This issue is the second edited by Allison Fellerhoff, and gives reports about IN THIS ISSUE:
several international conferences, useful information on the online renal risk
score, and is highlighting the tremendous work Paul has done for the diabetes 1. Editorial
community in New Zealand.
In her article ‘Response to the Havelock North Gastroenteritis Outbreak' Rachel
Chamberlain looks at the resourcefulness our patients show in a situation of
crisis, and suggests what we, as health care professionals, can learn from it in.
Vickie Corbett invites those interested in working with young people with diabetes to join the special interest group (page 10) and Sarah Price asks for expression of interest for the development of an interest group for Insulin Pump Therapy. On page 11 we have the 'President's Ponderings', reminding us of the importance to reach out to our colleagues in primary care.
2. Paul Drury retirement (Prof T Cundy)
3. Havelock North Gastroenteritis Outbreak/ NZSSD website
4. ADA (R Milne)
5-6. Diabetes Nurse Specialist Symposium (E Hajje)
Please use this opportunity and have a look at the new NZSSD webpage, give us
your welcome feedback, and be reassured the executive will take your sugges- 7. Educational Retreat, Diabetes and
tions on board. Spring is in full swing, Christmas planning and summer preparaEndocrinology, MidCentral Health
tions are underway, and we would like to use this opportunity to remind you of
the upcoming deadlines (please see below and throughout the issue).
8-9. Retreat (A Fellerhoff) / AADE
Ole Schmiedel (former editor)
2014 (H Ashton)
2017 Annual Scientific Meeting: Do not forget to diary the 2017 Annual
Scientific Meeting in Dunedin, 2-5 May. The two international keynote
speakers are Amanda Adler MD, PhD, FRCP (UK) and Carmel Smart
RD, PhD (Australia).
10. Special interest groups—insulin
pump therapy / young people
Key dates are: Registrations open
1 November 2016
Abstracts close: 5pm 17 February 2017, no extension will be given
Decision re abstracts:
10 March 2017
Early bird registrations close:
17 March 2017
Final date for registrations:
14 April 2017
Professional development awards: Next
round closes 1 November 2016. For further
information see
www.nzssd.org.nz/
awards.html or contact
[email protected]
Professor Tim Cundy recognises Dr
Paul Drury’s contribution:
Paul Drury retired in May this year
after 22 years as the Clinical Director of the Auckland Diabetes Centre. Paul has made, and continues
to make, enormously valuable contributions to diabetes - not only in
Auckland, but also nationally and
internationally. He will be a hard
act to follow. (cont. over)
Dr Drury is pictured to the right
11. On-line Renal Risk Score to Assess
People with Type 2 Diabetes Kenealy/
Elley
12. AADE 2016 (L McTavish)
13. President’s ponderings
Page 2
Paul Drury retirement (Prof T Cundy)
Paul’s pre-clinical training was at the University of Cambridge in the UK, and his clinical training at Kings College
Hospital (University of London). He showed early promise, collecting a hatful of prizes and first class degrees along
the way. After house officer jobs at Kings, Paul became a medical registrar in Stoke-on-Trent, and obtained the
MRCP. In 1978 he had a sabbatical in the southern hemisphere working as a radio doctor in Australia and then a
GP in Upper Hutt, which fortunately influenced him favourably toward Aotearoa.
Returning to the UK, Paul worked at St. Bartholomew's Hospital, London, then a powerhouse in endocrinology,
first as a Senior Registrar and then Lecturer. During this period he published extensively, with research concentrated mainly on the endocrinology of hypertension. In 1986, he was appointed Consultant Physician with joint
appointments at Greenwich Hospital and the renowned diabetes unit at King’s College Hospital. Although this arrangement meant considerable time contemplating the South London road traffic, Paul continued to be very productive in research, and published key papers on diabetic nephropathy.
In 1994, we managed to lure to New Zealand Paul and his wife, Sue Rudge and their small son, CJ (who is now a
doctor, himself). Sue, a rheumatologist, was appointed to positions both at the Starship Hospital in Auckland and
the Hutt Hospital, and Paul became the first Medical Director of diabetes services. It is difficult to overestimate
the transformation that Paul has overseen in the past 20 years, as we have become only too aware of the rising
tide of diabetes and its associated problems. During this period the Centre has had three changes of site, and
there have been major developments in the organisation of retinal screening and foot clinics, in-patient care and
the establishment of satellite clinics. The diabetes workforce has increased fourfold and Paul has particularly emphasised for all the professional staff the importance of continued education and evidence-based practice. He has
taught, supported and mentored many nurses, dietiticians, medical students, registrars and consultant colleagues,
and was instrumental in the development of and support for the pioneering diabetes nurse prescribing project.
