Glycated haemoglobin for the diagnosis of diabetes

The development of specific diabetes complications correlates with glycated haemoglobin (HbA1c), the most accepted measure of chronic glycaemia. An HbA1c of 48 mmol/mol (6.5%) or greater has now been recommended in Australia for diagnosis of type 2 diabetes. The HbA1c test should greatly simplify the diagnostic pathway, negating the need for oral glucose tolerance tests in the majority of patients. However, improved performance and precision of the assay with its standardisation across Australia is required. Many clinical situations can impact on the HbA1c assay and the clinician needs to be aware of these if it is to be used appropriately for diagnosis

Factors influencing adoption of conservation tillage in Australian cropping regions

The purpose of this research is to improve understanding of conservation tillage adoption decisions by identifying key biophysical and socio-economic factors influencing no-till adoption by grain growers across four Australian cropping regions. The study is based on interviews with 384 grain growers using a questionnaire aimed at eliciting perceptions relating to a range of possible long- and short-term agronomic interactions associated with the relative economic advantage of shifting to a no-tillage cropping system. Together with other farm and farmer-specific variables, a dichotomous logistic regression analysis was used to identify opportunities for research and extension to facilitate more rapid adoption decisions. The broader systems approach to considering conservation tillage adoption identified important determinants of adoption not associated with soil conservation and erosion prevention benefits. Most growers recognised the erosion-reducing benefits of no-till but it was not an important factor in explaining whether a grower was an adopter or non-adopter. Perceptions associated with shorter-term crop production benefits under no-till, such as the relative effectiveness of pre-emergent herbicides and the ability to sow crops earlier on less rainfall were influential. Employment of a consultant and increased attendance of cropping extension activities were strongly associated with no-till adoption, confirming the information and learning-intensive nature of adopting no-till cropping systems.adoption, conservation tillage, herbicide resistance, no-till, perceptions, weed management, Farm Management,

Choosing a screening tool to assess disordered eating in adolescents with type 1 diabetes mellitus

[Extract] Disturbed eating behaviours and insulin omission in adolescents with type 1 diabetes mellitus have concerned diabetes clinicians for decades, yet screening and management protocols using validated tools for this high risk group are lacking. Clinical eating disorders and milder forms of disordered eating can impact negatively on glycaemic control and are associated with serious health consequences (Rydall et al., 1997). Early detection and treatment of disturbed eating thoughts and behaviours is important (Goebel-Fabbri, 2009)

Queensland's high risk foot database: tracking the length and width of Queensland's foot ulcers [Conference Abstract]

Background Foot ulcers are a leading cause of avoidable hospital admissions and lower extremity amputations. However, large clinical studies describing foot ulcer presentations in the ambulatory setting are limited. The aim of this descriptive observational paper is to report the characteristics of ambulatory foot ulcer patients managed across 13 of 17 Queensland Health & Hospital Services. Methods Data on all foot ulcer patients registered with a Queensland High Risk Foot Form (QHRFF) was collected at their first consult in 2012. Data is automatically extracted from each QHRFF into a Queensland high risk foot database. Descriptive statistics display age, sex, ulcer types and co-morbidities. Statewide clinical indicators of foot ulcer management are also reported. Results Overall, 2,034 people presented with a foot ulcer in 2012. Mean age was 63(±14) years and 67.8% were male. Co-morbidities included 85% had diabetes, 49.7% hypertension, 39.2% dyslipidaemia, 25.6% cardiovascular disease, 13.7% kidney disease and 12.2% smoking. Foot ulcer types included 51.6% neuropathic, 17.8% neuro-ischaemic, 7.2% ischaemic, 6.6% post-surgical and 16.8% other; whilst 31% were infected. Clinical indicator results revealed 98% had their wound categorised, 51% received non-removable offloading, median ulcer healing time was 6-weeks and 37% had ulcer recurrence. Conclusion This paper details the largest foot ulcer database reported in Australia. People presenting with foot ulcers appear predominantly older, male with several co-morbidities. Encouragingly it appears most patients are receiving best practice care. These results may be a factor in the significant reduction of Queensland diabetes foot-related hospitalisations and amputations recently reported

Letter from M. D'Emden to George Washington Walker

Letter from M. D'Emden to George Washington Walker on 21 November 1836 asking for a loan of sixty pounds

Microvascular Complications in Cystic Fibrosis-Related Diabetes Mellitus: a Case Report.

