General Comments

In 2012 – ANDIAB2 collected and benchmarked data that were more Education Centre and Patient Self-care focused than the more ‘Medically’ focused ANDIAB. Twenty four NADC member Diabetes Centres participated. Data were provided for assessment on 1892 individuals [with similar demographic findings to those in ANDIAB 2011 [4.2 & Table 2 Page 7] – although there were some differences with [for instance] over one quarter initial visit patients (27.3% versus 13.5% ANDIAB 2011) and 6.7% (versus 1.8%) having GDM.

Missing Data

There were minimal missing data [4.10 Page 18 & Table 15 Page 19]. In ANDIAB2 42.0% of the data items were less than 5% missing. Whilst this is not as impressive as was ANDIAB2 2010 [53.7%], it is still far superior to ANDIAB 2011, where only 13.9% of the data items were less than 20% missing. Whilst much of the ANDIAB 2011 missing data relate to Fields such as Eye Data, which may not be readily available to the Clinician, there would appear no doubt that the ANDIAB2 completeness of data collection is a testament to the diligence of those who participated [including the individuals themselves in completing the EQ-5D and DDS components]. Sites were given an opportunity to supply any missing data and to validate questionable data. Table 15[a] Page 18 shows the Missing ‘Vital’ Data items obtained by requesting their provision from sites – with quite substantial improvements noted.

Limitations of ANDIAB2

No option to indicate Injectable Incretin use
We did not alter the Diabetes Treatment data item options to include the ability to indicate Byetta use. This was an unintended oversight.

High numbers of Initial Visit Individuals
There were a quarter of the patients [27.3%] for whom this was an initial visit and the possibility exists that the reduced prevalence findings for many of the items assessed may in some part be related to no [or minimal] previous diabetes education [or possibly no recent educational contact for individuals with longer diabetes duration] – even though overall 73.5% of individuals reported having seen a Diabetes Educator within the last 12 months. To assess this further we looked at duration of diabetes, initial visit data and whether individuals had seen a Diabetes Educator in the last 12 months - Table 17[a] {complete data available for 1792 of the 1892 individuals [94.7%]}. Overall three quarters or more of the individuals had seen an Educator [DE] in the last 12 months irrespective of duration [but decreasing with increasing duration]. As regards the recently diagnosed, where analysis shows this represented 19.6% of individuals, that for 38.9% of them this was an initial visit, and that just over half [56.2%] had already seen an Educator. Of those with longer diabetes duration – half or more initial visit individuals {43.9% only for 2-5 years duration} and 78.9 to 90.0% of non-initial visit individuals - had seen an Educator in the last 12 months. It is thus more likely that the reduced prevalence findings for the self-care items assessed, are true ‘deficiencies’ in self-care and less likely due to no or minimal education, or to education undertaken some time ago.

Table 17[a] 2010 & 2012 Duration: Initial Visit: Seen by Educator last 12 Mths


Duration2010 n2010%2010 DE
last 12mths
2010
Initial Visit
= Yes
2010 DE
last
12mths
2010
Initial Visit
= No
2010 DE
last
12mths
<134816.9%71.3%46.8%50.3%53.2%89.7%
1-2844.1%72.6%27.4%65.2%72.6%75.4%
2-521210.3%68.9%30.2%48.4%69.8%77.7%
5-1041120.0%69.3%23.6%58.8%76.4%72.6%
10+100148.7%69.2%16.5%58.8%83.5%71.3%
Duration2012 n2012%2012 DE
last 12mths
2012
Initial Visit
= Yes
2012 DE
last
12mths
2012
Initial Visit
= No
2012 DE
last
12mths
<135219.6%81.3%38.9%56.2%61.1%97.2%
1-2703.9%81.4%28.6%60.0%71.4%90.0%
2-523012.8%72.2%28.7%43.9%71.3%83.5%
5-1033318.6%75.1%24.9%55.4%75.1%81.6%
10+80745.0%74.5%19.0%55.6%81.0%78.9%

The same analysis in ANDIAB2 2005 is presented in Table 17[b], with very similar findings.

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Table 17[b] 2005 Duration: Initial Visit: Seen by Educator last 12 Months.

Duration2005
n
2005%2005 DE
last 12mth
2005 Initial
Visit = Yes
2005 DE
last 12mth
2005 Initial
Visit = No
2005 DE
last 12mths
<138828.7%78.1%41.0%51.6%59.0%96.5%
1-2644.7%70.3%20.3%69.2%79.7%70.6%
2-516212.0%66.7%19.1%41.9%80.9%72.5%
5-1028120.8%67.3%16.4%54.3%83.6%69.8%
10+45833.9%64.6%16.2%50.0%83.8%67.4%

A similar analysis to that in Table 17[a] is presented in Table 17[c], showing data re ‘seen by Dietitian in the last 12 months’. The patterns are similar across duration categories, although fewer individuals had seen a Dietitian compared with a Diabetes Educator.

