Now showing 1 - 10 of 16
  • Publication
    Journal Article
    Codesigning enhanced models of care for Northern Australian Aboriginal and Torres Strait Islander youth with type 2 diabetes: study protocol.
    (2024-03-06)
    Kirkham, Renae
    ;
    Puszka, Stefanie
    ;
    ;
    Freeman, Natasha
    ;
    Weaver, Emma
    ;
    Morris, Jade
    ;
    Mack, Shiree
    ;
    O'Donnell, Vicki
    ;
    Boffa, John
    ;
    ; ; ;
    Graham, Sian
    ;
    Scott, Lydia
    ;
    Sinha, Ashim K
    ;
    ;
    Shaw, Jonathan E
    ;
    Azzopardi, Peter
    ;
    Brown, Alex
    ;
    Davis, Elizabeth
    ;
    Wicklow, Brandy
    ;
    Premature onset of type 2 diabetes and excess mortality are critical issues internationally, particularly in Indigenous populations. There is an urgent need for developmentally appropriate and culturally safe models of care. We describe the methods for the codesign, implementation and evaluation of enhanced models of care with Aboriginal and Torres Strait Islander youth living with type 2 diabetes across Northern Australia.Our mixed-methods approach is informed by the principles of codesign. Across eight sites in four regions, the project brings together the lived experience of Aboriginal and Torres Strait Islander young people (aged 10-25) with type 2 diabetes, their families and communities, and health professionals providing diabetes care through a structured yet flexible codesign process. Participants will help identify and collaborate in the development of a range of multifaceted improvements to current models of care. These may include addressing needs identified in our formative work such as the development of screening and management guidelines, referral pathways, peer support networks, diabetes information resources and training for health professionals in youth type 2 diabetes management. The codesign process will adopt a range of methods including qualitative interviews, focus group discussions, art-based methods and healthcare systems assessments. A developmental evaluation approach will be used to create and refine the components and principles of enhanced models of care. We anticipate that this codesign study will produce new theoretical insights and practice frameworks, resources and approaches for age-appropriate, culturally safe models of care.The study design was developed in collaboration with Aboriginal and Torres Strait Islander and non-Indigenous researchers, health professionals and health service managers and has received ethical approval across all sites. A range of outputs will be produced to disseminate findings to participants, other stakeholders and the scholarly community using creative and traditional formats.
  • Publication
    Journal Article
    The ASQ-TRAK: Validating a culturally adapted developmental screening tool for Australian Aboriginal children.
    (2021-12-01)
    Simpson S
    ;
    Eadie T
    ;
    Khoo ST
    ;
    ; ;
    Thompson R
    ;
    Wunungmurra A
    ;
    Jeyaseelan D
    ;
    Dunham M
    ;
    D'Aprano A
    BACKGROUND: Developmental monitoring, performed using culturally relevant tools, is of critical importance for all young children. The ASQ-TRAK is the culturally and linguistically adapted Ages and Stages Questionnaire (ASQ-3), a developmental screening tool, for Australian Aboriginal children. While the ASQ-TRAK has been well received in practice, investigating its psychometric properties will enable professionals to make informed decisions about its use. AIMS: To conduct a rigorous validation study of the ASQ-TRAK by applying Kane's argument-based approach. SUBJECTS: The ASQ-TRAK, Bayley-III and/or BDI-2 were administered cross-sectionally to 336 Australian Aboriginal children aged 2-48 months across ten participating sites in the Northern Territory and South Australia. A sample of staff and caregivers completed feedback surveys about the ASQ-TRAK. RESULTS: ASQ-TRAK domain scores were moderately positively correlated with corresponding domain scores on the Bayley-III or BDI-2. Inter-rater and inter-instrument reliability were high. Sensitivity (83%), specificity (83%) and negative predictive value (99%) were acceptable. Staff and caregivers expressed high levels of satisfaction with the ASQ-TRAK. CONCLUSIONS: Regular developmental screening can provide important information about developmental vulnerability and the need for services. The ASQ-TRAK should be administered by trained Aboriginal community-based workers and the implementation approach carefully planned. Areas for future research include longitudinal follow-up of children, investigating existing norms and cut-off scores, and considering the appropriateness of the ASQ-TRAK with Aboriginal people from different locations. The ASQ-TRAK has the potential to fill an important gap by enabling better access to high-quality developmental monitoring and targeted early intervention.
      2649
  • Publication
    Journal Article
    Postpartum uptake of diabetes screening tests in women with gestational diabetes: the PANDORA study.
