ORCID Profile
0000-0002-3640-1370
Current Organisations
Sage Bionetworks
,
Western Sydney Local Health District
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Publisher: American Diabetes Association
Date: 06-12-2022
DOI: 10.2337/DC21-1666
Abstract: Continuous glucose monitoring (CGM) is increasingly used in type 1 diabetes management however, funding models vary. This study determined the uptake rate and glycemic outcomes following a change in national health policy to introduce universal subsidized CGM funding for people with type 1 diabetes aged & years. Longitudinal data from 12 months before the subsidy until 24 months after were analyzed. Measures and outcomes included age, diabetes duration, HbA1c, episodes of diabetic ketoacidosis and severe hypoglycemia, insulin regimen, CGM uptake, and percentage CGM use. Two data sources were used: the Australasian Diabetes Database Network (ADDN) registry (a prospective diabetes database) and the National Diabetes Service Scheme (NDSS) registry that includes almost all in iduals with type 1 diabetes nationally. CGM uptake increased from 5% presubsidy to 79% after 2 years. After CGM introduction, the odds ratio (OR) of achieving the HbA1c target of & .0% improved at 12 months (OR 2.5, P & 0.001) and was maintained at 24 months (OR 2.3, P & 0.001). The OR for suboptimal glycemic control (HbA1c ≥9.0%) decreased to 0.34 (P & 0.001) at 24 months. Of CGM users, 65% used CGM & % of time, and had a lower HbA1c at 24 months compared with those with usage & % (7.8 ± 1.3% vs. 8.6 ± 1.8%, respectively, P & 0.001). Diabetic ketoacidosis was also reduced in this group (incidence rate ratio 0.49, 95% CI 0.33–0.74, P & 0.001). Following the national subsidy, CGM use was high and associated with sustained improvement in glycemic control. This information will inform economic analyses and future policy and serve as a model of evaluation diabetes technologies.
Publisher: Wiley
Date: 23-08-2023
DOI: 10.1111/DME.15195
Abstract: To examine the psychometric properties of the Diabetes Management Experiences Questionnaire (DME‐Q). Adapted from the validated Glucose Monitoring Experiences Questionnaire, the DME‐Q captures satisfaction with diabetes management irrespective of treatment modalities. The DME‐Q was completed by adults with type 1 diabetes as part of a randomized controlled trial comparing hybrid closed loop (HCL) to standard therapy. Most psychometric properties were examined with pre‐randomization data ( n = 149) responsiveness was examined using baseline and 26‐week follow‐up data ( n = 120). Pre‐randomization, participants' mean age was 44 ± 12 years, 52% were women. HbA1c was 61 ± 11 mmol/mol (7.8 ± 1.0%), diabetes duration was 24 ± 12 years and 47% used an insulin pump prior to the trial. A forced three‐factor analysis revealed three expected domains, that is, ‘Convenience’, ‘Effectiveness’ and ‘Intrusiveness’, and a forced one‐factor solution was also satisfactory. Internal consistency reliability was strong for the three subscales ( range = 0.74–0.84) and ‘Total satisfaction’ = 0.85). Convergent validity was demonstrated with moderate correlations between DME‐Q ‘Total satisfaction’ and diabetes distress (PAID: r s = −0.57) and treatment satisfaction (DTSQ r s = 0.58). Divergent validity was demonstrated with a weak correlation with prospective/retrospective memory (PRMQ: r s = −0.16 and − 0.13 respectively). Responsiveness was demonstrated, as participants randomized to HCL had higher ‘Effectiveness’ and ‘Total satisfaction’ scores than those randomized to standard therapy. The 22‐item DME‐Q is a brief, acceptable, reliable measure with satisfactory structural and construct validity, which is responsive to intervention. The DME‐Q is likely to be useful for evaluation of new pharmaceutical agents and technologies in research and clinical settings.