Table 17[c] 2010 & 2012 Duration: Initial Visit: Seen by Dietitian last 12 Mths


Duration2010 n2010%2010
Dietitian
last
12mths
2010
Initial
Visit =
Yes
2010
Dietitian
last
12mths
2010
Initial
Visit =
No
2010
Dietitian
last
12mths
<134817.0%62.6%47.1%42.7%52.9%80.4%
1-2844.1%59.5%27.4%47.8%72.6%63.9%
2-521010.3%46.2%30.0%38.1%70.0%49.7%
5-1040920.0%51.6%23.7%43.3%76.3%54.2%
10+99348.6%47.1%16.4%45.4%83.6%47.5%
Duration2012 n2012%2012
Dietitian
last
12mths
2012
Initial
Visit =
Yes
2012
Dietitian
last
12mths
2012
Initial
Visit =
No
2012
Dietitian
last
12mths
<134919.5%64.5%39.0%36.8%61.0%82.2%
1-2703.9%54.3%28.6%40.0%71.4%60.0%
2-523213.0%44.4%28.9%25.4%71.1%52.1%
5-1033218.6%41.6%25.0%26.5%75.0%46.6%
10+80645.1%44.4%19.1%32.5%80.9%47.2%

Some sites provided data on small numbers of individuals
This fact is always of concern regarding the reliability of the data provided being representative of the individuals seen at a particular Diabetes Centre. The Mean and Median number of individual forms provided by sites in ANDIAB2 2012 [79 and 85 respectively (range 14-154)] suggests a reasonable spread – and indeed 5 sites had 100 or more forms. Four sites had less than 50 however - with three of these less than 40. Notwithstanding this, the pooled data are similar in demographic characteristics to the last ANDIAB collection in 2011 as noted above [Page 7 and Table 2]. It is therefore not considered that small ‘non-representative’ numbers have adversely affected interpretation of the pooled data as reported here.

Over one third of Sites withdrew
Over one third of Sites who indicated they wished to participate, in fact withdrew and did not proceed with ANDIAB2 2012, after initially indicating an intention to participate and having been forwarded paperwork to enable them to do so. It should be noted that in 2012 the Secretariat function moved from the ADEA Office in Canberra to the ADS Office in Sydney and this move took 9 weeks, causing an over 3 month gap between distributing invitations to participate and being able to distribute the papers to enable sites to commence. It is unknown why any of the 13 sites that withdrew did so – but it is impossible not to speculate that this delay was a contributing factor for many or if not most.

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Strengths of ANDIAB2

Geographical spread; significant patient numbers
A total of twenty four sites participated from across the country, but predominantly from the east coast: [NSW 7; VIC 6; QLD 5; TAS 2; WA 1; SA 1; ACT 1; NT 1]. De-identified data were provided from 1892 individuals.

Data completeness and correctness
‘Validation Reports’ generated for each Centre requesting missing data and correction of questionable or potentially invalid data were addressed and returned by all but four of the twenty four sites. This means that most sites have done their upmost to ensure data completeness and correctness, enhancing the reliability of the findings.

Presentation of the Data

The following Abstracts (next page), [representing analyses of data from ANDIAB2 2010], [Figures 2 & 3], were submitted and accepted as Oral Presentations at the 2011 ADS/ADEA Annual Scientific Meeting and were published in the Proceedings: Australian Diabetes Educators Association Meeting, Perth, 31st August – 2nd September 2011; Abstract 117, page 112 and Abstract 118, page 113 respectively. Regrettably, despite these presentations and a direct approach to the ADEA Board, nothing was done to address these findings.

Figure 2

Diabetes Self-Care Practices Fall Short Of Recommendations: Results From ANDIAB2 2010
Jeff R. Flack1, Stephen Colagiuri2 , on behalf of the NADC
1 Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Bankstown, NSW.
2 Boden Institute of Obesity, Nutrition and Exercise, Sydney University, Sydney, NSW, Australia

Background: There has long been a perceived need for a more ‘education and patient self-care’ focused initiative than the more ‘medically’ focused ANDIAB. After a successful pilot in 2005, ANDIAB21 was undertaken in 2010.

