Australian National Diabetes Audit Australian Quality Self-Management Audit

ANDA-AQSMA FINAL REPORT

2018

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ANDA-AQSMA 2018

Australian National Diabetes Audit - Australian Quality Self-Management Audit

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Acknowledgements ANDA-AQSMA 2018 has been supported by funding from the Australian Government Department of Health. ANDA Project Executive

Professor Sophia Zoungas - Project Lead Ms Dimitra Giannopoulos - Project Manager Mr Sanjeeva Ranasinha - Biostatistician A/Professor Arul Earnest - Senior Biostatistician Ms Trieu-Anh Truong - Data Management Officer Dr Eleanor Danek - Clinical Research Fellow Ms Elspeth Lilburn - Secretariat Ms Natalie Wischer - NADC CEO ANDA Scientific Advisory Committee

Professor Sophia Zoungas - Chair A/Professor Sofianos Andrikopoulos A/Professor Wendy Davis Mr Georges Dwyer Professor Barbora deCourten Professor Jeff Flack Professor Jenny Gunton Dr Konrad Kangru Ms Gloria Kilmartin Professor Jane Speight Ms Natalie Wischer A/Professor Jencia Wong We would like to thank the participating diabetes centres and patients for their time and generous contribution to this work.

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Contents

Acknowledgements ........................................................................................................................ v

Contents ........................................................................................................................................vii

Abbreviations and acronyms ......................................................................................................... xi

Foreword ...................................................................................................................................... xiii

Executive Summary ....................................................................................................................... xv

Final Report .................................................................................................................................... 1

Background .................................................................................................................................... 3

Diabetes care in Australia ......................................................................................................... 3

Overview of NADC member centres ......................................................................................... 3

Are there differences between the diabetes centres that participate in ANDA? ...................... 3

Who will access the various diabetes services? ........................................................................ 4

ANDA-AQSMA 2018 ........................................................................................................................ 5

How the project can improve the care of patients with diabetes ............................................. 5

How efficiency of ANDA-AQSMA will be assessed .................................................................... 5

Ethics Approval ......................................................................................................................... 5

Governance ............................................................................................................................... 5

1. Methodology............................................................................................................................. 6

1.1 The dataset ......................................................................................................................... 7

1.2 The softwares ...................................................................................................................... 8

1.3 ANDA-AQSMA coordination ................................................................................................ 8

1.4 Participants ....................................................................................................................... 10

1.5 Data verification and validation ........................................................................................ 12

1.6 Data assumptions, decisions and manipulations .............................................................. 13

1.7 Assessments of Wellbeing, Health Status, Depression & Distress .................................... 14

1.8 Pooled data report ............................................................................................................ 15

1.9 Site data reports ............................................................................................................... 15

1.10 Questionnaires ................................................................................................................ 15

2. Results ..................................................................................................................................... 16

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2.1 Patient Characteristics and Management Methods ......................................................... 16

2.2 Lifestyle ............................................................................................................................ 22

2.3 Medication Use ................................................................................................................ 25

2.4 Patient Self-Care Practices................................................................................................ 26

2.5 Health Services Utilisation ................................................................................................ 27

2.6 Self-Rated Wellbeing ........................................................................................................ 29

2.7 Subgroup analysis - Centre type ....................................................................................... 35

2.8 Subgroup analysis - GDM at a glance ............................................................................... 38

2.9 Questionnaire Results ...................................................................................................... 40

3. Discussion ............................................................................................................................... 41

4. Conclusion .............................................................................................................................. 42

References ....................................................................................................................................43

Appendices

Appendix 1 - ANDA-AQSMA Documents ..…………………………………………………………………………………45

Appendix 2 - ANDA-AQSMA Questionnaires …………………………………………………………………………….95

Appendix 3 - Frequency Count Data …………………………………………………………………………….…………101

Appendix 4 - Missing Data ………………………………………………………………………………………………………115

Appendix 5 - Descriptive Report ……………………………………………………………………..………………………121

Appendix 6 - NADC Guide to Quality Improvement …………………………………………………….……….…185

Appendix 7 - NADC Diabetes Publications & Resource List 2018 ……………..….………………………….193

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Tables

Table 1 - Results at a glance ............................................................................................................ xxi

Table 2 - ANDA-AQSMA 2018 Participating Centres ....................................................................... 11

Table 3 - Data queries ..................................................................................................................... 12

Table 4 - Patient characteristics ...................................................................................................... 16

Table 5 - Country of birth ................................................................................................................ 17

Table 6 - Treatment by diabetes type ............................................................................................. 19

Table 7 - Medication use ................................................................................................................. 25

Table 8 - Use of complementary therapy ....................................................................................... 25

Table 9 - Patient dietary practices .................................................................................................. 26

Table 10 - Patient self-care practices .............................................................................................. 26

Table 11 - Health professional attendance by duration of diabetes ............................................... 28

Table 12 - Current or past psychology/psychiatry treatment and/or counselling .......................... 29

Table 13 - DDS17 questionnaire data by screening question score ................................................ 31

Table 14 - Mean DDS17 scores by diabetes type and year ............................................................. 32

Table 15 - Centre type .................................................................................................................... 35

Table 16 - Demographic data (GDM) .............................................................................................. 38

Table 17 - Country of birth (GDM) .................................................................................................. 38

Table 18 - Treatment (GDM) ........................................................................................................... 38

Table 19 - Glycated haemoglobin (GDM) ........................................................................................ 38

Table 20 - Physical activity (GDM) ................................................................................................... 38

Table 21 - Smoking status (GDM).................................................................................................... 39

Table 22 - Patient dietary practices (GDM) ..................................................................................... 39

Table 23 - Patient self-care practices (GDM) .................................................................................. 39

Table 24 - Health service utilisation (GDM) .................................................................................... 39

Table 25 - Mean Own Health State Rating (GDM) .......................................................................... 39

Table 26 - DDS (GDM) ..................................................................................................................... 39

Table 27 - Questionnaire 1 (Data collection process) responses .................................................... 40

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Figures

Figure 1 - Mean HbA1c (%) by diabetes type ................................................................................. xvi

Figure 2 - Physical activity ............................................................................................................. xvii

Figure 3 - ANDA-AQSMA Project Milestones .................................................................................... 9

Figure 4 - Geographical distribution of participating sites.............................................................. 10

