The KeepSight eye check reminder program has registered its 400,000^th participant – a major milestone in the prevention of diabetes-related eye complications.

The program, delivered by Diabetes Australia in partnership with the eye sector, makes it easier for people with diabetes to remember when they are due to get their eyes checked and help detect eye problems that can lead to vision loss.

Diabetes Australia Group CEO Justine Cain said the milestone was significant in the fight to maintain the sight of people living with diabetes.

“KeepSight is committed to preventing diabetes-related blindness,” Ms Cain said.

“Having over 400,000 people now registered with the program is a very significant milestone.

“This program is changing lives by supporting people with diabetes to proactively look after their eye health and prevent complications.

“You don’t have to look far to see that this program is changing the lives of people with diabetes,” she said.

Idwer Jajju, who lives with type 2 diabetes, urged people to never take their eyesight for granted.

“I have had bleeding and other symptoms in my eyes since 2010,” Mr Jajju said.

“Since then, I have undergone various treatments including lasers, injections, and surgery, but I still have symptoms and bleeding.

“KeepSight is a valuable program because it reminds you when you’re due for a diabetes eye check. Preventive eye care is very important.”

According to Specsavers’ Optometry Director Dr Ben Ashby, KeepSight registering 400,000 people is evidence of a successful strategic partnership with Diabetes Australia that delivers better outcomes for program participants.

“People registered with KeepSight are accessing eye care in a timely and regular manner, which is great to see,” Dr Ashby said.

“To provide that opportunity to 400,000 patients is an important milestone in the prevention of avoidable vision loss.”  

There are more than 1.5 million Australians living with all types of diabetes. They are encouraged to make an appointment with an eye care professional of their choice for a Medicare-funded diabetes eye test.

About KeepSight program

The KeepSight program, which is run by Diabetes Australia, has been co-funded by the Australian Government and Specsavers, with additional funding from Bayer, Novartis and Mylan. The program is supported by leading diabetes and eye health groups including Oculo, Vision 2020 Australia, Centre for Eye Research Australia, the Royal Australian and New Zealand College of Ophthalmologists, Orthoptics Australia, Optometry Australia, the Australian Diabetes Society and the Australian Diabetes Educators Association.

World Sight Day is on Thursday 12^th October 2023. This year the focus is on the importance of eye care in the workplace. The campaign encourages employers to make eye health initiatives standard practice in the workplace, and to promote eye health habits that will benefit the wellbeing, safety and productivity of millions of employees.

But of course, the first step is for individuals to prioritise their own eye health.

Our vision is one of the most precious gifts we have, it is a part of who we are. However, the importance of our eyes is often underappreciated until we experience a problem. So, what can you do to prevent eye problems?

A window to the world

Your eyes are at work from the moment you wake up to the moment you close them to go to sleep. Your eyes take in an abundance of information about the world around you — shapes, colours, movements, and more. Our vision allows us to be aware of our surroundings and 80% of everything we learn is through our sight. As we get older, changes to our eyes mean our sight becomes more vulnerable.

Risk factors for eye problems

A number of factors can cause eye disease. Other than diabetes, the most common factors are:

• Smoking
• Alcohol
• Ageing
• Excess screen time and in particular near-work such as reading, watching TV or looking at a computer screen
• High blood pressure
• High cholesterol
• Being overweight

Diabetes and eye health

People with diabetes have an increased risk of developing eye problems relating to high blood glucose levels.

For people living with diabetes vision loss is a major complication, so it is even more important to stay on top of eye health.

Short-term eye problems to be on the look out for

Short term eye problems can include:

• Blurred vision
• Infections
• Conjunctivitis (inflammation and redness of the lining of the whites of the eyes and the membranes surrounding the inner eyelids)
• Uveitis (inflammation of the middle portion of the eye, the uvea)
• Stye (a painful eye infection along the lash line due to blocked oil glands on the eyelid)

Long-term eye problems to watch out for

The risk of serious, more permanent eye problems increases when you have high blood glucose levels over a long period of time, or if your blood pressure or cholesterol levels are high. Long-term eye problems include:

• Cataracts, which can happen when protein from the lens clumps together and makes the lens cloudy, this can reduce vision. Although sun damage and ageing are the main risk factors, people with diabetes tend to develop cataracts faster and at a younger age than others. Without treatment cataracts will continue to develop until eventually vision loss is complete. Cataract surgery is often required if the cataracts affect your vision significantly.
• Glaucoma occurs when there is damage to the optic nerve, causing a build-up of pressure inside the eye. It can affect anyone, but again, it’s more common in people with diabetes. There are no warning signs of glaucoma, as it does not produce symptoms in the early stages. Early identification of glaucoma is important, as by the time you notice any vision changes, treatment may stop but cannot reverse any existing vision loss. Glaucoma is usually treated with prescription eye drops, though occasionally, laser and surgical procedures may be needed.
• Diabetic retinopathy can be the result of high blood glucose levels which, over time, can damage the small blood vessels in the retina of the eye, causing them to leak fluid. New blood vessels will grow to replace the damaged ones, but these new vessels are weak and rupture easily can cause a haemorrhage (bleed). New blood vessels can also leak protein or fluid into the macula and this can lead to macular oedema. In the early stages, there may be no symptoms or changes to your vision, but an eye check can identify the onset of problems. Diabetic retinopathy has five stages ranging from (1) no retinopathy to (2) mild, then (3) moderate to (4) severe non-proliferative diabetic retinopathy up to (5) proliferative retinopathy.
• Diabetic macular oedema is an additional and important complication of diabetes that can be found with any stage of diabetic retinopathy and that can run an independent course. When the macula is affected, you can lose your central vision.
• Retinal detachment can develop when the retina separates from the tissue that it is normally attached to, like wallpaper peeling off a damp wall. It can occur at any age, but it most commonly occurs in Caucasian males over the age of 40. Please be assured that retinal detachment is quite rare, occurring in just 1 in 10,000 people each year. If your retina is detached, you can lose some or all your vision permanently, if not treated urgently. Hence it is a medical emergency, that needs to be assessed as soon as possible, so that your ophthalmologist can start the treatment you may need to preserve any vision.

