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Achieving targets in diabetes care

Diabetes is one of the Australian Government’s National Health Priority Areas. It is a significant and increasing health issue in this country, which poses a considerable burden to patients, healthcare professionals and healthcare resources.

"Quality Use of Medicines" (QUM) is one of the 4 pillars of Australia's National Medicines Policy. QUM means selecting the best management options for the patient, choosing the most appropriate medicine when one is necessary, and ensuring medicines are used effectively and safely. In essence, QUM is about using medicines to their best effect. With DAVE, the Pharmaceutical Alliance has developed a tool that actively supports QUM at the point when these decisions are are being discussed and agreed during the doctor-patient consultation.

Bridging the Gap, NATSEM 2009

The National Centre for Social and Economic Modelling (NATSEM) has developed a report* to predict the future incidence and impact of type 2 diabetes in Australia. The report 'Bridging the Gap in Meeting Clinical Targets for the Treatment of Type 2 Diabetes', projects the serious magnitude of the challenge by 2050, and the impact of a range of interventions to help manage this potential health crisis.

*The report was developed in association with representatives from Diabetes Australia, The Pharmacy Guild of Australia, NATSEM, Baker IDI Heart and Diabetes Institute, Pretium, Improvement Foundation and Eli Lilly Australia (a TPA member company).

  • By 2010, over 1.2million adult Australians will be living with type 2 diabetes.  That's 8.3% of the population.
  • By 2050, the report estimates that around 1-in-7 Australians (14.4%) - nearly twice the current levels - will have type 2 diabetes, half of whom will have their condition undiagnosed.
  • Between 2047 to 2050, the total direct health costs for those living with diagnosed type 2 diabetes will be approaching AU$43 billion in today's figures.

The NATSEM research reviewed the five different evidence-based interventions listed below and found that all were effective in increasing the level of control patients had over their diabetes, reducing the number of complications and therefore reducing the associated health cost burden.

  • improving levels of exercise
  • improving use of medicines
  • enhancing primary care
  • introducing a medication
  • counselling support

click here to download the complete report 'Bridging the Gap in Meeting Clinical Targets for the Treatment of Type 2 Diabetes in Australia'

Type 2 diabetes – a unique challenge

Following other Quality Use of Medicines (QUM) projects, The Pharmaceutical Alliance conducted independent research 5 with medical practitioners to uncover just how complex and difficult diabetes can be to manage – both for patients and healthcare professionals.

To gain an understanding of the barriers to achieving the recognised targets, qualitative research was carried out in two stages:

  • Phase 1: 12 GPs, 4 endocrinologists, 6 diabetes nurse educators
  • Phase 2: 20 people with known diabetes

The research highlighted the very real difficulties medical practitioners face every day in managing type 2 diabetes, split across five key barriers:

  • Patient: attitude to diabetes; awareness and understanding of treatment targets; non compliance with lifestyle changes and medicines; lifetime challenge of chronic disease; gaps in information
  • Practitioner: flexible attitudes towards targets; difficulty in keeping up to date; motivation of patients to make changes or to adhere; limited consultation time; shortage of/inability to refer to educators
  • Medical: co-morbidities; diabetes complexity and complications; polypharmacy
  • Systemic: problems in the treatment cycle or medical system
  • Social/economic: cultural factors; cost of medicines and GP visits
To download a full copy of the report click here

Navigating the diabetes maze

The research highlighted the need for improvement in the following areas:

  • Clear communication of targets between practitioners and the patient
  • More evidence-based, treat to target approach in medical practice
  • The need for an emphasis on patient education and the importance of self-monitoring
  • Greater access to health professionals
  • Improved communication between GPs, endocrinologists and diabetes nurse educators; and
  • Increased awareness of diabetes in the wider community

Consequently, the outcomes of this research prompted the development of DAVE™, designed to help healthcare professionals successfully complete the complex reviews and decision-making processes for their type 2 diabetes patients within the time constraints of a consult.

To help prevent the progression of type 2 diabetes, effective management requires a comprehensive and responsive approach, including healthy lifestyle choices and appropriate use of medicines to give patients the best chance of reaching treatment targets.