Figure 5 - Diabetes type ................................................................................................................. 17

Figure 6 - Initial visit by diabetes duration ..................................................................................... 18

Figure 7 - Management methods in patients with type 2 diabetes ................................................ 20

Figure 8 - Glycaemic control in patients with type 1 diabetes ....................................................... 21

Figure 9 - Glycaemic control in patients with type 2 diabetes ....................................................... 21

Figure 10 - Physical activity ............................................................................................................ 22

Figure 11 - Influenza vaccination in the last 12 months by age group ........................................... 22

Figure 12 - Pneumococcal vaccination in the last 12 months by age group ................................... 23

Figure 13 - Vaccination status in the last 12 months by diabetes type .......................................... 23

Figure 14 - Smoking status ............................................................................................................. 24

Figure 15 - Methods of smoking cessation of past smokers ........................................................... 24

Figure 16 - Health services utilisation (over last 12 months) .......................................................... 27

Figure 17 - Number of health services utilised (other than diabetes specialist) ............................ 27

Figure 18 - Percentage seen by diabetes educator by diabetes duration & visit type ................... 28

Figure 19 - Percentage seen by dietitian by duration of diabetes & visit type ............................... 28

Figure 20 - BCD: ‘Likely depression’ by diabetes type .................................................................... 29

Figure 21 - Mean Own Health State Rating by diabetes type ......................................................... 30

Figure 22 - Mean Own Health State Rating by management method in type 2 diabetes .............. 30

Figure 23 - Total DDS17 score by diabetes type ............................................................................. 33

Figure 24 - Emotional burden score by diabetes type .................................................................... 33

Figure 25 - Physician-related distress by diabetes type .................................................................. 34

Figure 26 - Regimen-related distress by diabetes type .................................................................. 34

Figure 27 - Interpersonal distress by diabetes type ....................................................................... 34

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Abbreviations and acronyms

ANDA Australian National Diabetes Audit

AQCA Australian Quality Clinical Audit

AQSMA Australian Quality Self-Management Audit

BCD© Brief Case-Find for Depression

CVD Cardiovascular Disease

DDS Diabetes Distress Scale

DDS2 Diabetes Distress Scale - Screening Scale Q1 and Q2

DDS17 Diabetes Distress Scale - Questionnaire Q1-17

DVA Department of Veterans Affairs

GDM Gestational Diabetes Mellitus

HbA1c Glycated Haemoglobin

IQR Interquartile Range

NADC National Association of Diabetes Centres

NDSS National Diabetes Services Scheme

OTC Over the Counter

QoL Quality of Life

REDCap Research Data Capture

SD Standard Deviation

T1DM Type 1 Diabetes Mellitus

T2DM Type 2 Diabetes Mellitus

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Foreword The Australian National Diabetes Audit - Australian Quality Self-Management Audit (ANDA-AQSMA) provides an overview of the clinical status of people with diabetes attending services for diabetes care. Participating diabetes centres and diabetes health care professionals can evaluate their data against their peers, enabling them to identify and implement mechanisms to improve outcomes for their patients. This document reports on ANDA-AQSMA 2018, the sixth ‘Education and Patient Self-care' focused diabetes data collection facilitated by the National Association of Diabetes Centres (NADC). The 2018 collection is the largest to date. Sixty data collection sites participated, with de-identified clinical process and outcomes data collected on 4856 adults attending services for diabetes care over a one-month period in 2018 (May or June). Fifty-two sites provided data using paper forms, six using the web-based forms and two sites from electronic databases. We believe the information contained in this report of pooled data from all sites provides:

i) a unique snapshot of the current wellbeing, education and health care utilisation of people with diabetes attending services for diabetes care in 2018 and

ii) a comparison with previous collections ANDA-AQSMA 2018 has resulted in the collection of substantial data to provide a framework by which quality improvement initiatives could be developed both within diabetes centres and nationally. We hope this report will be widely disseminated. Past feedback from participating sites indicates that changes and refinements to services have been made in response to this benchmarking activity. In this undertaking we acknowledge the generous support of the Australian Government Department of Health, who provided the funding necessary to undertake ANDA-AQSMA 2018. The ANDA Project Executive and Scientific Advisory Committees would like to thank all the dedicated multidisciplinary teams who have participated and thus contributed to this report. Professor Sophia Zoungas Project Lead On behalf of the ANDA Project Executive and Scientific Advisory Committees E-mail: anda@nadc.net.au

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Executive Summary The biennial Australian National Diabetes Audit - Australian Quality Self-Management Audit (ANDA-AQSMA) is an important quality activity for services providing diabetes care across all states and territories of Australia. Participating diabetes services receive an individualised report of their diabetes practice processes and patient outcome data in comparison with their peers. In addition, the pooled national report is an important source of cross-sectional data on the self-management practices and outcomes of people with diabetes attending services across the country. The analysis of data from all participating centres forms the basis of this report. Every effort was made to ensure data were complete and correct prior to pooling and analysis. Specifically, centres were given an opportunity to supply any missing data and to validate questionable data, this reduced missing data rates. After site review and correction, any remaining questionable data were excluded from analysis. All identified duplicate records were removed. Unless otherwise indicated, outcomes are reported as the percentage of patients who answered the question, not the percentage of the total patient group. Pooled data have been grouped according to the various aspects of a patient’s health status and clinical characteristics.

ANDA-AQSMA

Health professional attendance

Medication use

Patient self-care practices

Demographics

Lifestyle issues

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ANDA-AQSMA 2018 included participating centres from every state and territory. This was the largest ANDA self-management audit to date, with data collected from 4856 adult patients across 60 diabetes centres.

Patient Characteristics, Diabetes Type and Management

In ANDA-AQSMA 2018: • Males and females were equally represented • The mean (±SD) age was 56 (±18) years • 5% of patients identified as Aboriginal/Torres Strait Islander • 67% of patients reported that they were born in Australia • 5% of patients required an interpreter for completion of the survey • 66% of patients had type 2 diabetes and 26% had type 1 diabetes • The median (IQR) duration of diabetes was 12 (5 to 20) years

Glycaemic Control

Improving glycaemic control is known to reduce the risk of complications of diabetes. The Australian Diabetes Society recommends a general HbA1c target of less than or equal to 7.0%, although targets should be individualised1.