Eye health checks

You can greatly reduce your risk of serious vision loss from diabetes through regular eye examinations and timely treatment. The sooner eye problems are detected and treated, the better the result.

It is recommended that you have your eyes checked at least every two years – by an optometrist or an eye specialist (ophthalmologist). Have your eyes checked more often if your eye care professional advises, especially if you already have eye problems or if you are planning a pregnancy. Discuss any changes in your vision that develop in between your routine eye checks with your optometrist, eye specialist or your GP.

Your eyes can be checked by an optometrist without the need for a medical referral. Medicare provides a full rebate on most optometry appointments, but does not reimburse you if glasses are needed.  Most private health funds will at least partially reimburse you for your prescription glasses, depending on your level of cover.

A referral from a general practitioner, optometrist or other medical specialist is required to obtain the Medicare rebate for an ophthalmology consultation. Appointments are prioritised according to medical need.

KeepSight

KeepSight is a program developed by Diabetes Australia to make it easier for people with diabetes to get their eyes checked. KeepSight provides electronic alerts and reminders to help you remember your diabetes eye checks. When it’s time for a diabetes eye check you get a reminder. It’s that simple. KeepSight can also help you find an optometrist if you don’t know one.

Take an active role

There are a number of things you can actively do to reduce your risk of developing eye problems and these include:

• Aim for blood glucose levels and blood pressure as close to your target ranges as possible and aiming to avoid large glucose excursions (jumps from low to really high and vice versa)
• Keep your cholesterol level within the recommended range. Regular appointments with your health professionals can help you with this.
• Don’t smoke. If you do smoke, try and quit. If you feel you can’t give up smoking on your own, ask for help – talk to your doctor or call the Quitline on 13 78 48.
• See your optometrist or ophthalmologist for an eye check as soon as you notice any changes in your vision, though better still, see them annually.
• Speak to a psychologist or social worker if the health of your eyes is causing you to feel worried or anxious.

In summary

In Australia 90% of blindness and vision loss is preventable or treatable; however, this rises to 94% for Aboriginal and Torres Strait Islander people. It is estimated that in Australia over 500,000 people are affected by blindness or vision loss and that 80% of blindness and vision impairment is caused by five common eye conditions (listed alphabetically):

• age-related macular degeneration (AMD)
• cataracts
• diabetic retinopathy
• glaucoma
• uncorrected or under-corrected refractive error.

In most cases, the earlier eye problems are treated, the better the result. Your eye specialist can advise what treatments are available. But as always, prevention is better than trying to cure.

By Credentialled Diabetes Educator, Carolien Koreneff

Peripheral neuropathy (PN) is a common condition related to living with diabetes, with almost 50% experiencing it as part of their diabetes journey.

The term peripheral means that it affects the parts of our bodies furthest from our hearts. These are your hands and lower limbs below the knees, including the feet. Neuropathy means nerve dysfunction; it means your nerves aren’t working as they should.

The jury is still out on the exact cause of PN; however, ongoing research reveals both large and small nerves are affected. Damage to large nerves is related to loss of sensation, numbness, and muscle weakness. When smaller nerves are involved, it can lead to pain and ulcers.

Prevention, diagnosis, and treatment strategies are difficult because there are so many mechanisms involved. Some affect the whole body such as infections or chemical exposure, for example chemotherapy. Others are on a cellular level, perhaps how our bodies use glucose or fats, or there may be confusion of the immune response to differing stimuli. These pathways then lead to inflammation, gene damage, signalling failure, or compromise of the protective layer around the nerves known as the myelin sheath. There are many possible pathways to PN, and this article can’t cover all of them. There is much still yet to be understood, and research is ongoing.

Signs and symptoms

• Pain on one or both sides of the body – sensations such as aching, stabbing and throbbing
• Numbness
• Pins and needles
• The sensation of insects crawling on your skin
• Hot areas or a burning sensation
• Cold areas which are difficult to warm up
• Muscle weakness
• Lower leg or foot ulcers.

Risk factors for PN are as varied as the signs and symptoms

Here’s what we know so far: diabetes is a risk factor. This is different for each individual and related to factors such as age, blood glucose time in range, average HbA1c levels, duration of diabetes, type of diabetes and so on. But living with diabetes is not the only possible risk factor.

Other possible causes of PN include alcohol consumption, side effects of certain medications, deficiency of certain vitamins such as thiamine (vitamin B1) and cobalamin (vitamin B12), exposure to specific toxins, some autoimmune conditions, and associated inflammation and immune responses, smoking related oxidative stress, genetics and gene mutations, some conditions of the nervous system such as CIPD (Chronic Inflammatory Demyelinating Polyneuropathy), HIV, having a heavier than recommend weight, or compromised thyroid function. This is not an exhaustive list. Sometimes we just don’t know why PN develops.

So why might you care?

We all deserve to live our best lives. As well as the signs and symptoms listed earlier, you may also experience:

• Damage to feet, lower limbs or hands
• Altered gait, with discomfort or ongoing mobility issues
• Compromised balance increasing falls risk
• Development of ulcers – with possible pain and infection
• Reduced independence
• Less ability to keep up with the grandchildren
• Limits to work around the house or paid employment
• Questioned eligibility of driving license
• Disturbed sleep
• Associated anxiety, depression, and diabetes burnout
• Possible amputation when wounds do not heal.

