetes and Intellectual disability
• Support strategies for families, diabetes educators, schools and respite care workers

Group Interactive exercise

Panel discussion

Learning outcomes:

At the conclusion of this session, participants will:

1. Be aware of the high prevalence, and reasons for the high risk, of type 2 diabetes (T2D) in people with ID.
2. Identify the co-morbidities and issues that require consideration in the provision of health care to people with ID and diabetes.
3. Appreciate the range of resources and strategies to include people with ID in their diabetes self care to the best of their ability.
4. Be able to state the barriers and facilitators for the prevention or optimal management of T1D and T2D in people with ID in various levels of supported care and the expected impact of the introduction of the NDIS.

The session will be run with presentations and interactive activities to actively engage the audience in their exploration of the topic and learning.

• Improving Diabetes Care of People with Intellectual Disability - Jayne A. Lehmann RN CDE, Gary Wittert and Anne Marks RN NP CDE

*NB: The entrance to Central Room B is via the Exhibition Hall

If you wish to attend this masterclass, please ensure you arrive on time as places are limited