On the national stage, Paul has served on or advised many bodies including the Pharmac Diabetes Sub-Committee,
the Ministry of Heath Diabetes/CVD Expert Advisory Group, the Land Transport Safety Authority, the Health Research
Council, the New Zealand Guidelines Group and the National Diabetes Research Strategy Group. Since 2012 he has
been Chair of the National Diabetes Services Improvement Group and from 2014 Clinical Advisor on diabetes to the
Ministry of Health. In recent years Paul has worked closely with colleagues at the Ministry to develop the Virtual Diabetes Registry which continues to produce invaluable national data on the trends in the prevalence of diabetes. Paul
served on the NZZSD Executive Committee from 1994-7 and was President from 2003 to 2006 and Medical Director
from 2009 to 2016 and made a Life Member in 2012. On top of all this Paul has continued to work as a much loved
and respected clinician, and maintained a strong interest in research - again involving all the professional staff at the
Centre - with a steady output of publications in top-ranked journals. The research topics included epidemiology and
cardiovascular disease and new drugs and insulin types.
Paul’s many contributions were celebrated at a lovely evening function in May, where many colleagues, past and present, gathered together at a waterfront venue. Cheryl Atherfold, who was one of the few DNS in post when Paul arrived in Auckland, spoke warmly of his contributions. Mele Kaufusi gave thanks on behalf of the Pasifika community,
whose needs Paul has recognised and helped address, and presented Paul and Sue with wonderful fine woven mats.
His colleagues at the Diabetes Centre presented Paul with a fine painting of Maungakiekie by a local artist - a view
that he would have enjoyed had he turned his desk the other way and not read the many, many agenda papers that
covered it. We are not losing him altogether, as he continues his valuable work explaining, representing and advocating for diabetes at the Ministry of Health, but we most sincerely wish Paul all health and happiness after 22 years
hard labour and outstanding service.
Professor Tim Cundy
Page 3
Havelock North Gastroenteritis Outbreak/ NZSSD website
Diabetes Specialist Service Response to the Havelock North Gastroenteritis Outbreak:
The Havelock North gastroenteritis outbreak was a busy few weeks for the staff of HBDHB.
The Diabetes Specialist Service made contact with 30-35 of our patients who identified as living in, or
working in, the Havelock North area. Around 25-28 of these were patients registered with and identified
by Te Mata Peak Practice as having type 1 diabetes. The remaining patients were children/adolescents
known to the specialist service who reside or attend school in Havelock North.
A few of the children’s families had already made contact with the service for advice early that week during the initial phase of the illness. On phoning the remaining patients, those who had been unwell had
managed their diabetes appropriately. We took the opportunity to go over how to manage diabetes during a concurrent illness, with all the patients, including those who had not contracted the illness. One
child was particularly unwell with the illness and was prescribed antibiotics by his GP, but none of the
patients needed hospitalization.
We considered that during the outbreak, a number of university students may have been at home in
Hawkes Bay on study leave, so were mindful to include them in our contact list. These consisted of any ex
paediatric patients who were known to have lived or currently have family in Havelock North that they
may have be staying with.
Many of those patients contacted expressed their appreciation for the courtesy call and support.
From this experience we have identified that we do not have robust information systems to draw patient
data like this easily as the specialist service as a whole does not have a database identifying these patients by domicile. The information given to us by the GP practice was based on practice register rather
than patient domicile so a number on this list did not actually live in Havelock North.
However, we do keep a spreadsheet of our children and adolescents which includes both patient domicile data and also the school they attend. This enabled us to identify and contact those patients quickly.
In the future should a similar situation arise it would be advantageous to post some general information
about key messages on the DHB facebook page, website, Health line or at local pharmacies about managing chronic illness (stopping/continuing certain meds, drinking fluids, when/where to seek help).
This experience has highlighted how resilient and well our patients are with self-management while unwell, and also know when and where to seek advice as needed.
Rachel Chamberlain., Paediatric Diabetes Nurse, Diabetes Specialist Service, Hawkes Bay DHB
NZSSD website changes
Hopefully you have all seen the new updated website. It has been a long, slow job and not yet
finished. The website has a great deal of information on it and it needs updating. Firstly we employed a student who knew how to design a website. Then we talked about how we wanted it to
look. Some new header s or tabs were added to
try and make it easier to navigate. We are now
in the process of updating the information on
the web site.
I would like all members to have a look at the
site and see what do they think. What is good
about the site and what needs changing? What
should be included on the site, what’s missing ?
Please contact Kate Smallman on [email protected] with suggestions
ADA R Milne
Page 5
Page 4
Report on American Diabetes Association 76th Scientific conference, June 10-14, New Orleans, 2016
I wish to thank NZSSD who gave me a professional development award to help me to attend this conference,
to present my poster and listen to some of the talks from the multiple streams such as acute and chronic
complications, behavioural medicine, clinical nutrition, education and exercise, clinical diabetes and therapeutics to name a few. Over 16,000 people attended the conference – really too big to do much networking.
The conference came with the ability to listen to webcasts, provided the speakers consented, so that if you
missed a particular session you could hear it later or revisit one that you found of interest. With so many concurrent sessions I have found this invaluable.