Investigations

Due to the large number of risk factors for PN, several testing avenues might be offered including:

• A clinical picture such as family history, physical examination for signs and symptoms, duration, and severity
• Exposure to toxins for example in the workplace, or alcohol consumption
• Medications both current and historical
• Imaging or biopsy
• Nerve testing
• Blood pathology.

Prevention and treatments options

Prevention and treatment involve an inter-disciplinary approach, where a range of health providers work together to support you with your self-management of diabetes and related PN. Prevention is always the best path forwards. Some risk factors you can’t do anything about such as genetics. However, there are many lifestyle, dietary and other factors that can be modified.

• Daily foot monitoring and care performed by yourself or your carer.
• Your general practitioner may prescribe specific supplements or medications, provide advice, answer questions and also be the central contact point for your diabetes and PN healthcare team. He or she can request pathology or other investigations and refer you to health professionals and specialists. Some referrals may be subsidised under a Medicare Care Plan.
• A comprehensive podiatry assessment can check function and risk factors and can include advice about footwear and foot care.
• An accredited practising dietitian assessing and advising around diet, particularly if your doctor identifies deficiencies.
• The practice nurse assists your general practitioner answering your questions, and monitoring aspects such as weight, blood glucose and blood pressure.
• An accredited exercise physiologist can prescribe physical activity and exercises to help improve balance and fitness, based on your individual health issues and needs.
• A psychologist may provide psychological wellbeing strategies.
• A credentialled diabetes educator supports, answers questions and provides education relating to managing diabetes.  He or she can offer insight into modifiable and non-modifiable risk factors, and what’s happening in your body.
• Physiotherapy may be required if, for example, you experience a fall or other injury.
• Your pharmacist is your go-to for all information related to medications including side effects and interactions.

Treatment generally depends on symptoms, but often involves capsicum-based cream to distract from pain or tingling. These creams are available from pharmacies.

Next treatment options include a range of medications which include anti-depressants and anti-epileptics which as a side effect, decrease nerve pain.

And, lastly, spinal cord stimulation, which requires surgery to place an electrode in the spinal cord. This allows an electrical current to be applied to confuse pain signals to the brain.

Find out more

Take this two minute quiz to assess the health of your feet, or head to FootForward for more information.

The National Diabetes Services Scheme (NDSS) has good quality information on their website about self-assessment and care of hands, feet, and lower limbs. There are also face-to-face and virtual (online) programs available, such as FootSMART.

Peripheral neuropathy is the most common condition related to living with diabetes. The resulting compromise to quality of life can be profound. Diabetes Australia, the NDSS, and your healthcare team are here to help. Download a fact sheet, make a call on 1800 177 055, or set up an assessment appointment today.

Constance Russell, RN CDE

One in 20 hospitalisations in Australia is a person living with diabetes undergoing dialysis, and that figure is projected to rise as rates of kidney failure are expected to increase by 45% by 2040.

A new report, released today by Diabetes Australia, highlights the alarming rise in diabetes-related kidney disease and the massive impact this is having on the Australian health system.

The report estimates diabetes-related kidney disease costs Australia $2.68B per annum with the majority of the cost ($1.9B) associated with people living with diabetes experiencing kidney failure.

It calls for the introduction of a Diabetes Kidney Disease Screening Program to ensure people living with diabetes at high-risk of end-stage kidney disease are detected early when treatments are most effective.

The report also found:

• 324 Australians living with diabetes undergo a kidney transplant each year
• 10,249 Australians living with diabetes are undergoing kidney replacement therapy including dialysis each year
• 2,024 Australians living with diabetes die from kidney disease each year
• Better early detection of kidney disease could save the Australian economy around $500M per annum

Diabetes Australia Group CEO Justine Cain said the report was compelling proof of the need for earlier intervention to help prevent kidney failure.

“There are an estimated 330,000 people living with diabetes-related kidney disease which is about a quarter of all people living with diabetes,” Ms Cain said.

“More than 10,000 Australians living with diabetes are undergoing kidney replacement therapy which can include dialysis or kidney transplantation.

“Most kidney failure can be prevented with early intervention; however, just under a quarter (23%) of people are getting their kidneys checked within recommended timeframes.

“Several factors contribute to this including the complexity of the kidney health checks, the overall challenges of living with diabetes, and a low level of awareness about chronic kidney disease.”

Report co-author Professor Richard MacIsaac, Director of Endocrinology at St Vincent’s Hospital Melbourne, said keeping as many people off dialysis as possible was crucial.

“Dialysis takes a huge toll on the quality of life of the person receiving it and represents a massive burden on our health system,” Professor MacIsaac said.

“A person receiving dialysis is visiting hospital more than 150 times a year to receive around 780 hours of care.

“But if we can detect people early, existing medicines are excellent at stopping or slowing the progression of kidney disease.”

Lead author of the report, Professor Elif Ekinci, Director of the Australian Centre for Accelerating Diabetes Innovation, said the report clearly highlighted the impact of diabetes-related kidney disease and the need for urgent action.

“Diabetes is one of the most urgent health challenges of our time and one of the reasons for this is the massive impact of diabetes-related complications such as kidney disease,” Professor Ekinci said.

“The report sets out some clear recommendations for improving rates of screening for kidney disease and if we can reduce the impact of diabetes-related kidney disease.”

Ms Cain said Australia has a world-class health system, with many of the elements needed to deliver an effective national diabetes kidney disease screening program.

“Australia has excellent diabetes care infrastructure including a world-class diabetes health professional workforce, the National Diabetes Services Scheme which provides excellent information for people living with diabetes, and the Pharmaceutical Benefits Scheme which ensures people can affordably access the medicines they need,” she said.