Aim: To assess patient self-report of selected diabetes self-care practices in ANDIAB2. Methods: Participating NADC member Diabetes Centres completed a one-page scannable form of demographic, clinical and self-care practice items on patients seen over one month (April/May 2010). Results: Data from 27 sites from across Australia (except SA; NT) were provided for assessment on 2131 individuals. Mean + SD age was 53.6 ± 17.6 years, diabetes duration 11.5 ± 10.8 years, with 50.4% male and ‘Initial Visit’ 25.6%. Diabetes Type: Type1 27.5%; Type2 67.3%; GDM 3.7%; Other 0.7%; Unstated 0.2%. Significant self-care practice findings were:
  • ‘Adequacy of Physical Activity’ was adjudged as ‘sufficient’ in only 44.0%;
  • Only 65.4% of individuals ‘Carry Identification’ indicating that they have diabetes;
  • Only 60.4% of those on insulin or sulphonylureas ‘Carry Hypoglycaemia Therapy’;
  • Only 60.8% [80.0% of Type1 individuals] had ‘Told the Traffic Authority’ they had diabetes (64.6% of those on therapy other than diet). These data exclude those who do not drive;
  • 7.2% do not ‘Always take all of their medicines as prescribed’;
  • Whilst 27.8% admitted to ‘Use of Complimentary Medicines’, most (82.5%) had informed their Doctor.
Summary: Overall several areas of patient self-care were identified as deficient; areas where strategies could be developed and targeted, especially Carrying Identification; Carrying Hypoglycaemia Therapy; Informing Traffic Authority.

Conclusions: We conclude that ANDIAB2 was successful and forms the basis by which Diabetes Centre care delivery and patient self-care practices can be assessed and monitored. ANDIAB2 identified important aspects of self-care about which to educate/re-educate individuals so that they could potentially improve their health and wellbeing.

Acknowledgement: ANDIAB2 2010 was funded by the Commonwealth Department of Health and Ageing.

Reference: 1. Australian National Diabetes Information Audit & Benchmarking2 [ANDIAB2] 2010. A/Prof Jeff Flack and Prof Stephen Colagiuri on behalf of the National Association of Diabetes Centres

Figure 3

Self-Assessed Health Status: Results From ANDIAB2 2010
Jeff R. Flack1, Stephen Colagiuri2, on behalf of the NADC
1 Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Bankstown, NSW Australia.
2 Boden Institute of Obesity, Nutrition and Exercise, Sydney University, Sydney, NSW, Australia.
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Background: ANDIAB2 is more ‘education and patient self-care’ focused than the more ‘medically’ focused ANDIAB quality audit initiative. Following the successful 2005 pilot, ANDIAB21 was undertaken in 2010.

Aim: To review selfassessed health status in ANDIAB2.

Methods: Participating NADC member Diabetes Centres completed a one-page scannable form of items on patients seen over one month (April/May 2010). Patients completed the EQ-5D Visual Analogue Scale (1-‘worst imaginable’ to 100-‘best imaginable’ health status).

Results: Overall mean + SD age was 53.6±17.6 years, diabetes duration 11.5±10.8 years, with 50.4% male. Diabetes Type: Type1 27.5%; Type2 67.3%; GDM 3.7%; Other 0.7%; Unstated 0.2%. Health status data were provided from 1849 (86.8%) of 2131 individuals from 27 sites from across Australia (except SA; NT). Health status ratings:
  • Were a mean + SD of 63.1+20.5% [on the 0 to 100% scale];
  • Were similar irrespective of Diabetes Type {65.6% T1DM: 62.0% T2DM: 64.0% GDM [n= 508, 1266 and 43 respectively]};
  • Decreased with increasing age in T1DM but increased with increasing age in T2DM from 58.4+23.9% (age 16-35) to 64.4+21.2% (age 66+);
  • Decreased with increasing medication use in T2DM individuals in 2005 and 2010 (Table):

Diabetes Management
Method
2005 n=1405

Type 2

Mean±SD

2005 n=1405

Type 2

n

2010 n=2131

Type 2

Mean±SD

2010 n=2131

Type 2

n

Diet Only74.4±20.819466.4±23.2121
Tablets70.0±18.950063.5±21.0534
Insulin68.3±22.013157.7±20.5230
Insulin and Tablets65.2±22.623961.2±20.8541
Nil-060.0±14.13

Summary: These results were all lower than those reported in ANDIAB2 2005 and in DiabCo$t9. The increase with age in T2DM was not seen in DiabCo$t. Conclusions: We conclude that individuals with diabetes attending Diabetes Centres across Australia rate their health status lower than in previous such assessments, and considerably worse than that reported for non-diabetic individuals. Acknowledgement: ANDIAB2 2010 was funded by the Commonwealth Department of Health and Ageing. References: 1. ANDIAB2 2010. 2. DiabCo$t Australia: Assessing the burden of Type 2 Diabetes in Australia, Diabetes Australia, Canberra, December, 2003. Colagiuri S, Colagiuri R, Conway B, Grainger D, Davey P.