There was a symposium on the use of Metformin. Metformin can now be used mild to moderate renal impairment as it is unlikely to cause lactic acidosis and suggest with eGFR 45-60 review use, eGFR 30-45 reduce
the dose and don’t use when eGFR < 30 and the medication label was changed to reflect the reduced risk of
lactic acidosis with Metformin and renal disease. Metformin may improve cardiovascular risk and reduce
cancer risk by a variety of mechanisms. The reduced CV risk was found in UKPDS – 39% reduction in myocardial infarction and 36% reduction in all-cause mortality. Prof Holman said although the numbers in the
UKPDS on Metformin were small, later observational studies have shown similar benefits as people on metformin live longer and have fewer CV events. There is a new trial, the glucose lowering in on diabetic hyperglycaemia trail (GLINT) which will enrol 12,000 patients to try to provide better data about metformin and its
CV and cancer outcomes. The suggestion was that some metformin is what you need. Michael Pollack
spoke about repurposing Metformin as in some studies it has been observed to reduce cancer although this
is controversial. He speculated that the cause may be multifactorial. Metformin has been found to inhibit oxidative phosphoralisation (OXPHOS) in mitochondria, which oncologists are interested in, as cancer is often
dependent on OXPHOS. Metformin inhibits gluconeogenesis, they activate AMPK and inhibit MTOR which
overlaps with the effect of some anticancer medications. The suggestion is the metformin effect overlaps with
an anticancer effect. Metformin also reduces insulin and therefore reduces growth, some tumours grow with
diet and insulin so if reduce insulin, can reduce tumour growth. For example in randomised studies in colon
crypt cells have found in metformin vs placebo, that the metformin reduced the production of polyps in the
colon 38% vs 57%. For the future they are looking at other trails using second generation metformin to see
whether different strengths or combinations with other medications are more useful as an anticancer medication.
In a lecture about technology in the management of hospitalised patients there was concern raised about
point of care testing of blood glucose for accuracy but as yet there is nothing to replace what currently exists
so there is a need to update what exists and have more accuracy. Pumps require a hospital policy before
they are used for inpatients and certainly should not be used for DKA, confused patients, those undergoing
general anaesthetic, or unconscious or impaired. They should also not be used when a patient is undergoing
an MRI or any electronic investigation. Insulin pens have been found to be used by different patients so emphasis to reduce infection – need to ensure don’t use same pen or needle, lancets or cartridges for different
patients. So in some hospitals they have started having patient ID attached to the pen and record electronically when is used e.g. bar code on patient so correct insulin is given to correct patient. SMART insulin pens
would give information to the cloud recording how much insulin was used and when. There was discussion
around safety of technology as anything can be hacked so requires security.
The management of non-critically ill patients in hospital using a clinical decision support system called the
Glucodiab – this is a medical device which helps with identifying a basal bolus insulin algorithm for noncritically ill inpatients. It is based on the RABBIT 2 study algorithms and is based on weight, age, renal function and insulin sensitivity of the patient. When an in-patient is reviewed by a clinician and has an admission
blood glucose of > 11.1, insulin is initiated. Further doses are based on the pre-meal blood glucose, the nutritional intake, insulin sensitivity - the ward nurse using the system can work independently for the next 24
hours. The team reviews progress and makes adjustments to the algorithm daily. The system had workforce
support and was found to be effective and safe, comparable with best practice studies and risk of hypoglycaemia was not increased.
Page 5
Diabetes Nurse Specialist Symposium, Waipuna Conference Centre
PROFESSIONAL DEVELOPMENT AWARDS: Next round of awards closes 1 November 2016.
For further information please refer — www.nzssd.org.nz/awards.html or contact [email protected]
New technology and diabetic foot ulcer suggested that it could be used to prevent foot ulceration in patients
with diabetes. It is estimated that 85% of foot ulcers are preventable. Prevention can be achieved with annual
foot checks, daily foot checks, foot education on the prevention of ulcers, being selective about footwear, wearing shoes and socks, taking care of minor injuries. The issue is adherence. Cannot manage what you cannot
measure – so can use new technologies to predict ulceration earlier – measure the plantar temperature – as
this heats up before you get an ulcer, use an insole that measures the pressure and modify it to modify the
pressure helped prevent ulcer reccurrence by 11%. An additional effect of the study was that as were closely
following up the study patients’ adherence to foot wear increase by 46%. Smart in-soles can be used to inform
the patient when there is too much pressure in a particular part of the foot so that they can transfer weight- if
they get callous though will have to have this debrided before the pressure is relieved. For this to work the patient must be involved in their own self-care so react to the information they have. One study by Owen et al
measured shoe lace tightness finding that either too loose or too tight contributed to sheer force and sheer
force contributes to heat so there is a need to reduce the thermal temperature. Smart Sox are able to identify
pressure and sheer via fibre optics in the material and capture the thermal response to walking. Can also use
a pad that the patient stands on which is sensitive to temperature. The colour informs the patient that there is a
problem with the foot – can also have a smartphone linked to the insole that also informs the patient that there
is increased thermal temperature. There are mHealth apps to prevent diabetic foot ulcers which give on-line
support to patients and caregivers, provide information in the form of articles, or have discussion groups that
focus on this topic. The idea is to empower and motivate the patient to increase their self-care. Advances in
technology provide early, quick and objective assessment of the diabetic foot at home and in the clinical setting. They may improve prevention strategies through early identification of signs of diabetic foot ulceration or
deterioration in the wound healing process. It can assist patients to take care of their own health and help doctors to provide personalised care without necessarily spending more time with their patients. From my perspective anything that helps in the early recognition and prevention of diabetic foot ulcers is welcomed.