“Reducing the impact of diabetes-related kidney disease is cost-effective. It doesn’t require new clinics, new operating theatres or new hospital beds.

“It involves taking our existing health infrastructure, including existing databases and services, and optimising them to increase rates of screening.

“For instance, we are proposing that the NDSS database, managed by Diabetes Australia on behalf of the Australian Government, could be optimised to facilitate recall and reminders to encourage kidney checks for all Australians living with diabetes.

“Better integration with existing GP and pathology software could also support better information sharing between different members of a person’s healthcare team.

“Finally, this screening can be done with existing Medicare item numbers using existing pathology providers and primary care services.

“This is one of the most cost-effective interventions we can implement across the entire health system. Modelling shows every dollar spent on the detection and prevention of chronic kidney disease returns around $45.

“If we get this right we save lives and can reduce the impact of diabetes complications on our health system.”

Diabetes Australia commissioned the Australian Centre for Accelerating Diabetes Innovation led by Professor Elif Ekinci, Sir Edward Weary Dunlop Principal Research Fellow in Metabolic Medicine, and Dame Kate Campbell, Fellow at the University of Melbourne. Professor Ekinci is the lead author of the report.

A copy of the report is available here: Change the Future: Saving Lives by Better Detecting Diabetes-Related Kidney Disease

Group education programs for people living with diabetes are fantastic tools for improving an understanding of the best ways to look after health, but occasionally they offer an even more profound learning opportunity. Linda Uhr, Accredited Practising Dietitian and Diabetes Educator, shares the story of Graham, who experienced a “penny drop” moment during a FootSmart© program in South-Western Sydney.

A participant shared a deeply personal story about his long journey with type 2 diabetes. The condition had caused neuropathy (a loss of sensation) in his feet and this meant giving up on the activities in his life that brought him joy and normality. He was genuinely scared about what the future held for him.

As a facilitator this is always a tough moment. I remember looking around the room and seeing many of the group like me, welling up and lost for the right words to say.

After a moment of silence Graham, another member of the group, spoke up in a sincere and respectful way. Although his exact words evade me now, he essentially said how this moment – right now – was his wake-up call.

“Mate, I think I am you… but maybe 10 years earlier,” he said.

This was a penny drop moment; so sudden and so clear that no one in the room could ignore it.

As a health professional, passionate about prevention and early intervention, I was blown away by Graham’s words. They seemed far more powerful and meaningful than my own. Behaviour change research shows that people have a far greater tendency to listen to someone they identify with. With this in mind, Graham has kindly agreed to share his experience of pre-diabetes, diabetes and how early action is key.

Graham’s story

Graham spent 16 years in the Australian Army, worked as a commercial diver, a professional driver, an office worker and a senior manager. He was diagnosed with diabetes eight years ago and was told he needed to make changes.

“But men are stubborn!” says Graham. 

“I’m a man – I thought I was 10-foot-tall and bullet proof and that I’d just deal with it when it became a problem. I thought I could just get it fixed. But what did I know? 

“I’ve had more than my share of stress. All wonderful environments to learn bad habits in, and now it’s become a problem.

“What I have to change now has been pretty overwhelming and I am at the point that I really don’t have a choice. Why? Because I didn’t act on what I was told back then.

“Diabetes is a silent issue but it’s not taboo, it needs a voice. Had I looked into it earlier, I honestly believe my eyes would have been opened. The gentleman that was sitting to my left with foot issues presented an extremely powerful symbol to me. I felt for him, but also I wanted to do whatever I could do to not be in that position.”

Insulin resistance: The warning light

Insulin resistance is fancy terminology for describing the warning light that comes on to alert you that changes are happening in your body and that something needs to be done.

When you are healthy, you can process carbohydrates easily. They get eaten, digested into glucose and enter the bloodstream to make its way to all the cells in your body that require it for energy. The pancreas detects glucose in the bloodstream and releases a hormone called insulin to allow the ‘lock’ on your cell doors to be opened. This is often why insulin is described as a key.

Insulin resistance refers to those locks becoming rusted and making it more difficult for the glucose to enter your cells. You can be living with insulin resistance for many years, with no knowledge that anything is wrong. As Graham said, it can be silent.

Over time insulin resistance means your pancreas needs to work really hard. You may start to notice symptoms and be diagnosed with either pre-diabetes or type 2 diabetes. If left untreated you leave yourself open to the serious complications of diabetes.

Reducing the risk of diabetes complications

We know it’s tough to be given a diagnosis of pre-diabetes or type 2 diabetes, but it is a huge opportunity to address things early on.

“If you act early, the changes you need to make are small and you will barely notice them,” says Graham. 

“But the longer you let it go, the bigger the changes need to be. Visit your GP, health professional or diabetes specialist and ask what could happen if you don’t act now. Ask your mates if any of them have diabetes. I guarantee there will be more out there than you think, and they will tell you the same. Go to a specialist and listen to what they say, then act on it.”

Although insulin resistance and type 2 diabetes has a genetic component, along with other factors you can’t change, there are some things you might be able to address. Unfortunately, as we age we simply cannot continue to live a life full of extremes, at least not without consequences.

Think about your diet, exercise, reducing stress and sleeping well. These are all things that can act as the WD40 to help reduce the rusting. In other words, they help reduce insulin resistance. You have the power, especially in the early stages, of significantly reducing your risk of diabetes complications in the future. You could even potentially turn things around.

“Good luck, but if you make changes now, as early as possible, you won’t need luck. There is an incredible support structure out there, tap into it and listen!” says Graham.

It is the fourth anniversary of the KeepSight program this year and the important work that has been accomplished to date would not have been possible without the support of the optometry sector. 

