Diabetes e-Learning – Aboriginal and Torres Strait Islander health program wins Gold award.

We are proud to announce that Diabetes Australia and Interface learning won gold for Best eLearning Project (industry specific) at the LearnX Awards 2022 for the Diabetes e-Learning – Aboriginal and Torres Strait Islander health program.

The National Diabetes Services Scheme (NDSS) funded program offers a culturally appropriate interactive learning environment for Aboriginal and Torres Strait Islander health workers and practitioners and those health professionals working with Aboriginal and Torres Strait Islander Peoples living with diabetes.

The self-paced program is free of charge and comprises of nine online modules which can be accessed anywhere, at any time. Since its launch in April 2021, the program has had great success, training over 600 health workers and practitioners nationwide.

The LearnX Awards is an annual event run by the LearnX Foundation. The global annual awards program recognises excellence in learning and development across corporate, government, education, non-profit and community service sectors.

You can access the Diabetes e-Learning – Aboriginal and Torres Strait Islander health program via the NDSS website.

Diabetes complications are preventable, but complicated. Throw in the degree of progression of the condition and social, cultural and psychological determinants of health issues, including living in remote and rural regions, dealing with housing stress, and food insecurity, and the risk of diabetes complications significantly increases.

Complications are fundamentally driven by sustained higher blood glucose levels, which can damage the blood vessels and nerves. However there are so many factors affecting a person’s abiltity to manage their blood glucose levels into their safe range, from health literacy, social and emotional wellbeing, to how the systems, including the health system, do or don’t work for them.

This article aims to summarise some of the more common diabetes complication checks and balances, that are required for a person living with diabetes. However this summary is not exhaustive, as anywhere the blood flows through, and to, with sustained high glucose levels, can be damaged.

The end, or the start of a year, can be a good time to remind and or support people living with diabetes to have, question and or plan their necessary checks and balances to prevent diabetes complications. These checks can be referred to as the Annual Cycle of Care (ACC) and include:

• Blood Glucose (HbA1c) check: Every 3 months – yearly
• Emotional wellbeing check-in: Every visit
• Kidney check: Yearly
• Blood fats check: Yearly
• Blood pressure check: 6 monthly
• Eye check: Every 2 years
• Foot check: 6 monthly
• Medication review: Yearly
• Dietary intake check: At least yearly
• Physical activity check: At least yearly
• Smoking status check: Every visit if applicable

Blood Glucose (HbA1c) check – Every 3 months – yearly

The HbA1c is an important blood glucose test that forms part of the ACC. Glycosylated Haemoglobin is abbreviated to HbA1c and is a check that usually involves taking blood from a vein in the arm. However a point-of-care test (POCT) can be performed using machines that analyse a drop of blood from a finger prick. 

The HbA1c reflects the average blood glucose level over the last 10-12 weeks and it is recommended that Aboriginal and Torres Strait islander people living with diabetes have this test every three months unless their GP suggests otherwise. At the very least is should be performed every 12 months as part of the diabetes ACC.

The HbA1c develops when haemoglobin, a protein within red blood cells that carries oxygen throughout the body, joins with glucose in the blood, becoming ‘glycated’. For people living with diabetes this is important because the higher the HbA1c, the greater risk of developing diabetes-related complications. Red blood cells survive in the body for 8-12 weeks before they are renewed. This is the reason HbA1c tests are done at a minimum of three months apart.

The results of an HbA1c test are shown in two ways on the pathology report. They are expressed as a percentage (%) or as a value in mmol/mol. Mmol/mol has been added to pathology results because it is the international way of measuring HbA1c.

Goal for HbA1c for people living with diabetes is:

• 7% or 53 mmol/mol or less

Emotional wellbeing – Every visit

Emotional wellbeing is an important cornerstone of diabetes management. Diabetes distress, feelings of overwhelm, anxiety, trauma and depression can greatly impact the ability to manage diabetes, and engage in behaviours that help prevent complications. Emotional wellbeing check-ins should occur regularly throughout the year and referrals made to social and emotional wellbeing support workers, counsellors or psychologist where needed. Other supports can include caring peers or peer support groups such as the online Diabetes Australia – NSW&ACT ‘Diabetes Yarning Group’.

Kidney check: Albumin to Creatinine Ratio (ACR) – Yearly

Urine ACR is a urine test that forms part of the ACC which identifies early signs of chronic kidney disease, a complication of diabetes. If chronic kidney disease is detected early and managed, kidney function decline can be reduced and may even be reversed. Medicare funded point of care testing of ACR may also be available at Aboriginal and Torres Strait Islander Medical services.

