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How is birth by caesarean section delivery associated with the risk of childhood T1D?

Investigator: Dr Aveni Haynes, Telethon Kids Institute

Co-investigators: Professor Tim Jones, PMH, Professor Elizabeth Davis, PMH/Telethon Kids Institute

Summary: The number of children being diagnosed with Type 1 Diabetes (T1D) continues to increase each year and despite intense research efforts, no cause for this increase has yet been identified. In parallel with this increasing incidence, there has been an increasing number of babies being born by caesarean section delivery, with this mode of delivery now accounting for about 30 per cent of births in Australia. In 2008, a report analysing studies from different populations around the world, reported that birth by caesarean section delivery was associated with a 20 per cent increase in the risk of childhood T1D (1). So, could the increasing number of babies born by caesarean section delivery be contributing to the increasing incidence of childhood T1D? If so, is the increased risk of T1D similar for babies born by pre-labour, elective caesarean section, and those born by emergency caesarean section? This project aims to address these questions by a study of birth, pregnancy and delivery details for babies born in Western Australia between 1980 and 2015. By examining differences between those babies who went on to be diagnosed with T1D under the age of 15 years and those who did not, this study will investigate the relationship between factors related to pregnancy and delivery which may influence the future risk of babies developing T1D.

 

Health Literacy: Implications and Interventions for Adolescents and Young Adults with Type 1 Diabetes

Investigator: Jennifer Nicholas, Telethon Kids Institute/Princess Margaret Hospital

Co-investigators: Dr Melanie Burkhardt and Professor Bu Yeap, Fiona Stanley Hospital, Professor Donna Cross, Telethon Kids Institute, Professor Elizabeth Davis, Professor Tim Jones, Telethon Kids Institute/Princess Margaret Hospital

Summary: Poor health literacy (HL) is associated with inequalities in how people access healthcare, interpret healthcare messages and their health outcomes. Approximately 60 per cent of Australians are estimated to have low HL, which is an independent risk factor for more hospitalisations and poorer diabetes outcomes. Further, people with diabetes may experience higher rates of psychological distress, with evidence emerging around the impact of diabetes acceptance, as another factor influencing diabetes self-management behaviours and subsequently health outcomes. There are also known associations between lower HL and poorer communication with healthcare providers. These are likely to be particularly important considerations in the care of adolescents and young adults who are managing their diabetes through a time of significant developmental, social and healthcare transition. This project will examine HL, in conjunction with measures of psychosocial risk and wellbeing and diabetes health outcomes, in a Western Australian population of adolescents and young adults with Type 1 Diabetes. There is currently limited evidence of the potential risks of poor HL, and its associations with other determinants of health outcomes including knowledge, health behaviours and support systems, among adolescents and young adults with diabetes. The identification of ‘at risk’ groups will help to guide the delivery of targeted interventions aimed at maximising interest and intent, for individuals with Type 1 Diabetes to manage their health optimally.

 

Practical use of continuous glucose monitoring during exercise to improve time spent in target glucose range

Investigator: Dr Tarini Chetty, Diabetes and Endocrinology, Princess Margaret Hospital

Co-investigators: Dr Marie-Anne Burckhardt, Dr Martin De Bock, Professor Elizabeth Davis, Professor Tim Jones, Telethon Kids Institute/Princess Margaret Hospital, Dr Peter Adolfsson, University of Gothenburg, Gothenburg, Sweden

Summary: Physical exercise has many well-established health benefits for young people with Type 1 Diabetes (T1D). However, for people with diabetes, exercise increases the risk of low blood glucose levels. This makes it challenging to keep glucose levels normal during exercise. Continuous Glucose Monitoring (CGM) is a small wearable device that shows current glucose levels and trends (up, or down, and how fast it is changing). Given that CGM will be subsidised for children with T1D in the near future, there is a need to provide evidence-based guidance on how best to use this information during exercise. This study aims to explore the use of a carbohydrate intake guideline based on CGM trends during physical activity. Young people with T1D will be asked to come together for a sports day of fun-based activity, on two occasions. On one occasion they will wear and respond to their CGM. On the other occasion they will wear CGM but will not be able to see the sensor glucose levels and will manage their blood glucose levels using standard exercise advice. We will compare the time spent with normal sensor glucose levels during these two occasions. This study will provide information of a very practical nature about how to use real time CGM to better manage blood glucose levels during exercise. Our findings will inform larger studies that will help us update current guidelines about diabetes and exercise to help young people with T1D to exercise safely.