Publisher: Springer Science and Business Media LLC
Date: 28-01-2022
DOI: 10.1007/S00223-021-00935-Z
Abstract: Central giant cell granuloma (CGCG) is a rare lesion of the jaw occurring in young adults and adolescents. Surgery, the traditional mainstay of therapy, is associated with significant morbidity. Denosumab, a humanised monoclonal antibody to RANKL, is effective in a related entity, giant cell tumour of bone (GCTB), but experience in the more indolent CGCG is limited. This prospective observational study of all denosumab-treated CGCG at a tertiary referral centre (2015-2021) aimed to evaluate the safety, efficacy and recurrence risk using denosumab in CGCG at lower-frequency dosing than used for GCTB. All received standardised, time-limited courses of denosumab 120 mg with stepwise increase in dosing interval based on response. They were followed for up to 75 months using a radiation-minimising protocol: 3-monthly clinical, biochemical and radiological assessment (orthopantomograms, cone beam CT). Eight patients, median age 20.5 years [IQR 6], received 13 initial doses [IQR 10] of denosumab 120 mg. Radiologic response was seen after 5.5 doses [IQR 4.5]: ossification in all and size reduction in three. Recurrence occurred in four of seven completing therapy, observed 12 months post-cessation [IQR 6.5]. Larger baseline size, aggressive subtype and fewer than 12 initial doses were more common in the recurrence group. There was no osteonecrosis of the jaw. Hypocalcaemia occurred in one receiving modified dosing. This study represents the largest, most erse cohort of denosumab-treated CGCG with the longest follow-up in literature. It demonstrates the efficacy of lower-frequency, time-restricted course of denosumab but highlights the risk of recurrence. Long-term follow-up is critical.
Publisher: Wiley
Date: 09-09-2021
DOI: 10.1002/EDM2.295
Abstract: To determine advantages conferred by a youth‐specific transition clinic model for young adults with type 1 diabetes (T1D) at Westmead Hospital (WH) as compared with Australian registry data. Prospectively collected data included age, diabetes duration, visit frequency, post code, BMI, mode of insulin delivery, continuous glucose monitoring, HbA1c, albumin creatinine ratio, BP, retinopathy and diabetic ketoacidosis (DKA) for all WH T1D clinic attendees aged 16–25 between January 2017 and June 2018 ( n = 269). Results were compared with data collected during the same time period from 2 separate Australian data registries, one longitudinal (Australasian Diabetes Data Network, ADDN) and one a spot survey (the Australian National Diabetes Audit, ANDA). Across the three cohorts, HbA1c was similar (respectively, WH, ADDN, ANDA 8.7%[72mmol/mol], 8.7%[72mmol/mol], 8.5%[69mmol/mol]) and HbA1c was significantly higher in young adults years (8.7–8.9%[73‐75mmol/mol]) as compared with ≥21 years (8.5%[69mmol/mol], p .002). In the WH cohort, median interval between visits was shorter than in ADDN (4.5 vs. 9.0 months) and DKA was lower (respectively, 3.6 and 9.2/100 patient years p .001). While suboptimal HbA1c was recorded in all centres, the WH model of care saw increased attendance and reduced admissions with DKA as compared with other Australian adult centres.
Publisher: Wiley
Date: 16-04-2021
DOI: 10.1111/DME.14564
Abstract: Insulin resistance is an under-recognised metabolic defect and cardiovascular risk factor in Type 1 diabetes. Whether metformin improves hepatic, muscle or adipose tissue insulin sensitivity has not been studied in adults with Type 1 diabetes. We initiated the INTIMET study (INsulin resistance in Type 1 diabetes managed with METformin), a double-blind randomised, placebo-controlled trial to measure the effect of metformin on tissue-specific insulin resistance in adults with Type 1 diabetes. We will study 40 adults aged 20-55 years with Type 1 diabetes (HbA1c The INTIMET study is the first clinical trial to quantify the impact of metformin on liver, muscle and adipose insulin resistance in adults with Type 1 diabetes. This study may identify factors that predict an in idual's response to metformin in Type 1 diabetes. ACTRN12619001440112.
Publisher: Elsevier BV
Date: 04-2013
Publisher: The Endocrine Society
Date: 17-06-2020
Publisher: Oxford University Press (OUP)
Date: 24-06-2009
DOI: 10.1093/HMG/DDP292
Publisher: Oxford University Press (OUP)
Date: 20-07-2010
DOI: 10.1093/HMG/DDQ287
Publisher: American Diabetes Association
Date: 26-09-2022
DOI: 10.2337/DC22-0951
Abstract: The Continuous Glucose Monitoring (CGM) Initiative recently introduced universal subsidized CGM funding for people with type 1 diabetes under 21 years of age in Australia. We thus aimed to evaluate the cost-effectiveness of this CGM Initiative based on national implementation data and project the economic impact of extending the subsidy to all age-groups. We used a patient-level Markov model to simulate disease progression for young people with type 1 diabetes and compared government-subsidized access to CGM with the previous user-funded system. Three years of real-world clinical input data were sourced from analysis of the Australasian Diabetes Data Network and National Diabetes Services Scheme registries. Costs were considered from the Australian health care system’s perspective. An annual discount rate of 5% was applied to future costs and outcomes. Uncertainty was evaluated with probabilistic and deterministic sensitivity analyses. Government-subsidized CGM funding for young people with type 1 diabetes compared with a completely user-funded model resulted in an incremental cost-effectiveness ratio (ICER) of AUD 39,518 per quality-adjusted life-year (QALY) gained. Most simulations (85%) were below the commonly accepted willingness-to-pay threshold of AUD 50,000 per QALY gained in Australia. Sensitivity analyses indicated that base-case results were robust, though strongly impacted by the cost of CGM devices. Extending the CGM Initiative throughout adulthood resulted in an ICER of AUD 34,890 per QALY gained. Providing subsidized access to CGM for people with type 1 diabetes was found to be cost-effective compared with a completely user-funded model in Australia.