    (2022-11-07)
    Wood AJ
    ;
    Lee IL
    ;
    Barr ELM
    ;
    Barzi F
    ;
    Boyle JA
    ;
    ;
    Moore E
    ;
    Oats JJN
    ;
    McIntyre HD
    ;
    ;
    Simmonds A
    ;
    Zimmet PZ
    ;
    Brown ADH
    ;
    Corpus S
    ;
    Shaw JE
    ;
    AIMS: To determine rates and predictors of postpartum diabetes screening among Aboriginal and/or Torres Strait Islander and non-Indigenous women with gestational diabetes (GDM). METHODS: PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Postpartum diabetes screening rates at 12 weeks (75-gram oral glucose tolerance test (OGTT)) and 6, 12 and 18 months (OGTT, glycated haemoglobin (HbA(1C) ) or fasting plasma glucose) were assessed for women with GDM (n=712). Associations between antenatal factors and screening with any test (OGTT, HbA(1C) , fasting plasma glucose) by 6 months postpartum were examined using Cox proportional hazards regression. RESULTS: Postpartum screening rates with an OGTT by 12 weeks and 6 months postpartum were lower among Aboriginal and/or Torres Strait Islander women than non-Indigenous women (18% vs. 30% at 12 weeks, and 23% vs. 37% at 6 months, p<0.001). Aboriginal and/or Torres Strait Islander women were more likely to have completed a 6 month HbA(1C) compared to non-Indigenous women (16% vs. 2%, p<0.001). Screening by 6 months postpartum with any test was 41% for Aboriginal and/or Torres Strait Islander women and 45% for non-Indigenous women (p=0.304). Characteristics associated with higher screening rates with any test by 6 months postpartum included, insulin use in pregnancy, first pregnancy, not smoking and lower BMI. CONCLUSIONS: Given very high rates of type 2 diabetes among Aboriginal and Torres Strait Islander women, early postpartum screening with the most feasible test should be prioritised to detect prediabetes and diabetes for intervention.
      4164
  • Publication
    Journal Article
    Incidence of type 1 diabetes in 0-14 year olds in Australia from 2002 to 2017.
    (2020-04-18)
    Haynes, Aveni
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    Bulsara, Max K
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    Bergman, Phil
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    Cameron, Fergus
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    Couper, Jennifer
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    Craig, Maria
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    Demangone, Karen
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    Johnson, Stephanie
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    Lafferty, Antony
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    ;
    Davis, Elizabeth
    To determine the incidence of childhood onset type 1 diabetes in Australia from 2002 to 2017, and analyse incidence rate trends by calendar year, sex and age at diagnosis. Children newly diagnosed with type 1 diabetes aged <15years between 2002 and 2017 were identified from the National Diabetes Register, estimated as ~99% complete. Data were obtained for diagnosis year, sex, age and residential State/Territory at time of diagnosis. Population estimates by year, sex, single year of age and State/Territory were obtained from the Australian Bureau of Statistics and Poisson regression used to examine incidence and trends by calendar year, sex and age group at diagnosis. Between 2002 and 2017, there were 16,783 newly diagnosed cases of type 1 diabetes in children aged <15years (8,684 boys: 8,099 girls), giving a mean incidence of 25.0/100,000 person years (95%CI:24.6,25.4). A sinusoidal pattern in the incidence rate trend was observed with 5-yearly cycles providing the best model fit. No significant difference was observed in boys compared to girls (IRR 0.98(95%CI:0.95-1.01)). Compared to 0-4 year olds, the mean incidence was 75% higher in 5-9 year olds, and 224% higher in 10-14 year olds. A decreasing incidence rate trend was observed in 0-4 year old boys and girls. This study reports updated incidence and incidence rate trends in children and adolescents diagnosed with type 1 diabetes in Australia. A cyclical pattern in incidence trend persists, with an overall decreasing trend observed only in the youngest age group.
      1233
  • Publication
    Case Reports
    Challenges of managing congenital hyperinsulinism in remote Aboriginal Australian communities.
    (2021-05)
    Musthaffa, Yassmin
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    Papadimos, Emily R
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    Fairchild, Jan
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    Corpus, Sumaria
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    Huynh, Tony
    ;
    Conwell, Louise S
      885
  • Publication
    Journal Article
    Association between hyperglycaemia in pregnancy and growth of offspring in early childhood: The PANDORA study.
