The Australian National Diabetes Information Audit and Benchmarking [ANDIAB] is now a well established initiative that provides a platform within which Diabetes Service Providers [Diabetes Centres and Specialist Endocrinologists] can submit a standardised data set of items [with specific definitions]1,6 on patients with diabetes attending their Centre / Practice. ANDIAB collects demographic, clinical, biomedical, investigation and outcomes data that could be reasonably expected to be collected at least annually on every person with diabetes being assessed by a health professional or team. The data are collected in a deidentified fashion through a trusted third party and are collated and cleaned [verified & validated] thence analysed and reported through a variety of standardised report formats that enable sites to benchmark their Process and Outcomes data against other Centres / Specialists. ANDIAB collections have been undertaken in 1998 [Pilot], 1999, 2000 thence bi-ennially in 2002, 2004, 2006, thence 2009 and again in 20112. The format has been utilised to benchmark General Practice Diabetes data [2000 and 2003] and Diabetes in Pregnancy / GDM data [Pilot 2004 and 2006]. An ANDIAB Patient Follow-up audit was undertaken in 20033. Funded by a 2004 ADS-Servier National Action Plan Grant, we piloted ANDIAB24 in 2005 collecting and benchmarking ‘Education and Patient Self-care’ focused data versus the ‘Medically’ focused ANDIAB data. This was repeated as ANDIAB2 20105.

In 2012, funded by the Australian Government Department of Health, ANDIAB2 again collected and benchmarked Education and Patient Self-care focused data similar to the 2005 and 2010 collections. Thirty seven NADC member Diabetes Centres responded to an expression of interest and twenty four participated from all States and Territories: NSW 7; VIC 6; QLD 5; TAS 2; SA 1; WA 1; ACT 1; NT 1.

Data from these 24 sites were provided for assessment on 1892 individuals [with similar demographic findings to those in ANDIAB 2011, [see 4.2 Table 2 Page 7].

Key Findings are summarised below

  • There were 14.4% overall Current Smokers, 76.6% of whom reported they had tried to stop smoking;
  • Of Past Smoker ‘Yes/No’ respondents, 62.2% ‘just stopped’ 20.7% used ‘Nicotine Replacement’ and 16.7% used ‘Medication’;
  • Adequacy of Physical Activity was adjudged as ‘sufficient’ in only 45.7%;
  • Some 57.6% had had a Flu Vaccination and 11.4% a Pneumococcal Vaccination;
  • 38.3% reported ‘difficulties following their prescribed diet’;
  • Of those on Insulin, 11.5% had Lipohypertrophy, 0.9% Lipoatrophy and a further 0.5% had both;
  • 82.7% (87.7% of ‘Yes/No’ respondents) claimed to ‘always take all of their medicines as prescribed’ [therefore at least 17.3% do NOT];
  • In addition, 22.9% actually indicated they DO forget to take their medication – [of these, 46.7% once, 35.1% 2-3 times and 17.6% >3 times per week];
  • Whilst 30.9% admitted to the Use of Complimentary Medicines, most of these [85.8%] stated that they had informed their Doctor;
  • Using the Brief Case Find tool [BCD 1993 Monash University Department of Psychological Medicine], a BCD calculation could be done for 87.4% of individuals [compared with 90.4% of individuals in ANDIAB2 2010]. The reported Likely Depression was 24.2% versus 25.6% in ANDIAB2 2010;
  • The reported Current and Previous Psychiatric Treatment were 6.8% and 20.1% respectively; very similar to data reported in ANDIAB2 2010 (7.2% & 21.4%);
  • A total of 14.7% of all patients were reportedly On Antidepressants – the overwhelming majority being those with Likely [versus Unlikely] Depression as per the BCD [27.9% versus 9.4% respectively – also similar to what was reported in ANDIAB2 2010 (30.8% & 9.1%)];
  • As regards Health Professional Attendance, 62.2% had seen a Specialist and 73.5% a Diabetes Educator in the last 12 months, 46.7% had seen a Dietitian, 47.7% a Podiatrist, and 70.3% had seen either an Ophthalmologist or Optometrist or both. Relatively few had seen a Psychologist, Social Worker or Exercise Physiologist.