• The mean (±SD) HbA1c of all patients was 8.2% (±1.8) and slightly higher in those with type 1 diabetes (mean HbA1c (%) 8.5±1.6) than those with type 2 diabetes (mean HbA1c (%) 8.2±1.8) (Figure 1)

• The mean HbA1c over time has varied very little (8.3% in 2016, 8.2% in 2014 and 8.3% in 2012)

Figure 1 - Mean HbA1c (%) by diabetes type

Management methods

Management methods varied by diabetes type.

• 91.4% of those with T1DM were managed with insulin alone • Those with T2DM were most likely to be managed with insulin and tablets (40.5%) or

tablets only (32.6%) • Those with GDM were most likely to be managed with diet only (52.6%)

0%

2%

4%

6%

8%

10%

12%

T1DM T2DM

HbA1c (%)

Diabetes Type

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The prevalence of adjuvant non-insulin injectables among all diabetes types was similar to previous years. In patients with type 1 diabetes, 0.6% reported use of non-insulin injectables in addition to insulin and 0.4% reported use of non-insulin injectables in addition to insulin and tablets. In patients with type 2 diabetes, 0.8% reported use of non-insulin injectables in addition to insulin and 6.3% reported use of non-insulin injectables in addition to insulin and tablets.

Physical Activity and Nutrition

Lifestyle modification is the foundation for management of diabetes, with physical activity and a healthy diet important for both weight management and glycaemic control. Even where comorbidities such as ischaemic heart disease are present, access to safe and appropriate physical activity advice or programs should be made available to patients2.

Cardiovascular Risk Factors

Cardiovascular disease is the primary cause of death and disability for people with diabetes3. Control of cardiovascular risk factors forms a fundamental part of management of people with diabetes.

• Over half of patients reported that they do not engage in sufficient physical activity (150 total minutes per week) (54%)

• One third of patients reported they have trouble following their recommended diet. For these patients, barriers to appropriate food choices were:

• Time to prepare meals (34%) • Cost of food (31%) • They did not know what foods are best to eat (25%) • Those with T1DM - difficulty counting carbohydrates and weighing food (51%)

• 46% of all patients had attended a dietitian in the last 12 months • Current smoking was reported by 13% of patients, the same as 2016 • Of those who were currently smoking, three quarters (76%) reported that they had tried

to stop smoking

Figure 2 - Physical activity

Vaccination

Annual influenza vaccination is recommended for people with diabetes4.

• 65% of patients reported that they had been vaccinated against influenza in the last 12 months

• In those aged 60 years and over, 77% reported vaccination against influenza in the last 12 months

46%

39%

15%Sufficient

Insufficient

Sedentary

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Medication Use and Monitoring

Regular monitoring of blood glucose levels and adherence to prescribed medications are two important aspects in the self-management of diabetes.

• Of those using insulin or other injectable medications (incretin mimetics), the majority (96%) reported that they rotate their injection site

• The majority (93%) of patients reported that they usually take all of their medications and 73% reported that they do not ever forget to take their medications

• 30% of patients reported that they do not test their blood glucose levels as often as recommended. However, only 4% of patients were unsure of how often they should monitor their blood glucose levels

• 27% of patients reported use of complementary therapy or dietary supplements, and most of them (84%) had reported this use to their health care provider

Health Services Utilisation

Comprehensive care of people with diabetes requires a multi-disciplinary approach. This facilitates optimal diabetes control for prevention of complications and early identification and management of complications when present. In the last year:

• 74% had attended a diabetes educator and 70% a diabetes specialist • 69% reported that they had attended an optometrist, 36% an ophthalmologist and 25%

had seen both an optometrist and ophthalmologist • 57% reported that they had attended a podiatrist, 46% a dietitian, 46% a dentist, 13% a

psychologist, 7% a social worker and 10% an exercise physiologist • Health service utilisation appeared similar to previous years (2016, 2014 and 2012)

Patient Wellbeing and Quality of Life Assessment

Depressive symptoms and diabetes related distress are thought to have an impact on diabetes outcomes and optimal self-management5.

• 26% of patients were found to have ‘likely depression’, using the Brief Case Find tool (BCD©i)6

• This proportion was similar in patients with type 1 and type 2 diabetes and unchanged over the last 4 surveys

• Of those with ‘likely depression’ on the BCD: • 36% were on antidepressants • 21% were currently seeing a psychologist/psychiatrist • 14% reported taking both antidepressants and currently seeing a psychologist/

psychiatrist • 43% reported taking antidepressants or were currently seeing a psychologist/

psychiatrist • 48% had reported seeing a psychologist/psychiatrist in the past

i BCD©1993 Monash University Department of Psychological Medicine

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Diabetes Distress (Diabetes Distress Scale 17)

The DDS2 screening scale, consisting of two screening questions, was used to identify with high accuracy those at risk of diabetes distress. Those screening positive on the DDS2 screening scale were to complete a thorough assessment using the Diabetes Distress Scale 17 (DDS17 Appendix 1)7-9.

• 36% of patients were identified as at risk of diabetes distress. Of those who were at risk, 87% completed the DDS17 questionnaire

• Of those who were identified as at risk of diabetes distress AND completed the DDS17 questionnaire:

• 17% were experiencing high diabetes distress • 31% were experiencing moderate diabetes distress • Emotional burden was the sub-scale area in which the greatest proportion of

patients experienced high distress, affecting 34%

Self-Assessed Health Status (Own Health State Rating)

Patient self-assessed health status was measured using the Visual Analogue Scale of the EQ-5D, as in previous collections. Patients indicated their ‘Own Health State Rating’ on the day of completion on a scale of 0 to 100.