Blood fats check – 6 monthly

Safe ranges of cholesterol and triglycerides in the blood will reduce a person’s risk of diabetes-related complications.

Goals for blood fats for people living with diabetes are:

• Total cholesterol < (less than) 4mmol/L
• Triglycerides < 2mmol/L
• LDL < 2mmol/L 
• HDL > (greater than) 1mmol/L  

Blood pressure check – 6 monthly

Safe blood pressure ranges will reduce the risk of heart attack, stroke, eye and kidney disease.

Goal: 130/80 – 140/90 mmHg or less. 

Eye check – Every 2 years

These eye examinations (sometimes called diabetic retinopathy screenings) identify and prevent damage to the small blood vessels in the back of the eyes. This examination is usually performed by an Optometrist or Ophthalmologist, and can pick up eye damage due to high blood glucose levels and, if found early, can help prevent vision loss.

Foot check – 6 monthly

A foot check (sometimes called a diabetic foot assessment) is recommended to be performed twice a year to check the blood supply and sensation in both feet. Some people will require more regular checks by a Podiatrist. Aboriginal Health Practitioners, Diabetes Educators, Nurses and Doctors can also assist with foot checks. However everyday foot care at home is also really important to educate people living with diabetes on to help prevent foot complications.

Medication review – yearly

A referral from the Doctor (GP) to the Pharmacist (in store or home visit) for an annual medication review is really important. These checks ensure a person living with diabetes is on the correct type and dose of medication to help with their diabetes management but also other health conditions they may have, and helps prevent medication side-effects.

Dietary intake check: At least yearly

These help to identify what is and or isn’t doable in terms of making healthier food and drink choices and or to educate. Dietitians can provide intensive support in assessing and supporting nutritional health and wellbeing, and providing dietary guidance to help manage diabetes. A referral for the dietitian can be provided by the GP.

Physical activity check: At least yearly

These provide an opportunity to review and promote physical activity to optimise diabetes management and wellbeing. Physical activity is not limited to structured exercise, but can include housework, mowing lawns, gardening, fishing and walking on country, any movement that breaks up periods of sitting. The GP can assist with a referral to an Exercise Physiologist.

Smoking status check: regularly

Quitting smoking can help reduce a person’s risk of diabetes-related complications and improve overall health. Support can be found via the Quitline on 13 78 48.

Who can perform the ACC checks?

Many of the checks in the ACC can be performed without a GP present. For example, the pathology tests (blood and urine) can be performed by an Aboriginal Health Practitioner or Nurse. They, along with Diabetes Educators can perform the foot check and measure blood pressure. The GP will need to provide advice regarding the review of medications and checking all the items are complete. An Optometrist is qualified to provide a diabetes eye check recommended at least every two years as part the ACC. 

For most people living with diabetes it is also recommended they visit a Podiatrist once every 12 months for a foot check. 

715 Health Assessment

Aboriginal Health Workers can deliver a free 715 health assessment every 12 months, ~30-45 minutes.  These assessments can help identify any health needs (including diabetes management needs) people in community may have and provide them with Allied Health etc referrals.

For more information on diabetes for the health workforce and or people living with or at risk of diabetes, please head to the Diabetes Australia website here OR call the NDSS Helpline on 1800 637 700 to speak with a health professional.

Interactive learning modules for Aboriginal and Torres Strait Islander health workers to support people with diabetes has been launched via the National Diabetes Services Scheme (NDSS).

The package of online modules has been developed by Diabetes Australia to provide Aboriginal and Torres Strait Islander healthcare workers and practitioners with diabetes information and culturally appropriate resources to support people living with diabetes and their families. Press here to see a video preview about the online modules, and here for a description of the learning modules and Continuous Professional Development (CPD) points.

Diabetes e-Learning Aboriginal and Torres Strait Islander Health: https://www.ndss.com.au/indigenous-health-diabetes-learning  (10 NAATSIHWP CPD points)

Here is a  short preview about the online modules: https://youtu.be/jqMp6PxFfDc

And the online modules media release: https://www.diabetesaustralia.com.au/mediarelease/new-diabetes-online-modules-offer-diabetes-support-and-education/

Diagnostic testing for gestational diabetes during COVID-19

Diabetes Australia, along with the Australasian Diabetes in Pregnancy Society (ADIPS), the Australian Diabetes Society (ADS) and the Australian Diabetes Educators Association (ADEA) have developed some advice for diagnostic testing for GDM during pregnancy in the COVID-19 pandemic.

These changes are intended to limit the number of women attending pathology collection centres and the amount of time spent at pathology collection centres.

Read the advice here.