Context The prevalence of cystic fibrosis-related diabetes mellitus is increasing and is associated with increased survival from cystic fibrosis. Case Report This study describes a case of the premature onset of disabling and widespread microvascular complications resulting from cystic fibrosis-related diabetes mellitus. Previously asymptomatic retinopathy was diagnosed on recognition of diabetic nephropathy. Conclusions The treatment of pulmonary exacerbations has become more complex due to the nephrotoxic potential of intravenous aminoglycoside drugs which are frequently used to control chronic Pseudomonas infection in cystic fibrosis.Image: Renal biopsy: glomeruli with a global increase in the mesangial matrix

Working collaboratively to highlight the voices of young people in Townsville

Youth crime and crime prevention have been the focus of media attention and policy reforms in Australia. Recent inquiries, reports and reforms have brought about policy changes in the youth justice field, including engaging young people through diversionary services. The Lighthouse operated by the Townsville Aboriginal and Islander Health Service is an afterhours diversionary youth service. In this paper we present and discuss the current youth justice policy and funding context that led to the establishment of The Lighthouse, the service delivery model and practice of The Lighthouse, and report on the research collaboration, establishment, procedure and current status. We then describe a research collaboration between The Lighthouse and social work academics from James Cook University ('JCU'), based on research needs identified by The Lighthouse staff. This research is focused on exploring the voices of young people about service delivery, experiences and needs and mentoring Indigenous leadership. The collaborative research process and endeavours will be described and interim findings of the collaborative research presented

Using photography to voice young people's views about community and local service delivery

Youth offending has received significant attention in recent years in Queensland and across Australia. While the voices of young people who are offending or at risk of offending are evident in some studies, other reports do not identify them as key stakeholders. A recent university-industry research collaboration sought to prioritise the voices of young people engaging with The Lighthouse, a diversionary service within Townsville Aboriginal and Islander Heath Services (TAIHS), through use of qualitative, Photovoice methods. The primary aim of this photovoice project was to capture the perceptions and needs of young people currently at risk of offending, and to document those views to help shape local service delivery. A thematic analysis enabled the identification of four key themes. These themes identified that participants felt unsafe and under surveillance in public spaces; they wanted more amenities where they could enjoy being in the community with their peers; they reported that peers and family were very important to them; and they appreciated services on offer at The Lighthouse and acknowledged these services supported behavioural change. The findings provide a unique contribution to the use of creative research methodologies, and to policy and service delivery focused on young people at risk of offending

Survivors of intensive care with type 2 diabetes and the effect of shared care follow-up clinics: study protocol for the SWEET-AS randomised controlled feasibility study

Published online: 13 October 2016Background: Many patients who survive the intensive care unit (ICU) experience long-term complications such as peripheral neuropathy and nephropathy which represent a major source of morbidity and affect quality of life adversely. Similar pathophysiological processes occur frequently in ambulant patients with diabetes mellitus who have never been critically ill. Some 25 % of all adult ICU patients have diabetes, and it is plausible that ICU survivors with co-existing diabetes are at heightened risk of sequelae from their critical illness. ICU follow-up clinics are being progressively implemented based on the concept that interventions provided in these clinics will alleviate the burdens of survivorship. However, there is only limited information about their outcomes. The few existing studies have utilised the expertise of healthcare professionals primarily trained in intensive care and evaluated heterogenous cohorts. A shared care model with an intensivist- and diabetologist-led clinic for ICU survivors with type 2 diabetes represents a novel targeted approach that has not been evaluated previously. Prior to undertaking any definitive study, it is essential to establish the feasibility of this intervention. Methods: This will be a prospective, randomised, parallel, open-label feasibility study. Eligible patients will be approached before ICU discharge and randomised to the intervention (attending a shared care follow-up clinic 1 month after hospital discharge) or standard care. At each clinic visit, patients will be assessed independently by both an intensivist and a diabetologist who will provide screening and targeted interventions. Six months after discharge, all patients will be assessed by blinded assessors for glycated haemoglobin, peripheral neuropathy, cardiovascular autonomic neuropathy, nephropathy, quality of life, frailty, employment and healthcare utilisation. The primary outcome of this study will be the recruitment and retention at 6 months of all eligible patients. Discussion: This study will provide preliminary data about the potential effects of critical illness on chronic glucose metabolism, the prevalence of microvascular complications, and the impact on healthcare utilisation and quality of life in intensive care survivors with type 2 diabetes. If feasibility is established and point estimates are indicative of benefit, funding will be sought for a larger, multi-centre study. Trial registration: ANZCTR ACTRN12616000206426Yasmine Ali Abdelhamid, Liza Phillips, Michael Horowitz and Adam Dean