Publisher: AMPCo
Date: 28-02-2021
DOI: 10.5694/MJA2.50946
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.TEM.2019.11.007
Abstract: In iduals with type 1 diabetes (T1D) frequently fail to achieve glycemic goals and have excess cardiovascular risk and premature death. Adjunctive agents may play a role in reducing morbidity, mortality, and the adverse sequelae of insulin treatment. A surge in type 2 diabetes drug development has revealed agents with benefits beyond glucose lowering, including cardiovascular risk reduction. Could these benefits translate to T1D? Specific trials for T1D demonstrate substantial hemoglobin (Hb)A1c reductions with sodium glucose cotransporter inhibitors (SGLTis) and glucagon-like peptide (GLP)1 agonists, and modest improvements with metformin, dipeptidyl peptidase-4 inhibitor (DPP4i), and pramlintide. Studies exploring cardiovascular risk reduction are warranted. This review synthesizes the emerging literature for researchers and clinicians treating people with T1D. Challenges in T1D research are discussed.
Publisher: American Diabetes Association
Date: 12-2022
DOI: 10.2337/DC22-0853
Abstract: The relationship between diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes and long-term glycemic control varies between studies. We aimed, firstly, to characterize the association of DKA and its severity with long-term HbA1c in a large contemporary cohort, and secondly, to identify other independent determinants of long-term HbA1c. Participants were 7,961 children and young adults diagnosed with type 1 diabetes by age 30 years from 2000 to 2019 and followed prospectively in the Australasian Diabetes Data Network (ADDN) until 31 December 2020. Linear mixed-effect models related variables to HbA1c. DKA at diagnosis was present in 2,647 participants (33.2%). Over a median 5.6 (interquartile range 3.2, 9.4) years of follow-up, participants with severe, but not moderate or mild, DKA at diagnosis had a higher mean HbA1c (+0.23%, 95% CI 0.11,0.28 [+2.5 mmol/mol, 95% CI 1.4,3.6] P & 0.001) compared with those without DKA. Use of continuous subcutaneous insulin infusion (CSII) was independently associated with a lower HbA1c (−0.28%, 95% CI −0.31, −0.25 [−3.1 mmol/mol, 95% CI −3.4, −2.8] P & 0.001) than multiple daily injections, and CSII use interacted with severe DKA to lower predicted HbA1c. Indigenous status was associated with higher HbA1c (+1.37%, 95% CI 1.15, 1.59 [+15.0 mmol/mol, 95% CI 12.6, 17.4] P & 0.001), as was residing in postcodes of lower socioeconomic status (most vs. least disadvantaged quintile +0.43%, 95% CI 0.34, 0.52 [+4.7 mmol/mol, 95% CI 3.4, 5.6] P & 0.001). Severe, but not mild or moderate, DKA at diagnosis was associated with a marginally higher HbA1c over time, an effect that was modified by use of CSII. Indigenous status and lower socioeconomic status were independently associated with higher long-term HbA1c.