R Milne CNM – Diabetes, Whitiora Diabetes Service, Middlemore Hospital, South Auckland.
Diabetes Nurse Specialist Symposium, Waipuna Conference Centre, 6 Sep., 2016.
I had the privilege of attending the Diabetes Nurse Specialist symposium conference sponsored
by Novo Nordisk, held in Waipuna Conference Centre in September, 2016. There was a lot of
new information provided by the lecturers and poster sessions that were available..
Eirean is a Dietitian, she spoke about the CHO counting ISF CHO: insulin ratios. She presented an
overview about the requirement of the Insulin Sensitivity Factor (ISF) to equal the amount of 1
unit of rapid acting (bolus) insulin. She stressed that this would lower the blood glucose level and
the patient can do reverse corrections if the blood glucose would be below target.
Shaheen Mannan, pharmacist CMDHB, spoke about the polypharmacy medications in the elderly. She stated that the polypharmacy is the prescription, administration and the use of multiple
medications that are not clinically advised. Continued over…...
Page 6
Diabetes Nurse Specialist Symposium, Waipuna Conference Centre,
The reasons for polypharmacy in the elderly are due to the lack of physician and pharmacy visits
by the patient, poor communication between health professionals and inappropriate prescribing. She spoke about drug interactions that occur when the effects of one drug is changed by the
presence of another drug, food, drink or an environmental agent. She presented a table which
showed the drugs and substances with high potential for interactions, e.g, amiodarone, digoxin,
diuretics, grapefruit juice, warfarin, etc.
Furthermore, several case studies were presented by Diabetes Nurse Specialists- they presented
case studies that shared their experiences and stories with their patients.
Dr. Rinki Murphy’s clinical interest and expertise included the management of adults and adolescents. She spoke about ‘When type 1 is not type 1’. She reported about the investigation for genetic etiology of familial atypical diabetes and the management of monogenic diabetes: Maturity
Onset Diabetes of the Young (MODY) or maternally inherited diabetes and deafness (due to a
mitochondrial genetic disorder). She stated that glucokinase is a key regulatory enzyme in the
pancreatic beta-cell. It plays a crucial role in the regulation of insulin secretion and has been
termed the pancreatic beta-cell sensor. Given its central role in the regulation of insulin release,
it is understandable that mutations in the gene encoding glucokinase (GCK) can cause both hyperglycemia and hypoglycemia. Heterozygous inactivating mutations in GCK cause maturityonset diabetes of the young (MODY), characterized by mild hyperglycemia, which is present at
birth, but is often only detected later in life during screening for other purposes.
Her key components concluded that:

Genetic testing should request for neonatal diabetes

C-peptide is not a useful test in patients with possible neonatal disease

Past history of normal fasting glucose 5.1mmol/L means GCK is very unlikely

T1DM with family history of diabetes GAD-HNF1A mutation positive.
There were three posters that were displayed and discussed during the conference dinner. Elham Hajje, DNS, & Claire O’Brien, DNS, presented their poster about the Integrated Care Pathway (ICP) for discharge preparation of patients with diabetes. They identified that patients are
often not well prepared for discharge and ongoing self-management of their diabetes. They implemented the need of ICP for diabetic patients to promote shared responsibility by health professionals, caring for people with diabetes in partnership with patients who acquire knowledge
and resources for self-management.
The second poster was presented by Roberta Milne, DNS, Dr Brandon Orr-Walker, Jerome Tuhia,
Podiatrist - Diabetes Service Middlemore Hospital. Their objectives were to identify all patients
with diabetes with active foot disease, review diabetes and foot management, how to reduce
length of stay, when to refer to appropriate follow-up on discharge and prevent readmission.
The information identified from their poster of diabetes foot inpatients reviewed by the podiatrist is of concern, and showed the need to design interventions to reduce readmission.
This symposium was a wonderful meeting point for all health professionals from around New
Zealand involved in diabetes care and education.
ELHAM HAJJE – MHSc (Nursing), Designated Prescriber- Diabetes, Whitiora Diabetes service,
Counties Manukau Health
Page 7
Educational Retreat, Diabetes and Endocrinology, MidCentral Health
Educational Retreat 26 August, 2016, Diabetes and Endocrinology Service, MidCentral Health
Once or twice a year, at the Diabetes and Endocrinology Service Midcentral Health (MCH), we hold a team educational retreat. A full day of education is planned, where team members and invited MCH colleagues present to
each other on topics of interest. Themes for presentations are planned and the day provides an opportunity for us to
review how we do things and initiatives we could implement. This “mini conference” was the brain child of Dr
Owais Chaudhri, who has since moved to Australia, and I am happy to report we have continued with his team initiative, and Dr Veronica Crawford has taken up the challenge of organising the day.
