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Do vitamin D gene polymorphisms modify the effect of 25(OH)D on type 1 diabetes development?

Investigator: Kate Miller, University of Western Australia/Telethon Kids Institute

Co-investigators: Professor Elizabeth Davis, Perth Children’s Hospital/Telethon Kids Institute; Professor Prue Hart, Telethon Kids Institute; Ace Choo, Telethon Kids Institute; Dr Matthew Cooper, Telethon Kids Institute 

Summary: Vitamin D helps to regulate the immune system. Vitamin D deficiency has been linked with several autoimmune diseases, including type 1 diabetes. In our recent study, we found that children who were vitamin D deficient were diagnosed with type 1 diabetes at a younger age compared with children who were vitamin D sufficient and more likely to be admitted with diabetes ketoacidosis at the time of diagnosis. The active form of vitamin D exerts its effects by attaching to a protein called vitamin D receptor (VDR). The gene that provides instructions for making VDR is called the VDR gene. Minor variations in DNA components of the VDR gene can alter how effectively the VDR protein works. Children who are diagnosed with type 1 diabetes at the Perth Children’s Hospital can consent to providing blood samples for genetic research. In this study, we propose to use these samples, in combination with data from our previous study, to investigate whether variations in the VDR gene alter the association we have observed between vitamin D status and age of onset and the severity of presentation of type 1 diabetes. In the absence of a cure for type 1 diabetes, this study will help us to understand whether we can delay onset in children at risk of vitamin D deficiency and type 1 diabetes. 

What do children and adolescents with type 1 diabetes in Western Australia eat?

Investigator: Megan Evans, Perth Children’s Hospital

Co-investigators: Katherine Lancaster, Perth Children’s Hospital; Katherine Singh, Perth Children’s Hospital; Natalie Cordon, Perth Children’s Hospital

Summary:This project will provide detailed information on the dietary intake of children and adolescents with Type 1 Diabetes Mellitus (T1D) in WA. This information will allow dietitians within the Diabetes clinic team at PCH to review areas of need and alter services as required, to ensure that families have the information and skills needed to provide their children with energy and nutrient intakes for optimal growth and development.

Making friends with yourself: piloting a self-compassion program to promote physical and psychological wellbeing in youth with type 1 diabetes

Investigator: Dr Amy Finlay-Jones, Telethon Kids Institute

Co-investigators: Dr Keely Bebbington, Telethon Kids Institute; Assoc Professor Ashleigh Lin, Telethon Kids Institute; Assoc Professor Karen Bluth; University of North Carolina at Chapel Hill

Summary:Adolescents with type 1 diabetes (T1D) are at greater risk for poor mental health outcomes, relative to their peers without T1D. In turn, poor mental health can undermine self-management and contribute to worse clinical outcomes. As a result, programs designed to promote resilience and improve psychological wellbeing are a priority for T1D research. The Making Friends with Yourself (MFY) program is a strengths-based intervention which aims to help young people be kinder to themselves through self-compassion training. Self-compassion training has been shown to very successfully reduce diabetes-related distress, depression and improve metabolic outcomes in adults with T1D. However, to date the efficacy and acceptability of this intervention for adolescents with T1D is unknown. The aim of this project is to determine the capacity of a self-compassion program to improve psychological resilience and promote health outcomes in adolescents with T1D. To achieve this, we will conduct a pilot study of the MFY program with young people with T1D and measure changes in psychological resilience, metabolic control, self-management behaviours, and quality of life, compared with a waitlist control group.

Improving dyslipidaemia education and awareness in type 1 diabetes (IDEA-T1D)

Investigator: Dr Gerry Fegan, Fiona Stanley Hospital

Co-investigators: Dr Nick Lan, Fiona Stanley Hospital; Professor Bu Yeap, Fiona Stanley Hospital/UWA; Professor Alicia Jenkins, University of Sydney; Professor Gerald Watts, Royal Perth Hospital/UWA

Summary: People with type 1 diabetes tend to have abnormal cholesterol that may lead to narrowed or blocked arteries. This can increase the risk of having a heart attack or a stroke in the future. Lowering cholesterol is important in diabetes because it can reduce the risk of having these complications. However, there are studies showing that young people with type 1 diabetes often have cholesterol levels that are higher than what is currently recommended. This research project aims to identify and address any concerns that doctors and people with type 1 diabetes may have regarding cholesterol lowering and medications for cholesterol. 

The effect of acute hypoxia on the rate of fall in blood glucose levels and carbohydrate oxidation rates during moderate intensity exercise in individuals with type 1 diabetes

Investigator: Cory Dugan, University of Western Australia

Co-investigators: Professor Paul Fournier, UWA/Children’s Diabetes Centre; Dr Vinutha Shetty, Children’s Diabetes Centre/Perth Children’s Hospital (PCH); Professor Elizabeth Davis, Children’s Diabetes Centre/PCH; Professor Tim Jones, Children’s Diabetes Centre/PCH

Summary: Physical activity increases the risk of hypoglycaemia in individuals with type 1 diabetes (T1D). The fear associated with such a risk contributes to a lower participation rate in regular exercise and lower-than-average fitness levels in people with T1D. Several recommendations have been published to reduce such a risk. A major limitation with these recommendations is that they generally overlook the impact some environmental conditions have on the plasma glucose response to exercise. There is indirect evidence that exercise performed under hypoxic conditions, typical of high altitude, may increase the risk of hypoglycaemia in people with T1D. Indeed, past research in people without T1D has shown that their rates of glucose disappearance during physical activity increase significantly in response to acute exposure to hypoxia. No studies have examined the effect of combining altitude exposure and exercise on blood glucose level in individuals with T1D. The primary aim of this study is to test the hypothesis that acute exposure to hypoxia that mimics high altitude increases the rate of fall in blood glucose levels and carbohydrate oxidation rate during exercise in individuals with T1D. The goal of this research is to provide evidence-based recommendations for people with T1D living or travelling to areas of high altitude, with the hope of increasing their safety by decreasing their risk of hypoglycaemia.