About DAVE™ click here

References
  1. AusDiab 2005: The Australian Diabetes, Obesity and Lifestyle Study.  Tracking the Accelerating Epidemic: Its Causes and Outcomes.  2006 International Diabetes Institute, Melbourne
  2. Dunstan et al. The rising prevalence of diabetes and impaired glucose tolerance.  The Australian Diabetes, Obesity and Lifestyle Study.  Diabetes Care 2002; 25: 829-34
  3. DiabCo$t Australia Report, 2003
  4. Australian Bureau of Statistics. Australian Social Trends 2007
  5. The Pharmaceutical Alliance. Understanding why Australians with type 2 diabetes are not achieving treatment. May 2007
  6. Kemp TM et al. Glucose Lipid and Blood Pressure Control in Australian adults with type 2 diabetes – the 1999-2000 AusDiab. Diabetes Care 2005; 28(6): 1490-2
  7. Davis TME et al.  Glycaemic levels triggering intensification of therapy in type 2 diabetes in the community:  The Fremantle Diabetes Study.  MJA 2006; 184:325-8
  8. Bryant W et al.  Diabetes guidelines: easier to preach than practise?  A retrospective audit of outpatient management of type 1 and type 2 diabetes mellitus.  MJA 2006; 185: 305-9
  9. Diabetes Australia. Diabetes data [fact sheet]. Diabetes Australia 2008 Mar.
DAVE

 
FAST FACTS: diabetes in Australia
  • Approximately 275 Australian adults develop diabetes every day 1
  • Australia has one of the world’s highest reported levels of diabetes for a developed country 2
  • Type 2 diabetes accounts for 85-90% of all diagnoses in Australia 3
  • In 2008 it was estimated that around 1.7 million Australians are living with diabetes (types 1 and 2) 9
  • Nearly two-thirds of those diagnosed with type 2 diabetes are taking medication to manage their disease 4
  
 
FAST FACTS: achieving targets
  • Less than one-in-seven people diagnosed with type 2 diabetes are achieving the three treatment targets relating to blood glucose, blood lipids and blood pressure 6
  • The majority of Australians receiving treatment have suboptimal control of their type 2 diabetes (HbA1c >7.0%), putting them at greater risk of developing serious health complications 7
  • Seven-in-ten patients with type 2 diabetes receiving treatment from a major Sydney hospital were not achieving HbA1c targets of <7% 8
  
 

“The percentage of people with diabetes who are not meeting targets is unacceptably high and this is a major contributor to the development of serious and debilitating diabetes complications.”
Professor Stephen Colagiuri, Professor of Metabolic Health at the University of Sydney

  
 

“I believe diabetes is the most complex disease to manage in primary care.”
Dr David Lim, a GP from Newtown in Sydney

 
 

“Chronic disease management requires team-based leadership, with clear roles and responsibilities for the GP and appropriate resources for the patient. It is never easy, and achieving a clear pathway is hard for GPs and nurses when time is precious or resources are hard to locate. Anything that may ease this burden is welcomed, especially when the patient’s problems are complex, as we know chronic diseases can be.”
Dr Gary Deed, a GP from Brisbane and past President of Diabetes Australia

 
 

"Diabetes is an increasingly complex condition for GPs to manage at a consistently high clinical standard, because of changing intervention levels and new treatments. Many of us despair of remembering all the knowledge every time for every patient."
Dr Linda Mann, a GP from Leichhardt in Sydney, Medical Educator at the Sydney Institute for GP Education & Training and RACGP Representative on Editorial Panel

  

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The Pharmaceutical Alliance

The Pharmaceutical Alliance seeks views and guidance from a broad range of healthcare professionals. Where appropriate for these consultations, the Alliance provides remuneration specifically to cover their  time away from day-to-day responsibilities.  The Pharmaceutical Alliance has not provided any payment for comments expressed by people regarding the Alliance or its work. All views represent the opinions of the individual author and are independent of The Pharmaceutical Alliance.