Recently our retreat was held with a focus on diabetes-related complications.
Dr Veronica Crawford commenced the day presenting results of the recent EMPA-REG and LEADER trials with a
discussion on the lack of funded access to SGLT_2 inhibitors, GLP-1 agonist and DPP4 inhibitors. There was an
emphasis on cardiovascular risk reduction, and a general discussion on the importance of aggressive management
of young people with type 2 DM.
Our invited speakers included MCH nephrologist, Dr Norman Panlilio, who discussed diabetes kidney disease and
chronic renal failure. Increasing obesity globally has impacted on kidney disease. 50% of patients on dialysis have
diabetes, so between our services we have many “shared” patients. 25% of those patients on dialysis have hypertension, 13% have glomerulonephritis and 10% of patients will have other conditions leading to end stage renal
failure. Patients may take 18 – 20 years to progress from chronic kidney disease Stages 1 – 4, however once a patients has developed proteinurea 3x over the normal limit, there is an expected 3-5 year time frame to progress to
ESRF (Stage 5) requiring dialysis or palliative treatment.
Dr Nasser Shehata, obstetrician and gynaecologist, provided an interesting presentation on ultrasonography in diabetic pregnancy and the effect of DM on the developing foetus. He outlined the role of USS in estimating foetal
weight, diagnosis of congenital malformations, and the monitoring of pregnant women with gestational diabetes
mellitus (GDM) or pre-existing DM.
Dr Henry Liu, radiologist, discussed imaging in diabetes. Fatty liver, calcium deposits, emphysema of the gall
bladder, and atherosclerosis seen on imaging are frequent findings in patients with DM. Mr Keith Aitken, MCH
specialist diabetes podiatrist, gave an interactive presentation on imaging feet, with a focus on charcot foot; deformity, destruction, demineralisation and disorganisation are the features of charcot. Tania Bailey, clinical nurse
specialist (CNS) presented information on how well (or not) MCH manages diabetic foot disease. We currently do
not have a high risk MDT foot clinic at MCH. An action point from Tania’s presentation was recommendations on
how / when we can implement the NZSSD Diabetes Foot Screening & Risk Stratification Tool, ensuring it becomes embedded into routine assessments. A recommendation was to add the tool into the MCH website
“Controlled Document” page, so it is more easily accessed by all our colleagues. This tool would need to be implemented into primary care and will be helpful to identify the amount of people with moderate to high risk feet and
the appropriate clinical pathway. Emma Ball (CNS) presented findings of a recent audit she has completed on inpatient diabetes self-management education provided by ward staff. A previous audit was undertaken in 2014
which showed that patients were given little or no education on diabetes self management. In September 2015, 48
nurses at MCH were funded to complete the Diabetes Health Mentor on-line education package and we were interested to see if this had any impact on care delivery.
Shelley Mitchell, specialist diabetes dietitian presented on management of gastroparesis, and Kerrie Skeggs (CNS)
gave a case study on a patient with type 1 DM and gastroparesis. One of the “take home” messages was when assessing a patient with gastroparesis, watch out for food adaptations that might have already occurred, which may
have gone unnoticed.
MCH paediatricians Dr Nicola Pereira and Dr Werner Truter provided a paediatric perspective including a very
interesting case study. Alison Fellerhoff (CNS) then discussed management of high risk adolescents with type 1
Diabetes presenting in diabetes ketoacidosis (DKA).
Continued over… … … ..
Retreat (Fellerhoff) / AADE 2014 Helen Ashton
Page 8
(cont) We reviewed how we are doing in terms of the Ministry of Health Standards of Care (Standard 16), were
challenged by number of “frequent flyers” we see in the inpatient setting. The talk then focussed on interventions
such as how to maximise the multidisciplinary team to improve outcomes and reduce emergency admissions (such
as DKA) in this challenging group of vulnerable young adults.
Endocrinologist Dr Peter Mwamure completed the day with an excellent presentation on autoimmune mechanisms
of Type 1 DM. He provided a comprehensive summary of the immunology involved in disease pathogenesis and it
was great to include an element of basic sciences into the day.
It is very easy to postpone such days due to clinical workload, however setting aside a day to learn from each other,
and evaluate how we could improve care delivery based on up to date research, can provide fresh perspective on
how we are doing as a team. The overall feedback from our team is that attending the educational retreat helps us to
develop professionally, work better as a team and think about how we can become more creative and flexible in the
way that we work.
Alison Fellerhoff RN MN, Clinical Nurse Specialist, Diabetes and Endocrinology Service,
MidCentral Health
American Association Diabetes Educators (AADE) Annual Meeting 6 – 9th August 2014, Florida,
USA: Reflection: Two years on - what has stayed with me most from this conference? What has
impacted most on my practice as a Diabetes Clinical Nurse Specialist?