• The mean (±SD) ‘Own Health Status Rating’ was 66.7 (±19.9) in all patients, similar in patients with type 1 diabetes (67.9±19.2) and type 2 diabetes (65.6±20.1)

Key findings and recommendations

The Australian National Diabetes Strategy 2016-202010 encourages consideration of current approaches to diabetes services and care with a focus on reducing diabetes-related complications and improving quality of life among people with diabetes. In this context, we provide the following summary of key self-care indicators and process recommendations:

• Diligence is recommended in clinical assessment of important aspects of patient self-care such as those highlighted in this report, to identify areas where patients may need to be educated/re-educated and supported

• Improved access to appropriate professional advice and education on lifestyle modification may increase engagement with lifestyle measures. This should focus on counselling patients on safe strategies to achieve sufficient physical activity, and on consumption of healthy meals which are affordable and easy to prepare

• Uptake of lifestyle modification may be enhanced by improved routine access to dietitian consultation and exercise programs in diabetes centres

• Ongoing support for smoking cessation remains a priority in the care of patients with diabetes who continue to smoke

• Regular assessment of medication use and blood glucose monitoring. Clinicians should assist patients to identify barriers to meeting recommendations and facilitate improvements in patient self-care practices

• Increased utilisation of podiatry services, which play an important role in education on foot care, screening for and management of diabetes related foot disease

• Assessing for diabetes distress using a tool such as the Diabetes Distress Scale is a key part of standard care. We encourage sites that are not routinely assessing for diabetes distress to incorporate the Diabetes Distress Scale into their practice

• Routine access to psychological support may improve wellbeing for patients attending diabetes centres

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We recommend that:

• The information provided in this report and the individual site reports be used to reinforce successful strategies where areas of strength are identified, and to facilitate clinical practice improvements in areas which need improvement

• The NADC facilitates development of useful resources to assist with clinical practice improvements on the NADC website and links to evidenced based quality improvement programs, especially focussing on lifestyle modification, diabetes distress and ‘likely depression’

• ANDA-AQSMA continue as a regular diabetes audit activity in services providing diabetes care, to be run in alternate years to ANDA-AQCA. This will allow centres to measure the impact of health care improvement initiatives

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Summary of Results

Table 1 - Results at a glance

Item no. on data collection form

Field %/Mean±SD

(n=4856) Demographics

Age (calculated) 55.7 ± 17.5

1.2 Sex - males 51.3

1.2.1 Pregnant (females 18-55 years) 29.2

1.4 Initial visit 18.3

1.5 Aboriginal/Torres Strait Islander 4.5

1.6 Interpreter required 4.5

1.7 DVA 1.4

1.8 NDSS 91.7

Diabetes type and management

2.2 Type of diabetes

T1DM 25.9

T2DM 65.7

GDM 5.1

Don't know 1.8

Other 1.4

Duration of diabetes (calculated) (median(IQR)) 12 (5 to 20)

2.3 Management method

Diet only 6.6

Tablets 22.3

Insulin 32.8

Insulin & tablets 29.8

Insulin & injectables 0.7

Injectables 0.1

Injectables & tablets 3.3

Insulin & tablets & injectables 4.3

2.3.1 How long ago insulin started (only patients using insulin)

<1 year 15.6

1-5 years 22.6

>5 years 61.8

2.4 Physical activity

Sufficient 46.3

Insufficient 38.6

Sedentary 15.2

2.5 Flu vaccination 64.5

2.6 Pneumococcal vaccination 13.0

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Item no. on data collection form

Field %/Mean±SD

(n=4856) 2.7 Smoking status

Current smoker 13.1

Past smoker 36.0

Never smoked 51.0

2.7.1 Current smoker - Tried to stop smoking 76.0

2.7.2 Past smoker - Methods to stop smoking

Just stopped 79.2

Medication 5.9

Nicotine replacement 8.1

Hypnosis 1.4

Acupuncture 0.1

Other 3.7

2.8.1 Glycated haemoglobin (%) 8.2 ± 1.8

2.8.2 Glycated haemoglobin (mmol/mol) 66.3 ± 19.8

Medication Use

3.1 Ever forget to take medication 26.7

3.2 Usually take all medications 93.3

3.3 Sometimes stop taking medication when feeling better 5.1

3.4 Sometimes stop taking medication when feeling worse 6.5

3.5 Use complementary therapy or dietary supplement or OTC Rx 26.9

3.5.1 Told doctor/educator about complementary, dietary supplement, OTC Rx (if applicable)

83.8

Health Professional Attendances

4.1 Podiatrist 56.6

4.2 Diabetes educator 74.1

4.3 Dietitician 46.2

4.4 Psychologist 13.3

4.5 Social worker 6.9

4.6 Diabetes specialist 69.7

4.7 Ophthalmologist 35.6

4.8 Optometrist 68.6

4.9 Dentist 45.7

4.10 Exercise physiologist 10.1

Patient Self-Care Practices

5.1 Difficulties following recommended diet 35.4

5.1.1 Don't have enough time to prepare healthy meals 33.9

5.1.2 Costs too much to eat well 30.8

5.1.3 Don't know what foods are best to eat 25.4

5.1.4 Eat out a lot and find it hard to eat well 21.9

5.1.5 If T1DM - It is too hard to count carb/weigh food 53.5

5.2 Check blood glucose level as often as recommended 69.8

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Item no. on data collection form

Field %/Mean±SD

(n=4856)

5.3 Rotate injection site, if on injectables or insulin 96.0

Brief Case-Find For Depression (BCD)

6A.1 Having restless or disturbed nights 49.9

6A.2 Feeling unhappy or depressed 31.5

6A.3 Feeling unable to overcome difficulties 18.8

6A.4 Dissatisfied with their way of doing things 23.2

Treatment

6B.1 Taking antidepressants 18.6

6B.2 Psych. Treatment/counselling - past 26.8

6B.3 Psych. Treatment/counselling - current 9.4

Quality of Life Assessment

7.1 Own health state rating (0-100) 66.7 ± 19.9

7.2 Screening scale Q1 2.0 ± 1.2

7.3 Screening scale Q2 2.1 ± 1.3

Diabetes Distress Scale 17 (where Screening scale Q1 or Q2 ≥3)

7.4 DDS 17 questionnaire completed 86.9

7.4.1 Total DDS 17 Score 2.2 ± 0.9

7.4.2 Emotional Burden 2.7 ± 1.2

7.4.3 Physician-related Distress 1.5 ± 0.9

7.4.4 Regimen-related Distress 2.5 ± 1.1

7.4.5 Interpersonal Distress 2.0 ± 1.2

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ANDA-AQSMA 2018 Australian National Diabetes Audit

Final Report

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Background Diabetes care in Australia The National Association of Diabetes Centres (NADC) established in 1994 is a national collective of diabetes centres brought together by a common desire to see improvement in the standard of diabetes care in Australia. With a focus on proactive maintenance of good health and prevention of complications, NADC diabetes centres aim to provide integrated care and to bridge the gap between the acute care hospital system, and the long-term chronic care provided by primary care and community-based services. The NADC facilitates the ANDA initiative as part of monitoring and improving quality of care. NADC was created to establish and promote effective health care practice and, ultimately, to achieve better outcomes for people with diabetes. In particular, the development of standards of care and quality review initiatives, information provision, and training and support for health professionals.