Diabetes management during COVID-19

Diabetes Australia and the Royal Australian College of General Practitioners have developed some important advice to help GPs support people with diabetes during the COVID-19 pandemic.

This includes important information about helping people with diabetes reduce their risk of developing inter-current illnesses and ensuring they continue to access routine care.

Read the advice here.

Bill Lord, University of the Sunshine Coast

When would you call 000 for an ambulance? When a fall results in a nasty fracture? Concern that labour is progressing so rapidly that you’ll give birth before you can get to hospital? Weakness from prolonged vomiting and diarrhoea?

If you take a look at some Australian ambulance websites, none of these examples meet their definition of a “medical emergency” suitable for an ambulance response. But that doesn’t mean you shouldn’t call for an ambulance in these situations.

In 2016-17, Australian ambulance services attended 3.5 million incidents. These include cases categorised as urgent but not a “lights and sirens” response, as well as transport between hospitals and other health facilities. Only 1.1 million of the incidents, or approximately 37%, were classified as emergencies.

What happens when you call 000?

When someone calls the emergency number and asks for an ambulance, the call-taker typically takes the caller through a computer-based script. They attempt to define the health problem, and determine the response required: lights and sirens, or not.

Call-takers are not medically trained, but use a call screening program to identify the health problem. This system includes non-urgent categories such as “sick person”, which includes complaints such as an earache, sore throat and hiccups.

People may find it easiest to call 000 for a broad range of health problems, particularly after hours. But the deployment of paramedics for non-urgent health problems reduces their availability to respond to medical emergencies and major incidents.

Where are we going wrong?

Media campaigns have been used to educate the public about when it’s appropriate to call an ambulance. Strategies such as the Ambulance Victoria Ambulances are for Emergencies campaign includes stories of lives saved that may have been lost had ambulances been tied up with non-emergency calls.

Health promotion bodies have also highlighted the types of problems that should be considered health emergencies: chest pain, breathing difficulty, altered level of consciousness, sudden numbness, or paralysis of the face or limb.

But attempts to define a “health emergency” often fail to appreciate that the definition is dynamic and depends on context. A complaint of weakness associated with prolonged vomiting and diarrhoea may not be an emergency when you have family support and transport options. But it may be an emergency when the patient is an elderly person living alone without support.

There is also a difference between the patient’s perception of a health emergency and a health professional’s definition. This has been investigated by an Australian study that found patients cannot be expected to accurately evaluate the urgency of a health event. Social and emotional cues are often used to identify medical urgency. Understandably, people may be poorly placed to make rational, informed decisions about care options during a health crisis.

Research on ambulance use in Queensland aimed to understand why people use ambulance services for minor health problems. It found that people who arrived at an emergency department by ambulance had a higher self-reported perception of the seriousness or urgency of their problem than patients who self-presented to hospital emergency departments.

The ambulance users were more likely to believe that ambulance services were for everyone to use, irrespective of the severity of their condition. They were also more likely to believe that arriving by ambulance would lead to priority treatment at the hospital.

One possible explanation for these findings relates to health literacy. Poor health literacy affects the person’s ability to interpret health advice and navigate the health system to identify options for unscheduled care. Low levels of health literacy also limit the effectiveness of interventions that are designed to change behaviour.

Research from the Productivity Commission found the majority of Australians have inadequate health literacy. The proportion is greatest for those with chronic conditions. Even 40% of people with a health-related qualification have inadequate health literacy.

Where can we improve?

Taking into account the difficulties of making crucial decisions during a crisis situation, there are a number strategies which may facilitate more effective use of ambulance resources.

One alternative approach is to use experienced clinicians to screen emergency calls and direct the caller to the most appropriate health pathway.

Several Australian ambulance services have introduced such a system, and the outcome of this screening process may be to dispatch an ambulance, or initiate a home visit by a doctor, nurse or paramedic trained to manage non-urgent health problems.

These systems have been shown to provide effective referral options for cases that don’t represent medical emergencies. Instead of discouraging people to call 000, they use call screening systems to identify emergency cases, which may include those not explicitly listed on ambulance service websites.

If you you’re confident navigating health information, you may find sites such as healthdirect useful. This service uses a web-based algorithm to question the user about the nature of the health problem to direct the patient to local health services based on the nature of the complaint. It also provides a national phone number to contact a registered nurse about your health problem.

But if you’re unsure whether an ambulance is required, it’s OK to call 000 for advice. After all, delaying a call for a serious health problem can lead to a catastrophic outcome.

Bill Lord, Associate Professor in Paramedicine, University of the Sunshine Coast

This article was originally published on The Conversation. Read the original article.