Effect of ketogenic low carbohydrate diets on hypoglycaemia threshold and symptoms in adults with type 1 diabetes mellitus

Investigator: Zac Leow, School of Sport Science, Exercise and Health and School of Paediatrics and Child Health, UWA

Co-investigators: Professor Paul Fournier, Assoc Prof Kym Guelphi UWA and Professor Tim Jones, Telethon Kids Institute/PMH

Summary:  Maintaining good glycaemic control plays in important role in the prevention of long-term diabetes complications but it is not an easy task to achieve for people with Type 1 Diabetes (T1D) as they often experience severe episodes of hyperglycaemia. There is evidence that low (<100g/day) carbohydrate high-fat diets can decrease the magnitude of these excursions and improve glycaemic control in adults with T1D, with our unpublished findings showing that excellent glycaemic controls (HbA1c<6%) are achieved with very low carbohydrate diets (~30 g) that result in moderate increases in ketone bodies levels (ketogenic diets). What is unclear, however, is whether these diets have the potential to increase the risks of severe hypoglycaemia by decreasing the blood glucose threshold level for hypoglycaemia symptoms. That this might be the case is suggested by the observation that the brain can use ketone bodies as fuels, thus decreasing its reliance on blood glucose and enhancing its tolerance to low blood glucose levels. This predicted lowering of hypoglycaemia threshold and resulting narrower blood glucose range available to take appropriate corrective measures in face of impeding hypoglycaemia are expected to increase the risk of experiencing severe hypoglycaemia requiring assistance. For these reasons, our primary aim is to determine whether it is the case that T1D adults on a ketogenic diet do not display any counter-regulatory responses, hypoglycaemia symptoms, and cognitive impairments in response to an acute exposure to a level of blood glucose (2.8mmol/L) known to cause hypoglycaemia responses in non-ketotic individuals with T1D.

 

Genetic risk in type 1 diabetes in West Australian patients

Investigators: Helen Clapin, PMH Diabetes and Endocrinology; Prof Elizabeth Davis, PMH Diabetes and Endocrinology; Dr Aveni Haynes, Telethon Kids Institute; Dr Andrew McLean-Tooke, Dept of Clinical Immunology, PMH and Sir Charles Gairdner Hospital; A/Prof Lloyd D'Orsogna, Dept of Clinical Immunology and PathWest, Fiona Stanley Hospital; Pathology & Lab Medicine, UWA, Grant Smith, Telethon Kids Institute

Summary: The incidence of Type 1 Diabetes (T1D) is increasing worldwide by about 3 per cent per year. Human leukocyte antigen (HLA) is the strongest genetic risk factor for T1D and HLA genotypes can be used to categorise the risk of contracting T1D. PMH has HLA genotyping data for most of its patients since 2000 and we will investigate whether the HLA risk profile has changed over time and across demographic and clinical characteristics. If these outcomes are found to be associated with HLA genotype risk, this may help to improve clinical practice through identifying patients at higher risk of developing complications.

Sexual health and intimacy in type 1 diabetes and the impact this has on therapeutic choice

Investigators: Dr Martin de Bock, PMH Diabetes and Endocrinology; Courtney Robertson, Notre Dame University, New South Wales; Dr Ashleigh Lin, Telethon Kids Institute; Dr Lisa Gibson, Telethon Kids Institute; Dr Joey Kaye, Sir Charles Gairdner Hospital; Dr Bu Yeap, Fiona Stanley Hospital; Dr Seng Gan, Royal Perth Hospital

Summary: Treatment of Type 1 Diabetes is unique in that patients must choose between using visible, attached technologies like glucose sensors and insulin pumps or discrete therapy such as insulin pens and glucometers. It is known the uptake of pump and sensor technology is less than 50 per cent in children, and less than 10 per cent in adults. Many young people struggle with body image and forming relationships, and when to "come out" that they have Type 1 Diabetes. Adding technologies like insulin pumps and sensors can make this even more awkward, particularly when establishing a new relationship or becoming intimate. No research to date has looked at the issue of attached visible technology or the concept of third-party observation and how this disruption of body image and privacy can affect the decision on using emerging technologies or how this affects personal relationship formation and intimacy. By exploring these issues we will be better prepared to talk to adolescents and adults about perceptions and reality of diabetes technologies and how this may affect relationship building and intimacy and sexual health.