KeepSight is Diabetes Australia’s initiative to reduce the prevalence of vision loss and blindness amongst people with diabetes. With the support of the eye care sector, the program encourages people with diabetes to sign up to KeepSight to receive a reminder when their diabetes eye check is due. 

To celebrate the anniversary, Diabetes Australia sat down with nine optometrists to hear their stories and why they think KeepSight is important. 

Specsavers 

Babara Vermeulen 

Specsavers – Victor Harbor SA 

“KeepSight is a perfect example of optometrists putting their patients first and doing all they can to protect their sight and prevent vision loss that could have been avoided. As an optometrist who cares deeply about early intervention and looking after my patients, I am proud to support KeepSight and recommend it to all of my patients with diabetes.” 

Greeshma Patel 

Specsavers – Sydney NSW 

“As an optometrist who has seen the impact of diabetes related vision loss in my own family, I am very aware of how devastating and sudden these complications can be. There are many appointments involved in managing diabetes with various health care professionals. This means that you may lose track of time between eye examinations. We know that regular eye tests are important to detect early signs of diabetes related eye disease. KeepSight is a simple way to set a reminder for my patients, to ensure they don’t miss these vital checks.” 

Suren Naidoo 

Specsavers – Dapto NSW 

“Changes in the healthcare industry in recent years, especially during and post-COVID, have resulted in patients missing critical healthcare appointments. This is sometimes due to financial constraints, or just because they don’t perceive that they are having any issues with their diabetes or their vision. As a Specsavers optometrist, having an initiative like KeepSight at my disposal gives me a lot more peace of mind that my patients with diabetes will receive timely reminders to keep up their regular appointments, and also provides a reliable educational diabetes resource for them. In my opinion, this pushes us several steps forward in the fight to eliminate diabetes as the leading cause of preventable vision loss in Australia.” 

The Optical Company 

Jack Ma 

The Optical Co – Rutherford NSW 

“The rising prevalence of diabetes places a great burden on our healthcare system. I joined KeepSight as it is a great initiative to allow optometrists the opportunity to fully utilize our scope of practice, and help reduce some of that burden placed on our GPs and specialists, as well as our patients, who are required to attend many appointments. Ultimately, this will improve health outcomes for our population living with diabetes.” 

Richard Shaw 

The Optical Co – Sydney NSW 

“I joined KeepSight because I think it is a great initiate to help improve the visual outcomes of our patients living with diabetes. It is another tool in our arsenal in the fight against diabetic retinopathy and the permanent vision loss associated with it.” 

Sarah Park 

The Optical Co – Sydney NSW 

“KeepSight is a great way to ensure quality eyecare for patients with diabetes. The program allows optometrists to keep a closer relationship with patients with diabetes, helping them ensure they get timely eye health checks to maintain optimal eye health and prevent vision loss related to diabetes.” 

Bailey Nelson

Nino Mistry 

Bailey Nelson – Pacific Fair, Gold Coast QLD 

“I always think of the saying that ‘the world looks a lot brighter through healthier eyes’ and guide my work with this motto. As an optometrist, I seek out opportunities where I can contribute to supporting my patients to maintain good eye health. KeepSight offers another tool for me to do that. It helps me keep an eye on my patients’ eye health and gives that additional tool to support their diabetes management journey.” 

Sarah Golfis 

Bailey Nelson – Claremote, Perth WA 

“As an optometrist, I have seen the devastating long-term effects of poorly controlled diabetes on people’s vision. More often than not, a lot of this could have been prevented or detected earlier with regular eye examinations. When life gets busy, it’s easy to forget when you are due for appointments. KeepSight reminds people with diabetes about getting their annual eye exam. I believe it is so important to empower people with diabetes to understand their condition and be involved in their care.” 

Shalini Nanayakkara 

Bailey Nelson – Charlestown, Newcastle NSW 

“Diabetes is a multifactorial condition placing pressure on a patient to make thousands of decisions in a single day. KeepSight focuses on regular reminders and wide scale population screening to relieve this pressure and ensure those living remotely are never left out. 

They have increased opportunities for early detection by linking optometrists to GPs, endocrinologists and diabetes educators in team care arrangements. In doing so, they significantly reduce the public health burden. Having worked regionally, and as an advocate for preventative and holistic care, I view KeepSight as integral to patient management.” 

Thank you to the more than 1,100 optometrists who have joined KeepSight – Diabetes Australia’s national diabetes eye check reminder program. With your help we are making it easy for people with diabetes to receive regular reminders when their diabetes eye check is due. We know that diabetes can cause blindness, but 98% is preventable with early detection. is the support of the optometry sector is a key contributor to the incredible success of KeepSight over the last four years. 

Thank you to all the KeepSight optometrists for uniting with us in the fight against diabetes-related eye complications. 

New data from Diabetes Australia reveals people in the Northern Territory are more than four times more likely to be hospitalised with diabetes-related kidney disease than people living in Northern Sydney.

The data, which is modelled on figures from the Australian Institute of Health and Wellbeing’s report Geographical variation in disease: diabetes, cardiovascular and chronic kidney disease, revealsthat the 10 Primary Health Networks reporting the highest rates of diabetes-related kidney disease are all in regional and remote areas.

Diabetes Australia Group CEO Justine Cain says the findings demonstrate an urgent need for a National Diabetes Kidney Disease Screening Program to be established.

Ms Cain said the pattern of regions being hardest hit by kidney hospitalisations highlights the need to improve early detection and treatment of chronic kidney disease.

“Diabetes is one of the leading causes of chronic kidney disease, with more than 330,000 people living with both conditions,” Ms Cain said.

“The impact of diabetic kidney disease (DKD) on hospitalisations points to an urgent need to increase rates of kidney checks among people living with diabetes.