I was recently asked to provide a short report for NewSweet from this meeting. At first I panicked this
was two years ago, what can I remember? What might still be relevant? Then I asked myself, what
key messages have remained with me and what continues to impact and influence my practice the
most? So this is a reflection two years on about two keys areas from this meeting.
American Association of Diabetes Educators Association (AADEA)
First a little about AADEA. This association is a multidisciplinary organisation made of nurses, dieticians, pharmacists, exercise specialists and others and includes a membership of over 14 000 members. The overall mission of this organisation is to empower diabetes educators to provide innovative
education, management and support for people with diabetes. An annual meeting is held over four
days. Thousands of delegates attend. I made it to this annual meeting in 2014 held in Florida, Orlando. The event was on a scale I had never experienced, and although I initially rebuked on the necessity
of having an offered phone application to navigate my way around this four day meeting. However this
‘app’ soon became my best friend and made me really start to appreciate owning a smart phone.
Using Plain Language to make Diabetes Messages Clear and Simple
The first take home key message which has stayed with me and impacts on my practice was from a
session titled ‘Using Plain Language to Make Diabetes Messages Clear and Simple” presented by Wendy Mettger, MA, and Catherine Brown, MS, RD. This presentation highlighted the work being done by
the National Diabetes Education Program (NDEP) in America. NDEP is a federal funded program
including over 200 partners at national and local levels working to improve the treatment and outcomes for people with diabetes. NDEP creates a variety of materials which use plain language to help
people learn how to manage and prevent type 2 diabetes (Continued over…)
(cont.) In America a third of the population was identified as having poor health literacy skills. In New
Zealand over half of our adult population (56.2%) was identified in the Adult Literacy and Life Skills Survey conducted in 2006 as having poor health literacy. Therefore this session was very relevant. It has
made me think much more carefully of what language, what resources, and how I assess what the patient or the carer and or family understand.
We need to make sure our everyday medical language
does not become the language we use with our patients.
It is not only the language we use but it was also highlighted and shared during this session that we must
assess what message or understanding the patient takes away. A case shared was where a patient
was covering (squirting) insulin over his food as the message he took away was the insulin ‘was to cover
his food’. Another key point raised in this session was to remember that health literacy includes numeracy skills. Diabetes management often calls upon the ability of the patient to be able to carbohydrate
count and to apply correction factors. Are we adequately assessing numeracy skills? If you are thinking of developing a resource for patients with diabetes or get the opportunity to field test a resource I encourage you to take a careful look at the language used. Visit the NDEP website www.niddk.nih.govt to
get some helpful tips. I was really impressed with the willingness of NDEP to share resources. Some
of the brochures may need some adaption for New Zealand use but there is no copyright and NDEP encourages the content to be shared freely. For further information on health literacy also visit
www.healthliteracy.org.nz.
DAWN2 Study Findings presented by Martha Frunnell
Another session which continues to constantly to be with me in my practice today was a keynote presenation by Martha M.Funnell, MS, RN, CDE, FAADE, associate professor scientist in the Department of
Learning Health Sciences at the University of Michigan Medical School. This presentation discussed the
findings from the DAWN2 study.
For those not familiar with DAWN – this is the Diabetes Attitudes
Wishes and Needs study which was groundbreaking at its time of publication in 2001 because of its international focus, scope and size. Findings from the intial DAWN study confirmed diabetes contributes
to multiple psychosocial issues. Participant numbers and country numbers were more extensive in the
DAWN2 study. Notable participants also included family members. It was from this inclusion that diabetes-related distress was reported as a destructive by-product of the diease for not only patients but also
their families.
The pyschological impact of diabetes, both on the person with diabetes, but also the family, is something
that I am much more aware of and attempt to both acknowledge and address in my practice. I am
pleased to see the MOH, 2014 Quality Standards for Diabetes Care Toolkit Standard 4 recognising the
signficant psychological impact people and families living with diabetes have. There is reference to
DAWN for health professionals in this section and I would encourage you to have a look at some of
these assessment tools. www.health.govt.nz/publications/quality-standards-diabetes-care -toolkit-2014.
These final thoughts really sum up for me why this key note session on DAWN2 has remained cognisant
with me. I have constant admiration for each and every person and family I meet who live or support
someone with diabetes, conscious of the impact that this chronic disease has on their lives. Any changes in our health system that allow for an increase in psychological support being available and affordable
is something I would certainly support. In the meantime as Diabetes CNS we need to void this gap and
educate and upskill other health care professionals particulary PHC to do this for the increasing number
of people and families affected by T2DM.
I would like to thank NZSSD for their contribution which helped assist me gain the experience and enjoy
the opportunity to attend this conferecne. For further information about AADE, visit their website https://
www.diabeteseducator.org/
Helen Ashton RN MN, Clinical Nurse Specialist Diabetes, Waikato Regional Diabetes Service, WDHB.
