Contents
Executive summary ............................................................................................. 2
About this report .................................................................................................. 6
Background ......................................................................................................... 7
What is diabetes? ......................................................................................................................... 7
Risk factors .................................................................................................................................. 8
Complications of diabetes ............................................................................................................ 9
Measuring blood glucose ............................................................................................................11
Medicines for lowering blood glucose .........................................................................................12
Prevalence of diabetes ................................................................................................................12
Aboriginal and Torres Strait Islander people ...............................................................................14
Burden of disease .......................................................................................................................15
General practice ..........................................................................................................................17
Type 2 diabetes guidelines ................................................................................ 18
Australian guidelines on the management of diabetes ................................................................18
Risk assessment and screening ..................................................................................................19
Testing for type 2 diabetes ..........................................................................................................19
Initial evaluations and investigations ...........................................................................................21
Dietary and lifestyle interventions ................................................................................................22
Patient education and self-management .....................................................................................22
Treatment targets and glycaemic control ....................................................................................22
Blood glucose lowering medicines ..............................................................................................23
Management of absolute cardiovascular risk ..............................................................................28
Ongoing evaluations and investigations ......................................................................................28
Type 2 diabetes in young people ................................................................................................29
Gestational diabetes mellitus ......................................................................................................30
Use of medicines and medical tests ................................................................... 33
Medicines available for lowering blood glucose ..........................................................................33
Use of blood glucose lowering medicines ...................................................................................36
Exenatide ....................................................................................................................................39
Costs ...........................................................................................................................................40
Insulin pumps ..............................................................................................................................41
National Diabetes Services Scheme ...........................................................................................42
Medical test use ..........................................................................................................................43
Practice gaps and safety alerts .......................................................................... 46
Post market review Expert Reference Group deliberations .........................................................46
Diagnosis ....................................................................................................................................46
Treatment pathways ....................................................................................................................47
Treatment to target ......................................................................................................................51
Inappropriate prescribing.............................................................................................................53
Adherence to guidelines ..............................................................................................................54
Therapeutic inertia ......................................................................................................................56
Primary health of Aboriginal and Torres Strait Islander people ...................................................56
Access to health care ..................................................................................................................57
Risk factors .................................................................................................................................57
Safety alerts ................................................................................................................................58 4
document1
Consumer knowledge, attitudes and behaviours ................................................ 59
Attitudes towards having type 2 diabetes ................................................................................... 60
Consumer beliefs about the causes of diabetes ......................................................................... 61
Attitudes toward self-management ............................................................................................. 62
Attitudes towards diet and exercise ............................................................................................ 63
Knowledge, attitudes and behaviours relating to blood glucose lowering medicines .................. 65
Knowledge and attitudes towards blood glucose tests ............................................................... 70
Interaction with health professionals ........................................................................................... 72
Health literacy, knowledge, information and education ............................................................... 74
Blood glucose lowering medicine related enquires received by Medicines Line ......................... 75
Knowledge, attitudes and behaviours in Aboriginal and Torres Strait Islander people
.................................................................................................. 77
Attitudes towards having diabetes .............................................................................................. 77
Beliefs about the causes of diabetes .......................................................................................... 78
Attitudes towards self-management ........................................................................................... 79
Attitudes towards diet and exercise ............................................................................................ 80
Knowledge, attitudes and behaviours relating to blood glucose lowering medicines .................. 82
Knowledge and attitudes relating to blood glucose tests ............................................................ 82
Interactions with and access to health care professionals .......................................................... 83
Culturally and linguistically diverse communities and type 2 diabetes ................ 85
Attitudes towards having type 2 diabetes ................................................................................... 85
Beliefs about the causes of diabetes .......................................................................................... 86
Attitudes towards diet and exercise ............................................................................................ 87
Knowledge, attitudes and behaviours relating to blood glucose lowering medicines .................. 89
Knowledge and attitudes relating to blood glucose tests ............................................................ 90
Interaction with health professionals ........................................................................................... 91
Health professional knowledge attitudes and behaviours ................................... 93
Risk assessment and screening ................................................................................................. 94
Testing for type 2 diabetes ......................................................................................................... 94
Change in HbA1c units ................................................................................................................ 95
Prescribing of blood glucose lowering medicines ....................................................................... 95
Monitoring of type 2 diabetes ................................................................................................... 101
Self-monitoring of blood glucose .............................................................................................. 102
Ongoing management of type 2 diabetes ................................................................................. 102
Differences between GPs and specialists regarding type 2 diabetes management ................. 103
Challenges encountered in managing type 2 diabetes ............................................................. 103
Management of GDM ............................................................................................................... 104
Nurses role in type 2 diabetes management ............................................................................ 105
Pharmacists role in type 2 diabetes management .................................................................... 106
Guidelines and resources used in practice ............................................................................... 107
Perceived patient information needs ........................................................................................ 107
Suggestions for a 2016 NPS MedicineWise program on diabetes ........................................... 107
NPS MedicineWise interventions ..................................................................... 109
Health care professional focused interventions ........................................................................ 109
Feedback from the field force on the 2012 visiting program ..................................................... 111
Feedback from the field force on a 2016 visiting program ........................................................ 113
Evaluation of the 2012 program................................................................................................ 114
Consumer focused interventions .............................................................................................. 115 5
document1
Aboriginal and Torres Strait Islanders programs .......................................................................116
RADAR publications ..................................................................................................................117
Recommendations from related NPS MedicineWise programs.................................................117
Other interventions .......................................................................................... 119
Diagnosis ..................................................................................................................................119
Comparisons of quality improvement strategies ........................................................................120
Reviews of specific quality improvement strategies ..................................................................123
Interventions for indigenous peoples .........................................................................................133
Culturally and linguistically diverse interventions ......................................................................133
Interventions to improve adherence ..........................................................................................133
Current Australian healthcare professional training ...................................................................134
Type 2 diabetes management and GP prescribing software ............................ 137
Diabetes-related tools and preventive health prompts ..............................................................137
Resources available to assist GPs to complete diabetes-related MBS items............................139
Identifying people with diabetes in GP prescribing software .....................................................140
Patient information resources ....................................................................................................140
Other GP software that can assist in the management of diabetes ...........................................141
Using MedicineList+ as diabetes management tool ..................................................................142
Environmental scan ......................................................................................... 143
Government policy ....................................................................................................................143
Media ........................................................................................................................................146
Stakeholders .............................................................................................................................147
Peak bodies ..............................................................................................................................147
Research bodies .......................................................................................................................149
Support services .......................................................................................................................149
Online diabetes keywords, searches and commentary .................................... 151
Internet search trends ...............................................................................................................151
Social media ..............................................................................................................................153
Appendix 1: Blood glucose lowering medicines – comparative information ...... 155
Appendix 2: List of Australian guidelines .......................................................... 157
Appendix 3: PBS restriction wordings .............................................................. 159
Appendix 4: Impact of QI strategies ................................................................. 162
Appendix 5: Search strategies ......................................................................... 163
document1