“Australians living in regional and remote areas do not have access to the same health services as those in metropolitan areas and they’re paying a heavy price for that in terms of their kidney health.

“There are a number of effective interventions and medications that can prevent or slow the progress of kidney disease but early diagnosis is essential so treatment can start when it’s most beneficial.”

Although the Northern Territory PHN was the worst affected health district reporting 648 hospitalisations for diabetic kidney disease per 100,000 people, Western Queensland (359), Hunter New England and Central Coast (340), North Coast (327), Central Queensland and Sunshine Coast (315), Northern Queensland (296), Darling Downs and West Moreton (289), Country WA (278), Murrumbidgee (275) and Murray (270) PHNs topped Australia’s health districts for diabetic kidney disease hospitalisations.

Kidney Health Australia CEO, Chris Forbes said investment in early detection and management would greatly improve the lives of people living with diabetes and kidney disease, while also saving billions of dollars long-term for the health system.

“Kidney Health Australia recently released a Deloitte Access Economics report into the cost of chronic kidney disease on the health system, which found every dollar invested in early detection and prevention returns around $45,” Mr Forbes said.

“The time is now to invest in protecting more Australians from reaching kidney failure and provide more supports to those already living with the burden of this disease.”

Joseph Kizana, 58, is grateful that his nephrologist started him on dialysis while he still had some kidney function left. His specialist wanted Joseph to avoid further problems before they developed.

Joseph has experienced his unfair share of diabetes complications. Diagnosed with type 2 diabetes at 27, Joseph did his best to ignore the condition but six years after he was diagnosed, he was admitted to hospital with heart irregularities.

That was the start. Joseph developed kidney disease, damage to his eyes, peripheral neuropathy causing nerve pain and numbness in his hands and feet, and eventually his right foot was amputated.

Now Joseph is on dialysis three times a week for five hours each day. He is unable to have a kidney transplant as his heart function is too poor.

Ms Cain said Diabetes Australia was concerned about the low rates of annual kidney disease screening among people living with diabetes.

“We know that only one in four people living with diabetes are getting their kidneys checked within the recommended timeframe,” she said.

“Our message for people living with diabetes is simple. Make an appointment to get your kidneys checked today. Your best chance of delaying chronic kidney disease is by catching problems early.”

Studies looking at oral insulin, new ways of delaying type 1 and type 2 diabetes, and preventing diabetes-related complications such as blindness are among the 35 Diabetes Australia Research Program grants being funded this year.

Diabetes Australia Group CEO Justine Cain said she was delighted to announce funding for these potentially game-changing projects that could improve the lives of the nearly 1.5 million Australians who live with diabetes.

“These research projects create hope for people living with diabetes and provide vital funding to help ensure Australia’s best and brightest researchers want to work in diabetes research,” Ms Cain said.

“Diabetes is a complex condition impacting almost every organ in the body which makes it a very diverse area of research and the projects we are funding represent that diversity and complexity.

“For instance, a Diabetes Australia Research grant will support research into how changes in the gut health of babies could contribute to the development of type 1 diabetes later in life. This could pave the way for new treatments to prevent type 1 diabetes.

“Another study will look at ways of preventing the pancreas from ageing, which could be a step towards new treatments to prevent type 2 diabetes.

“Diabetes-related complications are one of the most devasting impacts of the condition and we are supporting studies looking at ways of improving outcomes in foot, heart and kidney complications. 

“The program is also funding research into emerging issues including the impact of COVID-19 on people living with diabetes.”

See the table below for a full list of successful researchers and their projects.

This year’s researchers are working in universities and institutes around Australia, including Monash University, University of Tasmania, Baker Heart and Diabetes Institute, Garvan Institute of Medical Research, University of Newcastle, Menzies School of Health Research, James Cook University, The Council of the Queensland Institute of Medical Research (QIMR Berghofer), University of Queensland, Flinders University, University of Adelaide, Deakin University, St Vincent’s Institute of Medical Research, University of Melbourne, and the University of Western Australia.

Chair of the Diabetes Australia Research Trust, Lucy Brogden AM, said the Diabetes Australia Research Program was established 36 years ago to support and develop diabetes-related research across Australia.

“Over the past 12 years the program has provided more than $36 million to support diabetes research,” Mrs Brogden said.  

“The successful research recipients have been chosen after a competitive, peer-reviewed selection process to ensure that we’re getting the maximum return of investment to ensure the biggest impact on the lives of people living with diabetes.

“We will continue to fundraise and invest in diabetes research to improve the quality of life for people living with diabetes and work towards prevention.”

People can help the Diabetes Australia Research Program fund more vital diabetes research by joining our regular tax deductible giving program. Click here for more details.