Special interest groups
Page 10
Expression of Interest for the development of the Special Interest Group for: Insulin pump therapy
On behalf of the Waikato Regional Diabetes Service Insulin Pump Team, I would like to extend an invitation to
all registered health professionals who work in Diabetes to join a special interest group (SIG) focusing on insulin pump therapy nationally.
The purpose of this group is to improve health outcomes for people with type 1 diabetes who are using insulin
pump therapy in New Zealand.
The proposed objectives of this group are to:
Encourage networking, innovation and ease of communication for all health professionals working with
people using insulin pumps.
To develop best practice pump guidelines in New Zealand, improve clinical outcomes and patient experience.
Discuss cases, share successes and keep up-to-date on new technology.
To register your interest to be part of this group, please send your name and email contact to Sarah Price at
[email protected]. Initially this SIG will be convened by the Waikato Regional Diabetes Service and once names have been collated, we will be in touch with you to initiate the networking.
Sarah Price, Clinical Nurse Specialist, Diabetes, Insulin Pump Team, Waikato Regional Diabetes Service
In January 2016, a special interest group for health professionals working with young people with diabetes between the ages of 15-25 years was established. The purpose of the group is to:
- Encourage networking, innovation and ease of communication for health professionals working with
similar populations.
- Identify resourcing issues for health professionals from around New Zealand as these will impact on
how each region works with their youth.
- Reduce barriers of communication for health professionals who may work in a limited resource area.
- Develop projects that are aligned with national and international recommendations.
- Create links with other organisations who work with similar age groups but not specific to diabetes.
Over 45 health professionals from around New Zealand have joined the group in which they can communicate with each other via the development of a ‘Google Group’. To date, a list of internet resources has been shared, expressions of interest to join national projects have been advertised and informal conversations about things of clinical interest have been started. Additionally, as our patients
move around the country, we are able to establish timely links with health professionals which may reduce concerns when transferring care from one service to another.
If you work with young people with diabetes and wish to join this special interest group, please email
me so I can add you to the network.
Vickie Corbett, Clinical Nurse Specialist, Waikato Regional Diabetes Service, [email protected]
November is Diabetes Awareness Month
The Whangarei Diabetes Service is having a fun run/walk on November 16 to raise funds
for Diabetes Youth to attend camps.
What do you have planned in your DHB?
On-line Renal Risk Score to Assess People with Type 2 Diabetes
People with type 2 diabetes are at significantly increased risk of end stage renal disease (ESRD) resulting in long-term kidney dialysis or kidney transplantation. Diabetes has become the leading cause of
ESRD and is 3-4 times more common in Maori and Pacific populations than it is amongst those of European origin in New Zealand (NZ). Early intervention can reduce the risk of progression if those likely to
progress to ESRD are identified early. A renal risk equation has been developed by the Diabetes Cohort
Study (DCS) team that assesses ESRD risk for people with type 2 diabetes of different ethnic groups and
risk profiles in NZ. The risk calculator has been integrated into the DCS cardiovascular risk calculator,
funded by NZSSD, and is freely available on the NZSSD website for health professionals to use: http://
www.nzssd.org.nz/cvd_renal/ .
The DCS has used anonymised data from the previous Get Checked diabetes programme and followed
all hospital admissions and other outcomes of the individuals for up to 12 years. The study is one of the
largest of its kind in the world. As such, it is a very valuable cohort study for assessing long-term outcomes in diabetes and the DCS team have undertaken many analyses of the complications experienced
by people with type 2 diabetes in NZ. The DCS team have also been working with the Chronic Kidney
Disease - Prognosis Consortium (CKD-PC) based at Johns Hopkins University in Baltimore in a collaboration of more than 40 cohorts and trials from around the world to investigate long-term kidney outcomes. The collaboration have investigated, amongst other things, the importance of urine protein, and
not just serum creatinine (or glomerular filtration rate), in assessing kidney and cardiovascular function.
The DCS have also helped to validate an international renal risk equation for those with existing kidney
damage.
Dr Tim Kenealy received a research grant from NZSSD and the work is now complete. Dr Raina Elley
wrote this report.
AADE 2016, L McTavish
Page 10
AADE 2016
I had the pleasure of attending the American Association of Diabetes Educators (AADE) conference in San Diego August 12 th – 15th. This was possible with the assistance of a Capital & Coast
DHB scholarship and an NZSSD travel grant, which I am very grateful to receive. This year’s
conference was reported to have the largest attendance ever with over 3,700 delegates, not including the staff of 200 on the stands in the trade display area. Within the trade display area,
there was a ‘map of the world’ where delegates were encouraged to place a coloured sticker to
indicate where they are from. Attendees came from the Philippines, parts of Africa, the Middle
East, UK, Canada and all over the USA. The delegates were largely Certified Diabetes Educators (CDEs) which included endocrinologists, hospital diabetes specialist physicians and general
physicians with a special interest in diabetes care, pharmacists, podiatrists, dietitians and registered nurses (nurse practitioners, senior nurses, nurse managers, bed-side nurses). An interesting mix of healthcare professionals.
Unlike other conferences I have been to, the AADE had very few research-focused sessions.