Publisher: Wiley
Date: 14-10-2019
DOI: 10.1111/CEN.14083
Publisher: Wiley
Date: 04-2018
DOI: 10.1111/IMJ.13649
Abstract: Management of type 1 diabetes mellitus in youth with diabetes (YWD) is complex, and glycaemic control often deteriorates during this challenging period. We hypothesise that attendance at a youth-specific diabetes clinic reduces hospital admission rates and length of stay (LOS) for diabetic ketoacidosis (DKA). To assess the impact of a youth-specific diabetes service for YWD on DKA admissions in two adjacent local health districts. A retrospective cohort analysis of admissions for DKA in YWD aged 15-25 years, presenting to four hospitals in Western Sydney in 2011 was performed. Number of admissions, LOS and DKA severity were assessed. Cost was analysed as a function of LOS. Groups were ided by attendance at a youth-specific diabetes service and no record of attendance. There were 55 DKA admissions from 39 patients (median age 20.0 years) the majority of admissions (82%) was YWD not supported by a youth-specific diabetes service. Median LOS was significantly longer in the unsupported group (3.0 vs 1.5 days, P = 0.028). Median pH at presentation in the unsupported group was significantly lower, 7.11 versus 7.23 (P = 0.05). The admission rate was four times greater for those not supported by youth-specific diabetes services, 5.5% compared with 1.6% (P = 0.001). The estimated cost saved by youth-specific services was over $250,000 pa. Lack of access to supported care for YWD during transition from paediatric to adult care has an adverse impact on subsequent DKA admission rates and LOS.
Publisher: F1000 Research Ltd
Date: 08-08-2023
DOI: 10.12688/WELLCOMEOPENRES.19383.1
Abstract: Background : The global ubiquity of smartphone use among young people makes them excellent candidates for collecting data about in iduals’ lived experiences and their relationships to mental health. However, to-date most app-based studies have been conducted in North America and Europe. Understanding young people’s willingness to participate in app-based research and share information about their mental health is key to understanding the feasibility of broad-scale research using these approaches. We aimed to understand the recruitment and engagement approaches influencing young peoples’ (aged 16-24) participation in app-based studies of mental health. We hypothesised that providing a choice of study topics will improve engagement. Methods : We developed a 12-week pilot study of mental health implemented in the MindKind app, designed to assess participants’ willingness to engage in remote mental health research, both actively and passively. Enrollees were randomised to one of two different engagement arms, either selecting their study topics of interest or receiving a fixed assignment of study topics, in order to understand the role of choice in study engagement. This pilot study was conducted in India, South Africa, and the United Kingdom. Different recruitment strategies were employed in each location. Results : The MindKind Study recruited 1,034 (India), 932 (South Africa) and 1,609 (UK) participants. Engagement differed by country with median days of activity = 2, 6, and 11 for India, South Africa, and UK, respectively. Most surprisingly, participants given a choice of study topics showed lower engagement relative to participants assigned to fixed topics (Hazard Ratio = 0.82). Conclusions : We observe equal or better engagement compared to previous comparable app-based studies of mental health. While providing participants a choice of study topics showed no advantage in our study, our qualitative analysis of participant feedback provides additional suggestions for improving engagement in future studies.
Publisher: American Diabetes Association
Date: 14-10-2020
DOI: 10.2337/DC20-1447
Abstract: To investigate glycemic and psychosocial outcomes with hybrid closed-loop (HCL) versus user-determined insulin dosing with multiple daily injections (MDI) or insulin pump (i.e., standard therapy for most adults with type 1 diabetes). Adults with type 1 diabetes using MDI or insulin pump without continuous glucose monitoring (CGM) were randomized to 26 weeks of HCL (Medtronic 670G) or continuation of current therapy. The primary outcome was masked CGM time in range (TIR 70–180 mg/dL) during the final 3 weeks. Participants were randomized to HCL (n = 61) or control (n = 59). Baseline mean (SD) age was 44.2 (11.7) years, HbA1c was 7.4% (0.9%) (57 [10] mmol/mol), 53% were women, and 51% used MDI. HCL TIR increased from (baseline) 55% (13%) to (26 weeks) 70% (10%) with the control group unchanged: (baseline) 55% (12%) and (26 weeks) 55% (13%) (difference 15% [95% CI 11, 19] P & 0.0001). For HCL, HbA1c was lower (median [95% CI] difference −0.4% [−0.6, −0.2] −4 mmol/mol [−7, −2] P & 0.0001) and diabetes-specific positive well-being was higher (difference 1.2 [95% CI 0.4, 1.9] P & 0.0048) without a deterioration in diabetes distress, perceived sleep quality, or cognition. Seventeen (9 device-related) versus 13 serious adverse events occurred in the HCL and control groups, respectively. In adults with type 1 diabetes, 26 weeks of HCL improved TIR, HbA1c, and their sense of satisfaction from managing their diabetes compared with those continuing with user-determined insulin dosing and self-monitoring of blood glucose. For most people living with type 1 diabetes globally, this trial demonstrates that HCL is feasible, acceptable, and advantageous.
Location: United States of America
No related grants have been discovered for Deborah Jane Holmes-Walker.