Patient self-assessed heath status was measured using the Visual Analogue Scale of the EQ-5D as was used in 2005 and 2010, and the Diabetes Distress Scale [DDS] instrument as used in 2010 [See 4.9 Pages 12-17 and Tables 12-14[b] for detailed explanation]. Of note: ‘Own Health Status’ rating was 64.4 (max rating 100) and similar for both Type 1 and Type 2, (although higher for GDM 72.7) [See Table 12 Page 13].

ANDIAB2 has thus built on the successful, well-established ANDIAB initiative, and the 2005 Pilot and 2010 collections, and has provided data on individuals attending Specialist Diabetes Services that were not previously available. We believe that this initiative has been successful on several fronts:
  • There were very little missing data compared with ANDIAB 2011 and whilst much of the ANDIAB 2011 missing data relate to Fields such as Eye Data which may not be 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 DDS component];
  • Each site received an individual report benchmarking their findings against others from which they can identify areas of service or patient self-care that may be deficient, and for which changes or educational strategies may need to be instituted;
  • Some general observations [and potential points for intervention] on the findings listed above include:
    • It is noteworthy that of the 14.4% current smokers – over 76% claimed to have tried to cease (and they may be amenable to further attempts to assist them to quit);
    • Physical Activity was adjudged as ‘sufficient’ in only 45.7%;
    • Over 17.3% admitted to NOT taking all of their prescribed medications and 22.9% admitting to forgetting to take medications;
    • Many [85.8%], but not all, of the 30.9% who admitted to the Use of Complimentary Medicines, stated that they had informed their Doctor of this fact;
    • Overall the survey also identified several areas of patient self-care as deficient, and where strategies could be developed to target and address these areas: [Smoking Cessation, Exercise and Medication Adherence];
    • Additionally, there was significant ‘Likely Depression’ (24.2%) and ‘Diabetes Distress’ identified by the BCD & DDS Scale: (Tables 13, 14[a]-[d] Pages 15-17).

Conclusions

We conclude that ANDIAB2 has been successful and forms the basis by which Diabetes Centre Care Delivery and Patient Self-care practices can be assessed and monitored. Diligence is recommended in assessing areas such as those highlighted in this Report, which should assist in identifying important aspects of self-care about which to educate / re-educate individuals so that they could potentially improve their health and well-being.

Recommendations

This format and these data items could be utilised for an ongoing quality audit activity in Diabetes Centres fulfilling the NADC desire to establish an Audit Program to be run in alternate years to ANDIAB which is more Patient / Education focused.

It is strongly recommended that NADC consider an Educational Initiative of Local and/or National strategies to attempt to address some of the deficiencies and problems noted in this report: Smoking Cessation, Exercise & Medication Adherence, and ‘Likely Depression’.

There are Findings here (as there were in 2010) that warrant educational initiatives to address.

Acknowledgement

ANDIAB2 2012 was funded by the Australian Government Department of Health and Ageing.


1. Diabetes data set (clinical) [National Health Data Dictionary {NHDD}]
National Health Data Committee 2003. Other Data Set Specification, Diabetes (clinical), National Health Data Dictionary. Version 12. AIHW cat. No. HWI 47. Canberra: Australian Institute of Health and Welfare.
2. Australian National Diabetes Information Audit & Benchmarking [ANDIAB] 2011. A/Prof Jeff Flack & Prof Stephen Colagiuri on behalf of the National Association of Diabetes Centres.
3. Pilot NADC ANDIAB patient Review Project 2004 [Follow-Up Data 2000 to 2003]. J R Flack and S Colagiuri on behalf of the National Association of Diabetes Centres. Final Report, June 2004.
4. Quality Assurance Of Patient Practices And Diabetes Centre Care: ANDIAB 2. A/Prof Jeff Flack & Prof Stephen Colagiuri on behalf of the National Association of Diabetes Centres Final Report, September 2006.
5. Quality Assurance Of Patient Practices And Diabetes Centre Care: ANDIAB2 2010. A/Prof Jeff Flack and Prof Stephen Colagiuri on behalf of the National Association of Diabetes Centres Final Report, September 2010.
6. Metadata Online Registry [‘METeOR’] - Diabetes (clinical) Data Set Specification. [see AIHW website]


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