Diabetes-Where to from here?
Prepared by [Lynne Gilks]
[CNC Diabetes Education]
[Diabetes Centre, Tamworth]
[November 2009]
1
Diabetes-Where to from here?
 Diabetes is a relatively common condition affecting
about 7.8% Australian population (AusDiab study)
 In some Aboriginal communities prevalence rates can
be as high as 31%. (DA NSW)
 Impaired Glucose Tolerance or Impaired Fasting
Glycaemia affects 16.3% of the population (AusDiab)
 1 in 4 Australians 25 yrs & over has Diabetes or
IGT/IFG (AusDiab)
 Diabetes has increased by 300% over the last 10 years.
(DA NSW)
Diabetes-Where to from here?
 Currently in Australia 275 people are
being diagnosed with diabetes each
day i.e. 100,000 new cases per year
 The rate of Diabetes in the lowest
socioeconomic group is almost
twice that compared with the
highest socioeconomic group
Diabetes-Where to from here?
 The number of people with Diabetes
is expected to double by 2010
 Type 2 Diabetes is predicted to have
the largest increase of the chronic
diseases by 2020
 Associated costs are predicted to
increase by 679% by 2031.
Diabetes-where to from here?
Cost of diabetes in Australia in 2005 was $10.3
billion of which:
* Health system costs $1.1 billion
*Productivity lost $4.1 billion
*Carer costs $4.4 billion
As well
*Lost wellbeing $11.6 billion
Total cost of diabetes in 2005 $21.3 billion
(NSW Diabetes Action Plan)
Diabetes-Where to from here?
Despite this epidemic of diabetes there has been
little corresponding increase in staffing.
In 2008 in NSW there are
* 920 Dietitians
* 800 Podiatrists
* 250 Diabetes Educators
* 130 Endocrinologists
Diabetes-Where to from here?
In NSW according to Diabetes Australia NSW
figures there are more than 271,000 people
diagnosed with DM therefore
 For every 1 Dietitian there are 295 PWD
 For every 1 Podiatrist there are 339 PWD
 For every Diabetes Educator there are 1,084
PWD
 For every Endocrinologist there are 2,085 PWD
Diabetes-Where to from here?
Diabetes-Where to from here?
Implications
 Increase in waiting times to see specialist
services
 Lack of resources to run preventative programs
 Prioritorising which clients to see first
 Less time for individual consultations
 Discharging clients from specialist Diabetes
services to GP’s when well managed
 Possible burnout of overworked staff
Diabetes-Where to from here?
How do we use existing resources to maximise
accessibility?
Training of existing Health Professionals (such as
Practice Nurses & GP’s ) to handle people with non
complicated type 2 diabetes.
Referral to specialist services for more complicated
patients
Collaborative programs with GP’s & Allied Health
More group programs
Encourage patients to more self management.
Diabetes-Where to from here?
Courses for Practice Nurses
 National Association of Diabetes Centres’ Training
program
 Australian Diabetes Educators’ Association online
training program
 Diabetes Australia, NSW &
virtualMedicalCentre.comwww.virtualnursingeducation.com

Australian Practice Nurse Association online
module
Diabetes-Where to from here?
Practice Nurses are not Diabetes Educators however-
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They can provide basic education, support & encouragement at
diagnosis
Explain benefits of exercise and advise of available local
programs
Give basic advice on healthy eating
Explain benefits of weight loss & control
Advise on locally available healthy lifestyle programs
Identify those patients who require referral to group education
&/or more specialist service
Review with patients their annual cycle of care & clinical targets
Diabetes-Where to from here?
Development of greater links between GP’s,
Diabetes Educators (DE) & Allied Health.
From May 1st 2007 Medicare allowed GP’s to refer
patients to group sessions conducted by
Credentialed Diabetes Educator, an Accredited
Practicing Dietitian or an Accredited Exercise
Physiologist (who are registered providers with
Medicare) using normal GP plan rather than a
team care plan.
Diabetes-Where to from here?
Thus people with Type 2 DM referred
by their GP are entitled to an initial
individual assessment, followed by
up to eight group sessions in a
calendar year provided by eligible
Health Professionals.
Diabetes-Where to from here?
Chronic Disease management (CDM) Medicare
Items (Enhanced Primary Care):
 Preparation of a GP management Plan (Item 721)
 Review of a GP Management Plan (Item 725)
 Coordination of Team Care arrangement (TCAItem 723)
 Coordination of Review of TCA (Item 727)
 Practice Nurse support & management
Diabetes-Where to from here?
Team Care arrangement which
involves GP & at least 2 other care
providers.
5 individual Allied Health Visits
available to eligible patients per
calendar year with Team care
arrangement.
Diabetes-Where to from here?
Eligible Allied Health Professionals:
 Aboriginal Health Worker
 Audiologist
 Chiropractor
 Diabetes Educator
 Dietitian
 Exercise Physiologist
Diabetes-Where to from here?
 Mental Health worker
 Occupational therapist
 Osteopath
 Physiotherapist
 Podiatrist
 Psychologist
 Speech Pathologist
Diabetes-Where to from here?
Also incentive payments to GP’s to
complete annual cycle of care
including BP, BMI, HbA1C, lipids,
smoking, nutrition, alcohol, &
physical activity as well as
complications screening-eyes, feet
& kidneys.
Diabetes-Where to from here?
 Some local GP’s run diabetes clinics within their practice
for non complicated Diabetes
 360 Health clinic group program
 TCA in conjunction with Diabetes services
 Medical student from UNE attending Diabetes Centre as
part of their training
 Practice Nurses attending NADC course
 Tamworth Diabetes Centre provides advice & support to
GP’s & Practice Nurses
 Discharge guideline
Diabetes-Where to from here?
Discharge Guideline:
 Objectives
 Service Description
 Service Priorities
 Intake System
 Discharge procedure for Type 2 DM
 Discharge criteria for Type 2 DM
 Discharge criteria for women with Gestational Diabetes
Diabetes-Where to from here?
Objectives
Intake of clients for DNE & Dietitian
Priority clients
Timely & appropriate discharge
Diabetes-Where to from here?
Priority Clients
 Children
 Pregnant women with DM
 Type 1 DM
 People with DM related complications
 Type 2 commencing insulin
 Aboriginal & TSI
 Unstable DM
Diabetes-Where to from here?
Discharge
Well controlled or when education is
complete Type 2 DM to be discharged
back to LMO with letter
Chime closed
Diabetes-Where to from here?
Discharge Criteria for Type 2 DM:
Well controlled DM with HbA1C <7%
and/or BG 4 to 8 mmol/l
If there has been an improvement in
glycaemic control & client shows
evidence of maximum capacity for
improvement has been reached
Diabetes-Where to from here?
Type 2 Insulin commencement
Client taught how to adjust insulin
Client aware of target for blood glucose
Review appointment to monitor progress
When stable refer back to LMO
Diabetes-Where to from here?