    (2022-05-29) ;
    Longmore DK
    ;
    Barzi F
    ;
    Barr, ELM
    ;
    Webster V
    ;
    Wood A
    ;
    Simmonds A
    ;
    Brown ADH
    ;
    ;
    Boyle JA
    ;
    Oats J
    ;
    McIntyre HD
    ;
    Shaw JE
    ;
    Craig ME
    ;
    BACKGROUND: Few studies have assessed whether children exposed to in utero hyperglycaemia experience different growth trajectories compared to unexposed children. OBJECTIVES: To assess association of type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) with early childhood weight, length/height and body mass index (BMI) trajectories, and with timing and magnitude of peak BMI in infancy. METHODS: PANDORA is a birth cohort recruited from an Australian hyperglycaemia in pregnancy register, and women with normoglycaemia recruited from the community. Offspring growth measures were obtained from health records over a median follow-up of 3.0 years (interquartile range 1.9-4.0). This analysis included children born to Aboriginal mothers with in utero normoglycaemia (n = 95), GDM (n = 228) or T2D (n = 131). Growth trajectories (weight, length/height and BMI) were estimated using linear mixed models with cubic spline functions of child age. RESULTS: After adjustment for maternal factors (age, BMI, parity, smoking, and socioeconomic measures) and child factors (age, gestational age at birth, and sex), children born to mothers with T2D or GDM had lower weight, length/height and BMI trajectories in infancy than children born to mothers with normoglycaemia, but similar weight and BMI by completion of follow-up. Children exposed to T2D had lower mean peak BMI 17.6 kg/m(2) (95% confidence interval [CI] 17.3-18.0) than children exposed to normoglycaemia (18.6 kg/m(2) [18.1-18.9]) (p = 0.001). CONCLUSIONS: Maternal hyperglycaemia was associated with differences in early childhood growth trajectories after adjustment for maternal BMI. Exploration of associations between in utero hyperglycaemia exposure and growth trajectories into later childhood is required.
      3309
  • Publication
    Journal Article
    Association between maternal hyperglycemia in pregnancy and offspring anthropometry in early childhood: the pandora wave 1 study.
    (2023-08-22) ;
    Barzi F
    ;
    Barr E L M
    ;
    Webster V
    ;
    Wood A
    ;
    Kelaart J
    ;
    Kirkwood M
    ;
    ;
    Boyle J A
    ;
    Moore E
    ;
    Oats J
    ;
    McIntyre H D
    ;
    Zimmet P
    ;
    Brown A D H
    ;
    Shaw J E
    ;
    Craig M E
    ;
    BACKGROUND: In-utero hyperglycemia exposure influences later cardiometabolic risk, although few studies include women with pre-existing type 2 diabetes (T2D) or assess maternal body mass index (BMI) as a potential confounder. OBJECTIVE: To explore the association of maternal T2D and gestational diabetes mellitus (GDM) with childhood anthropometry, and the influence of maternal BMI on these associations. METHODS: The PANDORA cohort comprises women (n = 1138) and children (n = 1163). Women with GDM and T2D were recruited from a hyperglycemia in pregnancy register, and women with normoglycemia from the community. Wave 1 follow-up included 423 children, aged 1.5-5 years (median follow-up age 2.5 years). Multivariable linear regression assessed associations between maternal antenatal variables, including BMI and glycemic status, with offspring anthropometry (weight, height, BMI, skinfold thicknesses, waist, arm and head circumferences). RESULTS: Greater maternal antenatal BMI was associated with increased anthropometric measures in offspring independent of maternal glycemic status. After adjustment, including for maternal BMI, children exposed to maternal GDM had lower mean weight (-0.54 kg, 95% CI: -0.99, -0.11), BMI (-0.55 kg/m(2), 95% CI: -0.91, -0.20), head (-0.52 cm, 95% CI: -0.88, -0.16) and mid-upper arm (-0.32 cm, 95% CI: -0.63, -0.01) circumferences, and greater mean suprailiac skinfold (0.78 mm, 95% CI: 0.13, 1.43), compared to children exposed to normoglycemia. Adjustment for maternal BMI strengthened the negative association between GDM and child weight, BMI and circumferences. Children exposed to maternal T2D had smaller mean head circumference (-0.82 cm, 95% CI: -1.33, -0.31) than children exposed to normoglycemia. Maternal T2D was no longer associated with greater child mean skinfolds (p = 0.14) or waist circumference (p = 0.18) after adjustment for maternal BMI. CONCLUSIONS: Children exposed to GDM had greater suprailiac skinfold thickness than unexposed children, despite having lower mean weight, BMI and mid-upper arm circumference, and both GDM and T2D were associated with smaller mean head circumference. Future research should assess whether childhood anthropometric differences influence lifetime cardiometabolic and neurodevelopmental risk.