RESEARCHER	INSTITUTE	PROJECT
Dr Jennifer Snaith	Garvan Institute of Medical Research	Reducing Cardiometric Risk with Semaglutide in Type 1 Diabetes (The RESET1 Study)
Dr Emily Cox	University of Newcastle	Enhancing Exercise Prescription and Adherence for Type 2 Diabetes Management for Adults with Long-COVID
Dr Soren Madsen	University of Sydney	Cross Species Analysis of Hepatic Steatosis
Dr Stewart Masson	University of Sydney	A genetic α-defensin variant provides mechanistic insight into the host-microbiome interaction that controls whole body insulin sensitivity
Dr Hooi Hooi Ng	University of Sydney	Redox Regulation of the Na+-K+ Pump ß1-subunit in Diabetes-induced Vascular Calcification
Associate Professor Natasha Rogers	University of Sydney	Ageing and beta cell dysfunction – can the endocrine pancreas be saved?
Associate Professor Melkam Kebede	University of Sydney	Understanding the heterogeneity of insulin secretory granules
Dr Stefanie Puszka	Menzies School of Health Research	Towards the development of a family-based approach to type 2 diabetes care in First Nations communities in the Northern Territory
Professor Jonathan Golledge	James Cook University	Assessing a novel drug therapy for ischemic ulceration
Dr James Krycer	The Council of the Queensland Institute of Medical Research (QIMR Berghofer)	Using organoids to elucidate how muscle contraction improves insulin action
Associate Professor Emma Hamilton-Williams	University of Queensland	Gut microbial metabolites during early-life development as predictors of islet autoimmunity
Professor Jamie Craig	Flinders University	Developing genomic predictors for diabetic retinopathy
Dr Vida Bitarafan	University of Adelaide	Combining lauric acid and tryptophan to lower postprandial blood glucose and reduce food intake in type 2 diabetes – developing a novel, nutrient-based management strategy
Dr Chinmay Marathe	University of Adelaide	Cardiac Autonomic Neuropathy in Indigenous Australians with Diabetes and Pre-Diabetes
Professor Chris Rayner	University of Adelaide	Impact of renal ‘sweet taste’ sensing on the risk of dysglycaemia
Professor Gary Wittert	University of Adelaide	Improving chronic disease outcomes remotely with a digital nudge in individuals with type 2 diabetes
Associate Professor Tongzhi Wu	University of Adelaide	Targeting intestinal bile acid sensing mechanisms to manage type 2 diabetes
Dr Jantina Manning	University of South Australia	Uncovering NEDD4L as a new regulator and potential biomarker in diabetic nephropathy
Dr Dino Premilovac	University of Tasmania	Understanding the role of insulin in the healthy and type 2 diabetic brain
Professor Judy de Haan	Baker Heart and Diabetes Institute	Validating a unique anti-inflammatory therapy to treat heart failure after a heart attack in Type 2 diabetic patients with co-morbid hypertension.
Dr Kevin Huynh	Baker Heart and Diabetes Institute	Plasma lipidomics to assess glucose tolerance and risk of type 2 diabetes
Dr Elizabeth Holmes-Truscott	Deakin University	Perceptions and experiences of social stigma among women with gestational diabetes: An exploratory qualitative study and development of a novel questionnaire employing co-design
Associate Professor Melinda Coughlan	Monash University	Boosting regulatory T cells with kidney-targeted nanoparticles to treat diabetic kidney disease
Dr Tracey Gaspari	Monash University	Pharmacological targeting of IRAP to resolve diabetes-induced cardiovascular complications
Dr Jay Jha	Monash University	Evaluating NOX5 as a promising therapeutic target for diabetic kidney disease
Associate Professor Lisa Moran	Monash University	Addressing type 2 diabetes risk in women with polycystic ovary syndrome (PCOS): A partnership between Monash Health PCOS clinic and Diabetes Victoria Life! community program
Professor Raymond Norton	Monash University	Novel Peptide-Based Inhibitors of Protein Kinase Ce Interactions as Dual-Action Agents for the Treatment of Type 2 Diabetes
Professor Rebecca Ritchie	Monash University	Lifting the Veil: Sex-specific Cardiac Benefits of Next-Generation Glucose-Lowering Therapy
Dr Arpeeta Sharma	Monash University	Inhibiting Complement C5a Receptor1 to Improve Heart Function in Type 2 Diabetes
Dr Chris Tikellis	Monash University	Splice-switching Oligonucleotides Targeting ACE2 for the Treatment of Diabetic k Kidney Disease
Dr Andrew Sutherland	St Vincents Institute of Medical Research	T cell Engineering for Enhancement of T Regulatory Cell Function in Type 1 Diabetes
Dr Garron Dodd	University of Melbourne	Targeting Fibrosis in the Brain: A New Class of Drugs to Treat Type-2 Diabetes
Dr John Karas	University of Melbourne	Oral Insulin
Professor Paul Fournier	University of Western Australia	Does Drinking Water Before and During Exercise in the Heat Increase the Risk of Hypoglycaemia in People with Type 1 Diabetes Mellitus?
Dr Shaun Teo	University of Western Australia	Developing Educational Exercise Resources to Improve Awareness and Knowledge of Type 1 Diabetes within Community Sport Settings

Diabetes is strongly linked to hearing loss. In fact, people living with diabetes are two to three times more likely to experience hearing loss compared to those without diabetes. Hearing loss can have a significant effect on your life. It impacts your ability to communicate and participate in social situations, it can affect learning and job opportunities, and contribute to social isolation and mental health issues. It may also contribute to the development of dementia.

Signs of hearing loss 

• Having to ask others to repeat what they have said
• Difficulty hearing on the phone
• Needing others to face you when speaking
• Finding it hard to keep up with a conversation, especially when there is loud background noise
• Having the television or music on louder than others do
• Struggling to hear the high-pitched or softly spoken voices
• Pain or ringing in the ears 
• Discomfort with loud noises
• Having family and friends question you about whether you have a hearing problem

If you have more than two of the above symptoms, it is time for a hearing check. See your doctor. Loss of hearing can be permanent; however, if you receive timely suitable treatment it may not be. If you experience sudden hearing loss you must go to your local emergency department as soon as possible.   

What can cause hearing loss?  

• High blood glucose levels over time can affect your hearing by causing damage to the blood vessels and nerves you need for hearing. 
• Extreme exposure to noise in the workplace or during leisure activities.  
• Certain chemicals or medications including aspirin, cancer drugs and some antibiotics.  
• Ear infections or a head injury.  
• Hand to arm vibration. 
• A history of hearing loss in the family.  

What can you do? 

