The University of Melbourne
Austin Health; Melbourne Health; Northern Health; St Vincent’s Health Melbourne
Diabetes is a major contributor to the mortality gap between Indigenous and non-Indigenous Australians. The risk and severity of diabetes complications are far greater in Indigenous than non-Indigenous Australians. We urgently need effective and convenient ways of improving diabetes management in Indigenous Australians, a goal of the National Diabetes Strategy. New technologies that continuously monitor blood glucose are effective in assisting people to improve their blood glucose levels by driving changes in behaviour, lifestyle and therapy. The devices are worn on the arm and provide continuous, real-time feedback on blood glucose levels, but have not been tested in Indigenous Australians. In this study, we will assess the feasibility of using these devices in Indigenous communities and gauge their effect on glucose management including achieving glucose targets, hypoglycaemia episodes and their effects on quality of life.
This project is supported by the Australian Government’s Medical Research Future Fund (MRFF) as part of the Rapid Applied Research Translation program.
The project aimed to assess the feasibility of undertaking a clinical trial of flash glucose monitoring in Indigenous Australians. It also assessed the effects of using flash glucose monitoring on, (i) haemoglobin A1c (HbA1c) and (ii) achieving blood glucose targets and reducing low blood glucose (hypoglycaemic) episodes; and (iii) to determine whether this strategy is cost effective in an Australian Indigenous health setting. Whilst we are still conducting the statistical analysis, the project has provided clear benefits in terms of engagement, access to diabetes technology for the patients and upskill the staff and capacity building for Indigenous Australians with type 2 diabetes at Rumbalara Aboriginal Health Cooperative, Goulburn Valley Health, and Austin Health. Participants in the study have had the opportunity to engage regularly with their health service to monitor their diabetes. This has resulted in improved diabetes care and management facilitated using flash glucose monitors. Bringing the latest technology to those most in need first, rather than to the most affluent, is fundamental in addressing the continued disadvantage experienced by Indigenous Australians. Our trial reflected this as it was the first in Australia to have access to the Freestyle Libre 2 which included alarms and alerts for low and high blood glucose levels. This project upskilled Indigenous nurses, clinic staff including primary care providers and importantly the patients in the use of flash glucose monitoring technology. Forty participants were recruited into the study, with no withdrawals. This reflects the strong engagement and dedication from both participants, healthcare providers and study staff in the trial.
This pilot study was instrumental in obtaining funding for a Clinical Trials and Cohorts Grant funded by the National Health and Medical Research Council (NHMRC) in 2020. The lessons learnt from the pilot study in terms of feasibility, implementation and engagement have been incorporated into the larger multicentre randomised controlled clinical trial which is being conducted at a national level. This pilot study will contribute to the body of evidence needed to incorporate flash glucose monitors in routine clinical care for all Indigenous Australians with type 2 diabetes on injectable therapies. Upon completion of the larger grant, the ongoing impact of this work will be that it is the first clinical trial globally for Indigenous people with type 2 diabetes using flash glucose monitoring. This technology has the potential to transform the management of diabetes and clinical health care deliver in Indigenous Australians.
- Poster: Flash glucose monitoring for Indigenous Australians with type 2 diabetes: a randomised pilot and feasibility study. Eer AS, Hachem M, Hearn T, Rumbiolo D, Jones J, Furler J, Eades S, Braat S, Twigg S, Sinha A, McLean A, Koye D, O’Brien RC, Clarke P, O’Neal D, Story D, Zajac J, Atkinson-Briggs S, Freund M, Brown A, Kelly R, Burchill L, Ekinci EI. Australian Diabetes Congress, Brisbane 2022.
- Poster: Initial experiences of Indigenous Australians with Type 2 Diabetes Mellitus using flash glucose monitoring. Ho R, Eer AS, Hearn T, Hachem M, Freund M, Burchill L, Atkinson-Briggs S, Singh S, Eades S, O’Brien RC, Furler J, O’Neal D, Story D, Zajac J, Braat S, Brown S, Clarke P, Sinha A, McLean A, Twigg S, Ekinci E. Australian Diabetes Congress, Virtual 2020.
- Eer AS, Hearn T, Atkinson-Briggs S, Drake S, Singh S, Neoh S, Pyrlis F, Hachem M, Zajac JD, Burchill LJ, Ekinci EI. (2022) Improved metabolic parameters of people with diabetes attending an Aboriginal health service in regional Victoria. Internal Medicine Journal. doi: 1111/imj.15856