Servier Grant Reports

The following grants were successful under the Servier ADS Grant Scheme in 2009 for projects commencing in 2010.

Project Title - 'Behavioural Management of Type 1 Diabetes in Young Adults: An investigation of adherence to medical and lifestyle regimens, metabolic control and psychological wellbeing'

Melanie Burkhardt*, Bu B. Yeap, David J. Leach, Gerry Fegan, Pixie Barrie
Diabetes Education Unit, Department of Endocrinology & Diabetes, Fremantle Hospital, WA

Standard care for young adults with Type 1 diabetes typically involves regular appointments with the doctor, diabetes educator and dietician. However, better health outcomes also depend on the consistency with which patients manage everyday personal behaviours contributing to better metabolic control. For well over 50% of people with chronic health problems, long-term adherence to medical treatment and lifestyle regimens is poor. The central aim of this research project is to establish higher levels of adherence to conventional medical and lifestyle diabetes care regimens via an innovative functional behaviour analytic approach. The approach is packaged as our Back for Action Program (BAP) which has already proven successful in changing patterns of everyday behaviours and routines of older people. By improving adherence levels we aim to improve glycaemic control and thus reduce the risk of acute and chronic diabetes-related health complications in this population. This study will experimentally evaluate the BAP as applied to young adults with Type 1 diabetes who are already receiving conventional multidisciplinary care. If successful, the package will provide a foundation for future research by extending the behaviour analytic approach to optimize diabetes care for a wider population of adults with Type 1 and Type 2 diabetes.

Project Title: ‘A randomized control trial of continuous subcutaneous insulin infusion (CSII) therapy and its impact upon cognition and behaviour in children and adolescents with type 1 diabetes’

Fergus Cameron*, Elisabeth Northam, Geoffrey Ambler, Alicia Jenkins, Susan Donath
Murdoch Children’s Research Institute, Department of Endocrinology & Diabetes, Melbourne, VIC

Type 1 diabetes in childhood is associated with impaired cognition and externalizing behaviour during childhood and adolescence, which in turn is predictive of poor mental health and functional outcomes in young adulthood (1,2).

Thus, cognition and externalizing behaviour in childhood and adolescence are important clinical determinants of
subsequent long-term diabetes outcomes.

We previously conducted a non-controlled, pilot study investigating consistent parental reports of improved cognition and behaviour of youth with type 1 diabetes following commencement of continuous subcutaneous insulin infusion (CSII) (3). This study documented significantly better performance on perceptual reasoning, selective attention, divided attention, cognitive flexibility and working memory after the commencement of CSII. In addition CSII resulted in fewer mood-related symptoms (internalising problems) and fewer behavioural problems (externalising problems).

These data are consistent with parent perception; however their wider interpretation is limited by the absence of a control group. The aim of this current study therefore, is to further examine the impact of CSII on cognition and behaviour in the robust setting of a randomized controlled trial. If CSII impacts positively upon these determinants, then its benefits are potentially greater than direct glycaemic effects. Such a finding would have significant implications for diabetes management during childhood and adolescence.

1) Northam EA, et al.Diabetes Care 2009; 32:445-50.
2) Northam EA, et al. Diabet Med 2005; 22:152-7.
3) Knight S, et al. Diabetologia 2009;52:193-8.

Project Title - 'Dietetic Intervention to Minimize Excessive Weight Gain in Early Pregnancy'   

Jeff Flack*, Robyn Barnes, Jane Hardman
Diabetes Centre, Bankstown-Lidcombe Hospital, Bankstown, NSW

Gestational Diabetes Mellitus identifies an at-risk pregnancy, as well as an increased long-term risk of Type 2 diabetes in the mother. Excessive weight gain in pregnancy is a known independent predictor of fetal macrosomia and contributes to maternal obesity. Aim: To establish an early intervention to achieve optimal weight gain in pregnancy in all women presenting to the antenatal clinic [ANC]. Methods: Introduce and evaluate a dietetic service involving the following components: development of a written resource for all women booked into the antenatal clinic [translated and printed in 3 languages]; distribution of this resource at the first ANC appointment; and provision of group dietetic education. This service will be trialed for a 6 months period, with all women receiving the intervention being followed up until delivery. Evaluation will involve assessing the following: attendance at group education sessions; pre and post knowledge; weight gain in pregnancy; number who develop GDM; delivery method; infant birth weight.

Project Title - 'Stepping Up Insulin Initiation in GP study' 

John Furler*, Irene Blackberry
Department of General Practice, The University of Melbourne, VIC

Most patients with T2D will require insulin yet this is often delayed in general practice. This project aims to pilot and evaluate the implementation of the “Stepping Up” program in general practice (see below) to help patients with poorly controlled type 2 diabetes (T2D) for whom insulin is indicated move onto insulin in a timely, evidence-based manner. The “Stepping Up” program involves supportive education for GP and practice nurse and a reorientation of the way GP and PN work together in working with patients towards starting insulin. This model of care is sustainable and potentially has wide application for improving patient diabetes outcomes in General Practice.  

GPs and Practice Nurses from three participating General Practices will attend a 2 hour evening training session about initiating insulin, identify 2-3 patients who are eligible to start insulin in their practice and develop their own “in-practice” system for linking those patients with the practice nurse to discuss intensifying their diabetes treatment. GP and PN will attend a final two hour evening session two months later to discuss their experience of the project and patients will attend a focus group.