Overview of NADC member centres In 2018 there were 117 NADC member diabetes centres across Australia and these are found working in a range of locations and facilities from major metropolitan adult and children’s hospitals to community-based services including general practices and pharmacies.

Are there differences between the diabetes centres that participate in ANDA? There are 6 membership levels of NADC:

1. Centres of Excellence Recognised diabetes centres that have demonstrated excellence in education, research, service delivery, practice/policy development and education. These centres must be tertiary level facilities.

2. Tertiary Care Diabetes Services

NADC centres that have the full range of diabetes service providers including endocrinologists, diabetes nurse educators, dietitians and podiatrists on staff (full-time) and who have demonstrated a high standard of care through service delivery and organisational capacity and have been accredited by the NADC.

3. Secondary Care Diabetes Services These services have a range of full and/or part-time diabetes staff but often do not have an endocrinologist as part of their usual team. They may be working toward accreditation as a Tertiary Care Diabetes Service.

4. Primary Care Diabetes Services These centres have part-time staff and work closely with the local general practitioners to provide care for people with diabetes.

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5. Pharmacy Diabetes Services These centres have staff that have received training and/or have expertise in diabetes and work closely with the local general practitioners and allied health staff to provide additional care and services for people with diabetes. NADC Pharmacy Diabetes Service membership is offered to groups of professional healthcare workers who have an active involvement in diabetes care provided in the pharmacy context, and are committed to the goals and objectives of the NADC and to monitoring the outcomes of their service, but do not have the full complement of services or resources of a larger diabetes service.

6. Network Members The NADC Network membership is offered to Primary Health Networks (PHNs) and Primary Care Partnerships (PCPs) around Australia. PHNs and PCPs work directly with general practitioners, other primary health care providers, secondary care providers and hospitals, to facilitate improved outcomes for patients. PHNs and PCPs are committed to providing efficient and effective primary health care, with objectives that align closely with those of the NADC.

NADC membership distribution in 2018

Centre Types Registrations Centres of Excellence 5 Tertiary Care Diabetes Services 44 Secondary Care Diabetes Services 24 Primary Care Diabetes Services 32 Pharmacy Diabetes Services 3 Network Members 9

Who will access the various diabetes services? Most patients referred to Tertiary Care Diabetes Services, including Centres of Excellence, are referred by their general practitioners so that they may receive specialist assessment and treatment. Given this role, it is probable that people attending Tertiary Care Diabetes Services will be those whose diabetes is less likely to be managed well in the community. In considering the outcomes of this data collection, it is important to remember that whilst Tertiary Care Diabetes Services will provide assessment and treatment, ongoing responsibility for management of diabetes remains with the person with diabetes and their general practitioner.

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ANDA-AQSMA 2018 How the project can improve the care of patients with diabetes The results of ANDA-AQSMA are expected to provide an indication of patient self-care practices and process of care found amongst participating centres throughout Australia. There will likely be wide variation in these findings which may inform areas of practice or knowledge deficit amongst patients, or identify the need for service development or revision. Sharing this information in a Final Report will assist in identifying processes that may be adopted to improve education and clinical care which, once implemented, should result in improved outcomes for people attending those centres.

How efficiency of ANDA-AQSMA will be assessed Efficiency of ANDA-AQSMA 2018 will be assessed in 2 ways:

• The participation rate in ANDA-AQSMA itself • The assessment of responses to the questionnaires

Ethics Approval This is a quality audit exercise utilising coded patient data from coded sites transmitted through a ‘trusted third party’ (the ANDA Secretariat). There is no disclosure of individual patient data. The usual ethics approval for the ANDA-AQSMA data collection will apply, which is, that each site determine how to address this within their individual setting.

Governance Established in 2015, the ANDA Scientific Advisory Committee, provides strategic guidance to ensure the objectives, outcomes and deliverables of ANDA, as specified by the Department of Health are achieved. This committee consists of representatives of key stakeholder organisations including endocrinologists, general practitioners, diabetes nurse educators, consumer representative and the NADC CEO and is working to agreed Terms of Reference with the ultimate vision of assisting ANDA to maintain high visibility, appropriate engagement and relevance for diabetes service delivery.

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1. Methodology The ANDA-AQSMA 2018 Australian National Diabetes Audit data collection process is summarised below:

1. Initial call for expressions of interest from all currently registered NADC diabetes centres (potential sites)

2. Formal invitations to participate and site acceptances (participating sites) 3. Allocation of unique site codes by the ANDA Secretariat in a double blind manner and

distribution of ANDA operational documents 4. Data collection by participating sites 5. Data entry, collation, verification and validation (including missing data query resolution) 6. Data analysis and reporting

The ANDA Secretariat invites diabetes centres and specialist endocrinologists in private practice to participate in the ANDA-AQSMA collection. All contact and correspondence with participating centres/specialist endocrinologists occurs exclusively through the ANDA Secretariat. The ANDA Secretariat provides participating centres with their unique site code and holds the only copy of this code. Sites that have participated in past surveys use their previously allocated unique site code. Sites that have not participated in past surveys are allocated a new unique site code. The central data management/analysis unit generates ‘Master Copies’ of the forms uniquely numbered for each site. The forms are then provided to the ANDA Secretariat who uploads them onto Basecamp Classic, a project management and collaboration system, in a secure file transfer web folder which is set up for each individual site. Each participating site is instructed to make copies (as many as required) of their unique form for use in the survey. Each site’s web folder contains the following documentation (Appendices 1 & 2):

• ANDA-AQSMA Protocol • ANDA-AQSMA 2018 Data Collection form • REDCap Data Entry Manual (for sites completing the web-based data collection form) • ANDA-AQSMA 2018 Data Definitions • ANDA-AQSMA 2018 Data Dictionary • Self-Assessment of Health Status • Diabetes Distress Scale 17 • Diabetes Distress Scale 17 Scoring Sheet • DDS17 Scoring Sheet - electronic • Guide to completing ANDA-AQSMA 2018 • ANDA-AQSMA 2018 Post Data Collection questionnaire • ANDA-AQSMA 2018 Individual Site Report questionnaire

Centres with computerised databases could choose to provide the data electronically. This year REDCap11, a web-based platform, to facilitate electronic data collection was also introduced.

