Diabetes Research and Clinical Practice - Volume 120 - Supplement 1 - October 2016

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Optimization of diabetes screening and diabetes risk
assessment in Australian community pharmacy settings:
Current evidence and future directions
Sophy T. SHIH1*, Kevin M.C. NAMARA 1, Jonathan MALO2,
Ines KRASS 3, Rob CARTER1, James DUNBAR1. 1Centre for
Population Health Research, Faculty of Health, Deakin University,
2 Greater Green Triangle Department of Rural Health, Flinders
University and Deakin University, 3Faculty of Pharmacy, University
of Sydney, Australia
Many studies have shown that a quarter to one half of type 2
diabetes mellitus (T2DM) cases were undiagnosed in various
Australian populations. Strict control and management of
T2DM can delay onset of complications. Additionally, 5 –10% of
people with impaired fasting glucose (IFG) and impaired
glucose tolerance (IGT) progress to T2DM annually. Studies
from different parts of the world have demonstrated that
lifestyle modification interventions can prevent T2DM in
people with IFG/IGT. Thus, early detection of T2DM, IFG and
IGT is crucial in achieving long-term health benefit.
Previous research demonstrated that risk factor question-
naires followed by point of care (POC) capillary blood glucose
testing in pharmacies was a superior screening strategy to that
using risk assessment as a stand alone test. When biomedical
profile data from three population surveys in rural south-
eastern Australia were analysed using risk categories deter-
mined by the subsequently validated Australian Type 2
Diabetes Risk Assessment Tool (AUSDRISK), results indicated
cut-off at AUSDRISK >=12 alone for entry to lifestyle modifi-
cation intervention was too relaxed and therefore resulted in
less impact on T2DM risk reduction. Although questionnaires
such as AUSDRISK are inexpensive and rapid tools to screen for
people at risk of diabetes, their use in conjunction with blood
glucose tests or glycated haemoglobin has been recommended
to improve intervention effectiveness and cost-effectiveness.
Similar findings were shown in the Melbourne Diabetes
Prevention Study (MDPS), an effectiveness RCT linked to a
state-wide translational diabetes prevention program (Life!) in
Victoria, Australia. Eligible MDPS participants were individuals
aged 50– 75 with AUDSRISK >=15 and 80% of trial participants
were recruited through community pharmacies. Participants
randomised to the intervention arm received one individual
and five structured group sessions, while the control group
received usual care. The MDPS results showed modest reduc-
tions in weight ( −1.13 kg) and waist ( −1.35 cm) in the
intervention group, due to the challenge in recruiting high-
risk individuals using screening questionnaires alone, as well
as the abbreviated intervention offered to individuals at low
risk of progression to diabetes.
As a convenient blood test with less intra-individual variance,
HbA1c has been recommended by the American Diabetes
Association to be used for T2DM diagnosis. Future research
should explore sequential testing by risk assessment tools
followed with point of contact capillary HbA1c test, to examine
the impact of community pharmacy-based screening
and referral for diabetes and IFG/IGT to reduce the burden of
T2DM.
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Partnering with general practitioners to improve access of
diabetes education for patients and caregivers
Brenda LIM 1*, Pei Kwee LIM1, Mio Na EIO1, Grace YAM1,
Magaret CHAN 1, Noorani OTHMAN 1, Authilakshmy NM1.
1 Association of Diabetes Educators, Singapore
Background: In Singapore, 25.4% of patients with Type 2
diabetes exhibit poor glycemic control with HbA1c value at
an unacceptable range of >8%. Patients with diabetes seek
primary care consultation at their neighborhood general
practitioners (GP) clinics have limited access to diabetes
education services.
Aims: Partner with general practitioners to Improve access of
diabetes education for patients and caregivers
Methodology: The Association of Diabetes Educators
(Singapore) (ADES) collaborated with the GPs who were
supportive of diabetes education to arrange their patients and
caregivers to attend diabetes nurse educators’ (DNE) service
at their clinics. The iControl Diabetes Program was set up
and supported a team of ADES members to provide diabetes
education reaching out to the GPs’ patients and caregivers.
Examples of education topics provided were understanding of
diabetes and its targets of control, self- management of blood
glucose, self-injection, foot care, and others.
A total of 3 diabetes education sessions per patient were
planned over a period of 3–6 months. The GPs identified
patients for either individual or group education. The DNEs
were notified by program leader of the date, time and location
of GP clinics to support. The same DNE supported the same
GP’s patients/caregivers for next 3 visits. The DNE updated GPs
or clinic assistants of activity of patient education sessions
accordingly.
Results: 3 GPs attended the pre-iControl meeting with DNEs. 6
GPs were recruited for iControl Diabetes Program through
program coordinator. 18 patients with caregivers (patient: N:
16; caregivers: 2) attended DNE sessions. 70% (N: 11) were
Chinese patients. The age of patients ranged from 39 to 75
years old. The last HbA1c values of GP patients reported were
range from 5.3% to 10.6%; POCT random blood glucose tested
were range from 5.6 mmol/dL to 18.7 mmol/dL. 8 patients and
caregivers attended group sessions and 9 attended individual
sessions. 3 patients were taught/reviewed on injection tech-
niques; 6 patients were taught with return demonstration on
use of home glucose monitoring; 7 patients received foot
examinationwithmonofilament; all patientswere informed of
target glucose control, effects of medication and diet control.
Conclusion: The program achieved its purpose to provide
accessibility of GP patients for DNE’s service to address their
diabetes care and concerns. The sustainability of this program
would largely depend on the GPs’ interests and effort to
support their patients for diabetes education.
PA-31
Serum vascular adhesion protein-1 is associated with obesity
and predicts incident diabetes
Chun-Heng KUO1, Jung-Nan WEI2, Chung-Yi YANG3,
Hung-Ren HSIEH4, Mao-Shin LIN 5, Shyang-Rong SHIH5,
Shu-Huei WANG6, Cyue-Huei HUA7, Yenh-Chen HSEIN7,
Hung-Yuan LI5*. 1Department of Internal Medicine, New Taipei City
Hospital, 2Chia Nan University of Pharmacy and Science,
3Department of Medical Imaging, National Taiwan University
Hospital and National Taiwan University College of Medicine,
4Department of Radiology, National Taiwan University Hospital Yun-
Lin Branch, 5Department of Internal Medicine, National Taiwan
University Hospital, 6Department of Anatomy and Cell Biology,
College of Medicine, National Taiwan University, 7Division of Clinical
Pathology, National Taiwan University Hospital Yun-Lin Branch,
Taiwan
Objective: Vascular adhesion protein-1 (VAP-1) is involved in
the pathogenesis of diabetic complications. Physiologically,
VAP-1 enhances glucose uptake in skeletal muscle and
adipocytes. Secreted VAP-1 can act as an endocrine or
paracrine hormone to induce glucose uptake in liver tissue.
Since the role of secreted VAP-1 in obesity and diabetes
remains unknown in human, we investigated the relationship
of serum VAP-1 (sVAP-1), obesity, and incident diabetes in this
cohort study.
Research design and methods: From 2006 to 2012, 600 subjects
without diabetes from Taiwan Lifestyle Study were included
and followed regularly. Diabetes was diagnosed by an oral
glucose tolerance test. Abdominal fat areas were measured by
abdominal computed tomography and sVAP-1 was analyzed
by ELISA.
Poster Presentations / Diabetes Research and Clinical Practice 120S1 (2016) S65–S211 S74