      3216
  • Publication
    Journal Article
    Type 2 diabetes after a pregnancy with gestational diabetes among first nations women in Australia: The PANDORA study.
    (2021-10-13)
    Wood AJ
    ;
    Boyle JA
    ;
    Barr ELM
    ;
    Barzi F
    ;
    ; ;
    Longmore DK
    ;
    Death E
    ;
    Kelaart J
    ;
    Kirkwood M
    ;
    Graham S
    ;
    ;
    Moore E
    ;
    O'Dea K
    ;
    Oats, Jeremy J N
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    McIntyre HD
    ;
    Zimmet PZ
    ;
    Lu ZX
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    Brown A
    ;
    Shaw JE
    ;
    AIMS: To determine among First Nations and Europid pregnant women the cumulative incidence and predictors of postpartum type 2 diabetes and prediabetes and describe postpartum cardiovascular disease (CVD) risk profiles. METHODS: PANDORA is a prospective longitudinal cohort of women recruited in pregnancy. Ethnic-specific rates of postpartum type 2 diabetes and prediabetes were reported for women with diabetes in pregnancy (DIP), gestational diabetes (GDM) or normoglycaemia in pregnancy over a short follow-up of 2.5 years (n = 325). Pregnancy characteristics and CVD risk profiles according to glycaemic status, and factors associated with postpartum diabetes/prediabetes were examined in First Nations women. RESULTS: The cumulative incidence of postpartum type 2 diabetes among women with DIP or GDM were higher for First Nations women (48%, 13/27, women with DIP, 13%, 11/82, GDM), compared to Europid women (nil DIP or GDM p < 0.001). Characteristics associated with type 2 diabetes/prediabetes among First Nations women with GDM/DIP included, older age, multiparity, family history of diabetes, higher glucose values, insulin use and body mass index (BMI). CONCLUSIONS: First Nations women experience a high incidence of postpartum type 2 diabetes after GDM/DIP, highlighting the need for culturally responsive policies at an individual and systems level, to prevent diabetes and its complications.
      2283
  • Publication
    Journal Article
    Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines.
    (2020-06-23)
    Peña, Alexia S
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    Curran, Jacqueline A
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    Fuery, Michelle
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    George, Catherine
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    Jefferies, Craig A
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    Lobley, Kristine
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    Ludwig, Karissa
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    Maguire, Ann M
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    Papadimos, Emily
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    Peters, Aimee
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    Sellars, Fiona
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    Speight, Jane
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    Wilson, Dyanne
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    Wong, Jencia
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    Worth, Caroline
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    Dahiya, Rachana
    INTRODUCTION: The incidence of type 2 diabetes mellitus has increased in children and adolescents due largely to the obesity epidemic, particularly in high risk ethnic groups. β-Cell function declines faster and diabetes complications develop earlier in paediatric type 2 diabetes compared with adult-onset type 2 diabetes. There are no consensus guidelines in Australasia for assessment and management of type 2 diabetes in paediatric populations and health professionals have had to refer to adult guidelines. Recent international paediatric guidelines did not address adaptations to care for patients from Indigenous backgrounds. MAIN RECOMMENDATIONS: This guideline provides advice on paediatric type 2 diabetes in relation to screening, diagnosis, diabetes education, monitoring including targets, multicomponent healthy lifestyle, pharmacotherapy, assessment and management of complications and comorbidities, and transition. There is also a dedicated section on considerations of care for children and adolescents from Indigenous background in Australia and New Zealand. CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES: Published international guidelines currently exist, but the challenges and specifics to care for children and adolescents with type 2 diabetes which should apply to Australasia have not been addressed to date. These include: recommendations regarding care of children and adolescents from Indigenous backgrounds in Australia and New Zealand including screening and management; tighter diabetes targets (glycated haemoglobin, ≤ 48 mmol/mol [≤ 6.5%]) for all children and adolescents; considering the use of newer medications approved for adults with type 2 diabetes under the guidance of a paediatric endocrinologist; and the need to transition adolescents with type 2 diabetes to a diabetes multidisciplinary care team including an adult endocrinologist for their ongoing care.
      1666