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1.1 The dataset Diabetes data collection is important for monitoring the quality of diabetes care, and in Australia there have been two national diabetes data collections undertaken:

• The National Divisions Diabetes Program (NDDP) data collection: Data collected on people with diabetes attending primary care physicians. This has been assessed twice, in 1999-2000 and 2002-2003

• The ANDA (previously ANDIAB2) data collection. This consists of the ANDA quality clinical audit (ANDA-AQCA) and the ANDA quality self-management audit (ANDA-AQSMA), which are undertaken on alternating calendar years.

o The ANDA-AQSMA was piloted in 2005 and revised for 2010 and subsequent biennial collections. It contains demographic, clinical, self-management and wellbeing data items that have standardised definitions, and has been promulgated for collection in all clinical practice settings

As with previous collections, ANDA-AQSMA 2018 data items used current agreed, preferably national definitions (where in existence), or original National Diabetes Outcomes Workshop (NDOW, now METeOR) dataset definitions12, 13. Data items included were intended to provide relevant information for services specialising in diabetes care about their patients, with a view to instituting change in areas where opportunity for improvement was identified. In ANDA-AQSMA 2018, the same dataset was collected as in ANDA-AQSMA 2016 with the following changes made to improve the quality of data: Added:

- Management method: Insulin and injectables - Year of diagnosis: Unknown - Glycated haemoglobin results: Not available - Medication use: Not applicable - Own health state rating and screening scale questions: Did not complete

Changed:

- ‘Centre ID’ to ‘Site ID’ - ‘Site Staff Identifier’ to ‘Staff initials (optional)’

The data dictionary (indicating field name, field type, format and codes) was updated and made available to all sites (Appendix 1).

2014

38 sites2681 patients

2016

50 sites3930 patients

2018

60 sites4856 patients

8

1.2 The softwares Paper-based data collection - Teleform ©

An application of Teleform© scannable/faxable software has been integrated with a Microsoft SQL Server 2010 running under a Windows 7 operating system V10.9. The Teleform© Designer module allows paper forms to be designed and printed. Once completed by sites, forms are mailed to the ANDA Secretariat at the Alfred Centre, 99 Commercial Road, Melbourne VIC 3004. The Teleform© Reader module assesses each form and either accepts the form (transferring data to an intermediate Access© data file), or suspends the form for verification of one or more data items that the Reader software cannot confidently identify. The Teleform© Verifier module allows an on-screen version of the scanned image to be viewed, and corrections made where necessary. Once such corrections are made and accepted, data from these forms are transferred and stored in the central ANDA database, hosted on Monash University’s secure network. Data collection forms are stored in a locked room at the School of Public Health and Preventive Medicine, Monash University. Data Extraction

Diabetes centres had the option to extract ANDA data directly from their in-house softwares to transfer via a secure file transfer protocol (SFTP) for collation and analysis alongside scanned form and web-based entered data. Web-based data collection - REDCap

The web-based REDCap11 electronic data capture was introduced for the first time this year.

Study data were collected and managed using REDCap applications hosted at Monash University. REDCap is a secure, web-based application designed to support data capture for research studies, providing: 1) an intuitive interface for validated data entry; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages; and 4) procedures for importing data from external sources.

Branching logic coding was used to skip irrelevant questions. Data validations were put in place to help prevent data entry errors and reduce data queries. Staff were granted access to patients from their sites only.

1.3 ANDA-AQSMA coordination ANDA coordination and conduct is overseen by the ANDA Secretariat and operational group based at the School of Public Health and Preventive Medicine, Monash University in partnership with Monash Health. The major Project Milestones are summarised in Figure 3.

9

Figure 3 - ANDA-AQSMA Project Milestones

January 2018

Revise ANDA-AQSMA Dataset.

February 2018

Revise ANDA-AQSMA Dataset (cont’d).

March 2018

Initial call for expressions of interest. Formal invitations received, collation of site acceptances. April 2018

Formal invitations received, collation of site acceptances (cont’d). Allocation of unique site codes. Generation and distribution of data collection forms and resources.

May 2018

ANDA-AQSMA Data Collection.

June 2018

ANDA-AQSMA Data Collection (cont’d). Study assessment: Post Data Collection Questionnaire. Data received from sites with in-house databases. Data entry and validation. Data queries generated for sites. Integration of returned data queries.

July 2018

Study assessment: Post Data Collection Questionnaire (cont’d). Data received from sites with in-house databases (cont’d). Data entry and validation (cont’d). Data queries generated for sites (cont’d). Integration of returned data queries (cont’d).

August 2018

Study assessment: Post Data Collection Questionnaire (cont’d). Data received from sites with in-house databases (cont’d). Data entry and validation (cont’d). Data queries generated for sites (cont’d). Integration of returned data queries (cont’d).

September 2018

Data entry and validation (cont’d). Data queries generated for sites. Integration of returned data queries cont’d).

October 2018

Final Data Analysis.

November 2018

Final Data Analysis (cont’d).

December 2018

Draft Pooled Data Report. Final Site Data Analysis Reports forwarded to sites.

January 2019

Final Pooled Data Report. Study assessment: Site Report Assessment Questionnaire.

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1.4 Participants In 2018, 67 diabetes centres expressed an interest in participating. Of those expressing interest, data were subsequently received, processed, analysed and reported from 60 sites (Table 2). Two diabetes centres provided data from in-house databases, six sites used the REDCap web-based data collection form and the remainder (52) used paper forms. Seven sites were unable to participate in the audit principally because of a shortage of staff to undertake the data collection.