Knowledge, attitudes and practices related to the transition of emerging adults with type 1 diabetes from paediatric to adult care in Western Australia

Investigator: Dr Keely Bebbington, Children’s Diabetes Centre, Telethon Kids Institute

Co-investigators: Dr Leanne Fried, Children’s Diabetes Centre/Telethon Kids Institute; Dr Ashleigh Lin, Telethon Kids Institute 

Summary: For emerging adults with type 1 diabetes (T1D) the transition from paediatric to adult healthcare services presents a unique set of challenges. Transition occurs at a stage of immense physiological, emotional and social development and it is now well documented that this population are at elevated risk for psychological disorders than their peers without diabetes. Poor mental health is known to be associated with a reduction in self-management behaviours and worsening glycaemic control. In addition to these challenges, the transition from paediatric to adult healthcare services requires the patient to assume greater autonomy for their diabetes management and to form new relationships with the clinical team, often in unfamiliar surroundings. As a result, many emerging adults disengage with healthcare services during this vulnerable stage, increasing their risk for poor physiological and psychological outcomes. The proposed project will lay the foundation for the development of an intervention to improve outcomes for emerging adults as they transition to adult care.

Piloting a peer mentor program for adolescents with type 1 diabetes and parents

Investigator: Leanne Fried, Telethon Kids Institute

Co-investigators: Professor Donna Cross, Telethon Kids Institute; Rena Vithiatharan, Telethon Kids Institute; Carol Cole, Telethon Kids Institute

Summary: It is well known that adolescents with type 1 (T1D) diabetes can struggle through the adolescent period to maintain psychological wellbeing and stable blood glucose levels. Social support offered through a mentoring program for people with chronic disease has been found to produce health-related and psychosocial benefits for not only the mentees but also the mentors. Given that adolescents highly value the support of peers who share chronic conditions, a mentor program, utilising young adults with T1D as mentors, may offer valuable support to adolescents with T1D. Support for parents may also indirectly enhance the psychosocial wellbeing of adolescents with T1D. This project will provide a foundation for developing a larger scale randomised controlled trial comparing the effect of a mentoring program with another psychosocial intervention for adolescents with T1D.

Effect of swimming and head-out of water immersion in cold water on the risk of hypoglycaemia in type 1 diabetes

Investigator: Kristina Abramoff, University of Western Australia

Co-investigators: Professor Paul Fournier, UWA/Children’s Diabetes Centre; Professor Elizabeth Davis, Princess Margaret Hospital/Telethon Kids Institute; Professor Tim Jones, Princess Margaret Hospital/Telethon Kids Institute

Summary: Physical activity increases the risk of hypoglycaemia in individuals with type 1 diabetes (T1D), with the associated increased fear of hypoglycaemia contributing to their lower participation rates in regular exercise and lower-than-average fitness levels. Several recommendations have been published to reduce hypoglycaemia risk. Unfortunately, these recommendations generally overlook the impact that some environmental conditions may have on blood glucose response to exercise. Since cold water immersion increases glucose oxidation rate and may inhibit the production of glucose by the liver in T1D individuals, this raises the issue of whether upright immersion or swimming in cold water increases hypoglycaemia risk. The primary aims of this proposed research project are to test the hypotheses that head out of water immersion in cold compared to thermoneutral water is associated with a faster rate of fall in blood glucose level; and exercising in cold water causes a greater rate of fall in blood glucose level compared to exercising under thermoneutral conditions.

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

Winner: Sabrina Binkowski, Telethon Kids Institute

Conference: 2019 Australasian Paediatric Endocrine Group Annual Scientific Meeting, Adelaide, Australia

Study presented: Identifying barriers to the management of type 1 diabetes in culturally and linguistic diverse families.


Winner: Kate Miller, University of WA/Telethon Kids Institute

Conference: 2019Australasian Diabetes Conference, Sydney, Australia

Study presented: Investigation on the association between 25 hydroxyvitamin D (25(OH)D) levels at diagnosis and type 1 diabetes risk and among those with type 1 diabetes, severity of disease and age of onset.


Winner: Dr Leanne Fried,Telethon Kids Institute

Conference: 2019International Society for Pediatric and Adolescent Diabetes, Boston, United States

Study presented: A qualitative study of schools that support students with type 1 diabetes.


Winner: Dr Aveni Haynes, Telethon Kids Institute

Conference: 55th Annual Meeting of theEuropean Association for the Study of Diabetes, Barcelona, Spain

Study presented: Why are more children being diagnosed with type 1 diabetes?

Winner: Wayne Soon, Telethon Kids Institute

Conference: 2018 International Society for Pediatric and Adolescent Diabetes (ISPAD), Hyderabad, India

Study presented: Reproducibility of blood glucose responses to exercise performed under similar conditions in type 1 diabetes.


Winner: Dr Aveni Haynes, Telethon Kids Institute

Conference: 2018 International Society for Pediatric and Adolescent Diabetes (ISPAD), Hyderabad, India

Study presented: The prevalence of comorbidities and diabetes-related complications in children diagnosed with diabetes in Western Australia from 2000 - 2017. 


Winner: Joanne O’Dea, Telethon Kids Institute

Conference: 2018 International Society for Pediatric and Adolescent Diabetes (ISPAD), Hyderabad, India

Study presented: a report of the anthropometric and clinical characteristics of our T2D patients at diagnosis.