• Whatever your age, and regardless of your diabetes type, learn about the relationship between high blood glucose levels and hearing loss. See your healthcare team if you need help keeping your blood glucose levels in target range.  
• Protect yourself from harmful noises by using noise reduction aids such as mufflers. Limit time spent in noisy places. Generally, if you are one meter away from someone and you both need to shout over the noise, then the noise is too loud. It is potentially causing harm.  
• Get your hearing checked. Perform a basic screening check with a free online test. However, for a diagnosis an appointment is needed with an audiologist. If there is a loss of hearing the audiologist can prescribe the appropriate hearing aid. Make this assessment part of your yearly health checks.  

Hearing aids 

Medicare does not offer a subsidy for these devices. However, for eligible people, the Australian Government Hearing Services Program provides free access to hearing services including hearing assessments, information and support, hearing aids and fittings. To be eligible you will need a referral from your doctor and have one of the following: 

• Centrelink pensioner concession card  
• Centrelink sickness allowance 
• Department of Veteran’s Affairs (DVA) pensioner concession card  
• DVA Gold Health Repatriation Card 
• DVA White Health Repatriation Card (for hearing loss) 
• A dependant of a concession card holder 
• Member of the Australian Defence Force  
• Aboriginal and/or Torres Strait Islander over the age of 50 years 
• Children and young adults up to and including 25 years of age under the National Disability Insurance Scheme (NDIS). 

For more information about this program go to www.hearingservices.gov.au, email hearing@health.gov.au or call 1800 500 726. 

Hearing aid banks

Hearing aid banks sell donated and reconditioned hearing aids at a reduced price. The hearing aid bank was established to provide access to subsidised hearing aids for working age hearing impaired Australians who do not otherwise meet the eligibility criteria to subsidised hearing aids under the scheme run by the Australian government. Further information visit hearingaidbank.org.au.

Donate old and unused hearing aids to  companies that specialise in refurbishing them and providing hearing aids to those who cannot otherwise afford them. Such companies include Sound Fair Victoria and Recycled Sound

Funding for hearing aids may be possible for over 25-year-olds eligible for the National Disability Services Scheme (NDIS).   

Otherwise, check private health insurance policies for hearing aid cover.  

Hearing loss occurs in all ages for people living with diabetes. Although there are many causes for hearing loss, high blood glucose levels are a contributor. Preventing hearing loss is the key. Managing healthy blood glucose levels and having regular hearing checks by an audiologist should be part of your prevention plan.  

By Amanda Callaghan RN/RM/CDE 

Trish was diagnosed with type 1 diabetes in 1975, at the age of 17. In 1990, during a routine check-up with her doctor, he noticed some changes in her eyes and sent her to an eye specialist.

“I hadn’t noticed anything at all,” she said. “There were no symptoms. But the ophthalmologist said I had diabetic retinopathy.”

The condition, where the tiny blood vessels at the back of the eye are damaged, is the most common eye problem in people with diabetes. In the early stages, it has no symptoms.

KeepSight makes it easier to schedule regular diabetes eye checks.

Trish had to undergo more than 10 rounds of thermal laser therapy, with more than 3000 laser shots in each eye. “It was very painful but being blind would be far more unpleasant,” she said. It turned out the treatment was just in time; not long after it had started Trish had bad haemorrhages in both eyes. “Some of the veins bled and I was completely blind for three months. It was very frightening.”

The laser therapy is used to minimise blood vessel leakage so it saved Trish’s sight. “If the haemorrhaging had happened before I had the laser treatment, I wouldn’t be able to see now.”

Trish’s experience is a warning to the 630,000 Australians with diabetes who are at risk of vision loss or blindness because they aren’t having regular eye checks.

Diabetes Australia is encouraging everyone with diabetes to sign up to KeepSight, a free national program that will remind you when it’s time for an eye test.

Trish’s sight gradually returned as the blood drained from the vitreous gel in her eyes. “I could watch a bit of TV because of the brightness of the screen but it was like looking through black lace curtains,” she said. “I measured my sight returning by watching TV and being able to see more and more. I was so grateful that my sight returned.”

Now 61, Trish has no night or field vision – her close-up peripheral vision. “I can see what I’m looking at but if someone is really close to me on my left or right, I can’t see them. If someone puts their hand out for me to shake, I don’t see it.

“I bump into people all the time at the shopping centre when they cut across me because I don’t see them, which can be embarrassing. I’m a lot more careful with my movements than I used to be.”

Trish, who lives in Melbourne, can still drive but not at night because of her night vision loss. “I crash into things at night all the time, even indoors. We’ve had to install several night lights all over the house.”

But she hasn’t let her vision loss interfere with her life. She still works part time as a business manager – “I’m only in trouble if someone turns out the lights!” – and enjoys spending time with her husband, Steve, two daughters and three grandchildren, aged five, eight and 13.

“My grandchildren are wonderful,” she said. “When we go to the movies, they’ll grab hold of my arm to make sure I don’t trip over in the theatre. The only time my eyes affect me with my grandkids is if I’m on babysitting duties; I have to stay the night because I can’t drive home.”

Trish now gets her eyes checked every six to 12 months and is thankful her condition was caught early. “When I was diagnosed with type 1 it was drummed into me that you need to get your eyes checked every two years. I’m very lucky my doctor saw my eye problem when he did. I think your sight is your most important sense.”

She urges everyone with diabetes to have regular eye tests. “I can’t understand why people don’t get their eyes checked. You can go to an optometrist and they do it for free. It’s such an easy thing to do.”

People registered with KeepSight will also receive important eye health information. “It’s really important to get all the available information,” said Trish. “Knowledge is power. The more you know, the less likely you are to get yourself into trouble. It’s a tragedy that so many people don’t get their eyes checked.”

To find out more and register visit www.keepsight.org.au