The theme of this conference was mainly focused on providing quality patient care. I was privileged enough to be invited to be one of the eight 30 minute oral presenters at the 4 day meeting.
I presented my study ‘Using a weight-based hypoglycaemia treatment protocol for insulin pump
therapy’. I found that many people were interested as it was a new concept for them and there
were many questions.
The AADE conference is about sharing the quality of patient care information and resources.
Each day of the conference had a specific focus. Friday 12 th largely focused on Type 2 diabetes
but also included presentations on managing the inpatient, treatment and care of the cystic fibrosis/diabetes related patient and CGMS systems involved with closed loop artificial pancreas systems. Saturday 13th was Type 1 diabetes day with a technological focus especially related to
teens and young adults. The Sunday was all related to pre-diabetes which was the first time the
AADE had ever devoted an entire day to this emerging issue. Monday 15 th had a more psychological and social theme to managing diabetes. There were six educational work streams to the
conference:
Advance Skills for Programme and Business Management for Entrepreneurial Organisations
Build Skills to Provide Diabetes Education and Support within Evolving Healthcare
Systems
Innovative Diabetes Care and Education Across Diverse Populations
Pathophysiology, Epidemiology, and Clinical Management of Pre-diabetes, Diabetes
& Related Chronic Conditions
Psychosocial Issues and the Promotion of Lifestyle Behaviour Change
Pioneer Diabetes Technologies and Connected Health Modalities to Deliver CostEffective Care
There were 133 poster presentations on the Sunday, with another 6 Industry posters held in the
main lobby, all of which were of exceptional quality.
The trade display area would be one of the most impressive I have ever seen. It was patientfocused rather than clinician focused. Of the 200, about a quarter were pharmaceutical or the
usual technological focused (blood glucose meter or CGMS). Continued over
Continued Many displays were healthy food and alternative medicine based, podiatry applicances,
dentistry, camp operators for children, eating disorder agencies and of course ADA book supplies.
The food was high quality and available within the trade display area. San Diego averaged above
28 degrees celcius and encouraged delegates to attend air conditioned sessions.
Given the value of of what I have taken from the 2016 AADE meeting, I believe it would of great
benefit for anyone in diabetes care to attend. I have copied the following advertisement:
‘The AADE Annual Meeting & Exhibition, organized by the American Association of Diabetes Educators will take place from 2nd August to the 5th August 2017 at the Indiana Convention Centre in
Indianapolis, USA. The conference will cover areas like ‘unparalleled opportunity to meet business
goals’ and ‘lay critical groundwork for the future. In addition to exhibiting opportunities, the event
includes top-notch educational sessions on supply chain management, growth strategies in today’s complex marketplace, ‘Want to Know How Your Product or Service Will Help Them Improve
the Way They Do Business’.
Lindsay McTavish, Charge Nurse Manager & Clinical Nurse Specialist (Diabetes), Endocrine, Diabetes & Research Centre, Wellington Regional Hospital
PRESIDENT’S PONDERINGS
Dear Colleagues
Spring is here and, following the ASM, your executive has been busy preparing for the year ahead. Planning
for the Annual Scientific Meeting in May 2017 is well under way, and invited speakers and logistical arrangements are now in place, and will be the subject of future announcements.
Feedback from the meetings and from the specialty groups and your executive representatives is informing
the direction our Society will take. More feedback is required and we invite you to contact us informally or by
email with suggestions ([email protected]). The Physicians’ Meeting next month is a forum we will be asking
for input. If you are not able to be there please write to me, [email protected] (or another executive member) with your thoughts so we can consider suggestions from the widest reach of our
Society.
Next month is Diabetes Awareness Month. Diabetes NZ will be promoting this and I encourage you all to participate in events and activities to raise the profile and encourage improved clinical care and services for our
patients.
A key challenge we face is to ensure that the clinical voice of advocacy is of a volume commensurate with the
size of the diabetes problem and the needs of people living with diabetes. This is a challenge when the large
majority of diabetes care is a small part of many clinicians’ daily work, as it is in New Zealand and most other
developed nations. Our patients really need the combined voice of primary care clinicians advocating for
their needs, not just for resources in primary care if an appropriately resources but also clinical culture of
excellence is to be embraced and become the new norm. Inviting primary care clinicians to be a key part of
our Society is a vital step in my opinion. To that end we have invited two Wellington GPs, well known to
many of you, to the Physicians’ Meeting. Dr Sandy Dawson was the Chief Advisor in the Ministry during the
years of the National Diabetes Strategy (2000) and the development of diabetes as a health target and roll
out of Annual “Get Checked”. Dr Bryan Betty has been an active participant in NZ Guidelines, National Diabetes Advisories, and is now a Deputy Medical Director at Pharmac. I value these colleagues’ opinions and insights in the highest in my thinking about diabetes care and management. We need to encourage their voice
and leadership, and to engage more clinicians from primary care to do likewise if we are to make substantive
improvements in diabetes care.
Best wishes for the coming months, and all on the Executive team look forward to catching up with you soon.
Brandon Orr-Walker