Centre Types Participating Sites Centres of Excellence and Tertiary Care Diabetes Services 36 Secondary Care Diabetes Services and Primary Care Diabetes Services 24

Figure 4 - Geographical distribution of participating sites

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Table 2 - ANDA-AQSMA 2018 Participating Centres

VICTORIA

Alexandra District Health Alfred Health Austin Health Baker Heart and Diabetes Institute Ballarat Health Services, Diabetes Education Clinic Barwon Health, Diabetes Referral Centre Beechworth Health Service Benalla Community Health Bendigo Diabetes and Endocrine Centre Bendigo Health Castlemaine District Community Health Centre Cobram District Health Gateway Health, Wangaratta Gateway Health, Wodonga GV Health Diabetes Centre Kyabram District Health Service Monash Health, Clayton Monash Health, Dandenong Monash Health Community Nexus Primary Health Northern Health Numurkah District Health Service Royal Melbourne Hospital Seymour Health St Vincent’s Hospital, Endocrinology & Diabetes Tallangatta Health Service Western Health

NEW SOUTH WALES

Blacktown Hospital Diabetes Centre Gardens Medical Group GNS Diabetes Service Healthfocus Family Practice Liverpool Diabetes and Endocrine Service Mount Druitt Hospital, Diabetes Centre Murrumbidgee Local Health District Royal Prince Alfred Hospital St Vincent’s Diabetes Service

Tweed Byron Diabetes Service Westmead Hospital, Diabetes and Endocrinology

QUEENSLAND

Brisbane South Complex Diabetes Service Cairns Diabetes Centre Ipswich Diabetes Service Logan Beaudesert Diabetes Service Princess Alexandra Hospital Queensland Diabetes and Endocrine Centre, Mater Health Redland Hospital & Health Service South West Hospital & Health Service Sunshine Coast Hospital & Health Service, Diabetes and Endocrinology Service Townsville Hospital Whitsunday Doctors Service

TASMANIA

John Morris Diabetes Centre, NICS, Launceston General Hospital North West Diabetes Centre Royal Hobart Hospital, Diabetes Centre

WESTERN AUSTRALIA

Perth Children’s Hospital Royal Perth Hospital Rockingham General Hospital, Endocrinology & Diabetes Service

SOUTH AUSTRALIA

GP Plus Noarlunga, Intermediate Care Diabetes Services Lyell McEwin Hospital (NALHN)

AUSTRALIAN CAPITAL TERRITORY

ACT Health Diabetes Service

NORTHERN TERRITORY

Alice Springs Hospital

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1.5 Data verification and validation As in previous years every effort was made to ensure data completeness and correctness, with specific validation reports generated for each site. All missing data, invalid entries and out-of-range values were queried. Attempts were made to provide sites with the opportunity to improve their data with the generation of these specific reports containing lists of missing or potentially invalid data, as well as possible duplicate individual entries. These were forwarded to the sites through the ANDA Secretariat and returned to the data management centre once reviewed. All sites were sent data queries. One site did not respond. All additional or corrected data items were entered/corrected respectively in the pooled database, prior to final data analysis. Duplicate records, (multiple case record entries for the same patient) were identified and reviewed. The first entry was retained and supplemented by any additional data contained in subsequent entries. All subsequent entries were then deleted from the dataset.

Table 3 - Data queries

(a) Missing vital data fields: A list was generated of all instances of missing data

(b) Potentially invalid data values:

A list was generated to check potential data inaccuracies as follows: 1. Date of visit < Date of birth 2. Year of diagnosis < Date of birth 3. Pregnant and male OR Female <18 or >55years 4. GDM and not currently pregnant 5. T1DM but insulin not indicated 6. Date of diagnosis < Years on insulin 7. T1DM and on insulin ≥3 years after date of diagnosis 8. Rotation of injection site when management method does not include

injectables or insulin 9. DDS17 completed when DDS2<3

(c) Possible duplicates: Identified based on unique ID, sex, date of birth and country of birth match

(d) Potentially incorrect out of range values:

1. Date of visit (May-June 2018) 2. HbA1c (4-20%) 3. HbA1c (20-195 mmol/mol) 4. Screening Scale Q1 and Q2 (1-6) 5. Diabetes Distress Scale 17 score (1.0-6.0)

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1.6 Data assumptions, decisions and manipulations As in previous years, data assumptions and decisions were made based on the following rules:

1. Due to insufficient number of sites including patients under 18 years, results of those patients are not presented in this pooled report, to prevent sites being identified.

2. Missing data were indicated conditionally where relevant: • Pregnancy=Yes, if female, aged 18-55 and GDM indicated • Insulin=Yes, if insulin duration indicated • Date of visit=1/06/2018 if missing • Insulin indicated in management method when insulin duration indicated • Current smoker=Yes when attempt to stop smoking indicated and method of

cessation not indicated • Past smoker=Yes when method of cessation indicated and attempt to stop

smoking not indicated • Complimentary therapy, dietary supplement or over the counter use=Yes when

‘Told doctor of complementary therapy, dietary supplement or over the counter use’ indicated

• ‘Difficulties following recommended diet’=Yes when reasons for difficulty with diet (data collection form fields 5.1.1 - 5.1.5) indicated

3. Clearly invalid data were excluded: • Date of birth > date of visit • GDM and male or female aged less than 18 years or greater than 55 years • T1DM and insulin use not indicated, unless diagnosed in 2017 or 2018

4. Calculations were necessary for the following variables:

• Age • Duration of diabetes • BCD score and likely depression • HbA1c (where measurements were provided just in mmol/mol, these measurements

were converted to percentage form to facilitate uniform analysis of glycaemic control)

GDM Sub-analysis

For the first time in 2018, patients with GDM were analysed separately. This was based on the clinical reasoning that patients with GDM may differ in terms of demographics, clinical management and self-management characteristics compared to patients with chronic forms of diabetes mellitus. To facilitate valid comparison of this year’s results to previous years, the main results section reports on the pooled results of all patient’s including patients with GDM. However, a secondary analysis of patients excluding those with GDM was conducted. Instances where the results from the primary analysis differed from the results from the secondary analysis were explicitly highlighted.

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1.7 Assessments of Wellbeing, Health Status, Depression & Distress

1.7.1. Assessments

Wellbeing was assessed using: i) The Brief Case Find For Depression (BCD©ii) ii) Antidepressant and psychiatric/psychological treatment iii) Own Health State Rating iv) Diabetes Distress Scale 17 (DDS17)

1.7.2 Brief Case Find For Depression

The BCD© is a tool used to calculate whether depression is ‘likely’ or ‘unlikely.’ Using the four questions seen in Section 6A on the ANDA-AQSMA 2018 Data Collection Form (Appendix 1): Relating to the last two weeks:

6A.1 Have you been having restless or disturbed nights? 6A.2 Have you been feeling unhappy or depressed? 6A.3 Have you felt unable to overcome your difficulties? 6A.4 Have you been dissatisfied with the way you have been doing things?