Identification of factors which impact glycaemic control in non-Caucasian patients with Type 1 diabetes

There is an increasing prevalence of patients with Type 1 Diabetes in Western Australia. Although previously thought to be a disease of the developed world, there has been an increasing incidence of non-Caucasians with Type 1 Diabetes. The education of Type 1 Diabetes is in an Australian context and may not be relevant in a changing demographic population. We know from our clinical practice that although a standard diabetes education is offered to all families at the time of diagnosis, some of our immigrant families continue to struggle with diabetes management. Anecdotally, problems have arisen from language barriers, variations in lifestyle and diet, and understanding of diabetes when attempting to educate patients and families. Variations from the Western lifestyle and diet also present a problem, as the role of carbohydrates, meal times and portion sizes may differ from the standard "norm". We tend to enforce dietary changes which do not align with cultural food habits. This is largely due to the inadequate information we have about the dietary, cultural and religious beliefs of these minority communities.

It is therefore important to explore these potential barriers to the delivery of diabetes education. The project aims to engage the families through interviews which will facilitate open discussion and help understand the barriers to providing culturally appropriate and effective diabetes care. This will guide the clinical team to help formulate a more culturally appropriate approach to diabetes education, ongoing care and ultimately improve the outcomes for these young people with Type 1 Diabetes.

How does exercise modify the genes of patients with type 1 diabetes?

Investigators: Dr Vinutha Shetty, Princess Margaret Hospital, Prof Graham Burge and Prof Karen Lillycrop, University of Southampton, UK. Prof Timothy Jones and Prof Elizabeth Davis, Princess Margaret Hospital, Professor Paul Fournier, University of Western Australia

Summary: Exercise improves the health of individuals with T1D, but may cause low blood sugar which results in reluctance to exercise. It is important to understand how this differs between individuals in order to help them exercise safely. Epigenetics is a new science that explains how genes work and why people differ in the way their body processes glucose. We will use blood samples from T1DM patients exercising at different intensities to measure the responses to DNA methylation of the genes that control glucose metabolism. This project will provide evidence that will help us to determine why differences occur between patients with T1D when they exercise.

 

Developing a smartphone application for studying changes the stress, anxiety and blood glucose levels in adolescents with type 1 diabetes

Investigators: Dr Ashleigh Lin, Telethon Kids Institute, Dr Daniel Rudaizky, UWA, Prof Timothy Jones and Professor Elizabeth Davis, Princess Margaret Hospital

Summary: Stress and anxiety are significant problems in children and adolescents in T1D because they impact quality of life, wellbeing and glycaemic control. Our understanding of the link between stress, anxiety and blood glucose levels (BGL) in youth with T1D is limited. This is because emotional states and BGL both fluctuate greatly over time and traditional measurements do not capture these fluctuations. We will be able to examine moment-to-moment associations between stress, anxiety and BGL using a mobile smartphone ‘App’ in combination with continuous glucose monitoring (CGM) technology. The findings from this study will help in the development of a mobile intervention to identify and treat stress and anxiety, designed specifically for people with T1D and could significantly improve mental health and wellbeing of people with T1D.

Economic evaluation of insulin pump therapy among children in Western Australia

Investigators: Natrisha Barnett, University of Western Australia, Professor Liz Geelhoed, University of Western Australia, Mr Alan Brnabic, biostatiscian

 

Summary: Although sensor-augmented technology has been found to significantly improve glycaemic control and health outcomes, the costs of non-subsidised consumables (sensors) are prohibitive for the majority of privately insured and non-insured patients. This project will combine standard economic evaluation and interviews, the health system perspective will be complemented with dollar-values of the patient’s preferences or ‘willingness-to-pay’ and benefits to society. Upon completion of the project, final economic evaluations aim to demonstrate cost-effectiveness, providing a clear argument for subsidisation to improve treatment access and long-term health outcomes for children living with the condition in Western Australia.

For general inquiries including collaborations, please contact senior program manager Tanyana Jackiewicz:

Phone: (08) 6456 4616
Email: tanyana.jackiewicz@health.wa.gov.au

Postal address

Children's Diabetes Centre
Telethon Kids Institute
PO Box 855
West Perth Western Australia 6872
Australia