Depression is considered likely if ‘Yes’ is answered to either or both of the first two questions (6A.1 and/or 6A.2) AND ‘Yes’ is answered to either or both of the second two questions (6A.3 and/or 6A.4).

1.7.3 Self-Assessment of Health Status

The mean Own Health State Rating was based on the EQ-5D instrument developed by the EuroQol Group © 2000 (used with permission)14. Individuals were asked to rate their ‘Own Health State Today’ on a visual scale from 0 to 100, where 0 is the ‘Worst imaginable health state’ and 100 is the ‘Best imaginable health state’ (Appendix 1). Diabetes Centre staff then transcribed the result on to the ANDA-AQSMA 2018 data collection form.

1.7.4 Diabetes Distress screening and scoring

The validated Diabetes Distress Scale 17 (DDS17)7-9 was used to assess diabetes-related distress, as in 2016, 2014 and 2012 allowing comparison across years. Detailed instructions on conducting the DDS17 can be found in ‘How to Complete ANDA-AQSMA 2018 Forms’ (Appendix 1). Summary on how DDS17 was completed:

• Two screening questions are first asked • If one or both screening questions are positive; scored as a moderate problem or above

(score ≥3), the patient is asked to proceed to complete the DDS17 questionnaire • The DDS17 yields a ‘Total DDS17’ diabetes distress score, and 4 sub-scores each

addressing a different kind of diabetes distress; Emotional Burden, Physician-related Distress, Regimen-related Distress and Interpersonal Distress

• An electronic DDS17 scoring sheet was available for calculation of the mean Total DDS17 score and the mean subscale scores

We use the revised criteria for interpretation of DDS179 where a mean score of: ii BCD© 1993 Monash University Department of Psychology Medicine (used with permission)

15

• Less than 2.0 indicates little or no distress • 2.0 to 2.9 indicates moderate distress • Equal to or above 3.0 indicates high distress in the relevant fields

Once DDS17 questionnaires were completed and the DDS17 scores calculated (Appendix 1), the Diabetes Centre staff transcribed the results on to the ANDA-AQSMA 2018 data collection form.

1.8 Pooled data report The ANDA-AQSMA 2018 final analysis report of pooled data includes:

• Pooled data (excluding paediatrics) • Subgroup analysis - Centre type • Subgroup analysis - GDM at a glance • Data collection documents (Appendix) • Data frequency counts (Appendix) • Missing data (Appendix) • Descriptive report (data tables and graphs) (Appendix)

Unless otherwise stated, results are reported as the percentage of those who answered the question, not the percentage of the total patient group. Results in written text are rounded to the nearest whole number. Missing Data for ANDA-AQSMA 2018 (Appendix 4) are shown as the number of patients and the percentage missing data of those who should have answered that field (for example: percentage missing data on ‘currently pregnant’ is the percentage missing data of those patients who are female, aged 18-55 years).

1.9 Site data reports A report providing comparison data for their site versus all other sites is generated for each site. Pooled data analysis addressing the outcome findings for all data fields enable sites to compare and benchmark their practice findings against other participating sites. Individual site data reports are generated for all participating sites including:

• Variable frequency counts (including % missing data) • Variable descriptive statistics • Comparative statistics by year of collection

Reports are presented in a standard format as tables and figures divided into the following:

1. Site Report at a Glance 2. National Benchmarking Report 3. Historical Comparison Report 4. Descriptive Report 5. ANDA-AQSMA Data Collection Documents 6. NADC Guide to Quality Improvement 7. NADC Diabetes Publications & Resource List 2018

1.10 Questionnaires Participating sites are asked to complete the first of two questionnaires at the completion of the data collection phase to assess the project overall. The second questionnaire is forwarded with their site report, to assess their response to this report (Appendix 2).

16

2. Results Data provided on a total of 4856 individuals. The secondary analysis excluding patients with GDM (n=4607) revealed that, in general, results did not substantially differ when patients with GDM were excluded from the analysis. Instances where the results from the primary analysis differed from the results from the secondary analysis are explicitly highlighted in the relevant results sections.

2.1 Patient Characteristics and Management Methods

2.1.1 Patient Characteristics

Patient characteristics are summarised in Tables 4 and 5. Important findings include: • The mean±SD age of patients was 56±18 years • Males and females were equally represented • 5% of patients identified as Aboriginal/Torres Strait Islander • An interpreter was required for 5% of patients • 33% of patients were born outside of Australia

Table 4 - Patient characteristics

Category 2012 2014 2016 2018 2018* n 1892 2681 3930 4856 4607

Age (years) 54.0± 16.8

55.0± 17.5

55.3± 17.4

55.7± 17.5

57.0± 17.0

Sex (%) (male) 47.1 50.7 49.7 51.3 54.1 Pregnant (%) (females 18-55 years) 28.8 23.7 24.7 29.2 7.0 Diabetes mellitus duration (years) (median(IQR))

8 (1 to 15)

11 (5 to 19)

12 (4 to 20)

12 (5 to 20)

13 (6 to 21)

Diabetes type (%) T1DM 21.2 26.0 28.0 25.9 T2DM 70.3 67.2 64.9 65.7 GDM 6.7 5.0 5.3 5.1 Unknown 0.3 0.2 0.5 1.8 Other 1.2 1.5 1.0 1.4 Unstated 0.3 0.1 0.2 0.0

Initial visit (%) 27.3 17.0 19.8 18.3 17.5 Aboriginal/Torres Strait Islander (%) 9.7 4.0 4.5 4.5 4.4 Interpreter required (%) 3.5 4.4 3.9 4.5 4.5 DVA patient (%) 0.7 1.1 1.3 1.4 1.5 NDSS member (%) 92.6 93.4 93.0 91.7 92.1

*Excluding patients with GDM

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2.1.2 Country of birth

Australia was the country of birth for most patients (Table 5).

Table 5 - Country of birth

Country n % n* % * Australia 3260 67.1 3096 67.2 England 194 4.0 192 4.2 New Zealand 92 1.9 80 1.7 Italy 78 1.6 78 1.7 India 72 1.5 53 1.2 Greece 57 1.2 56 1.2 Philippines 54 1.1 53 1.2 Sri Lanka 48 1.0 48 1.0 Vietnam 47 1.0 44 1.0 Other 755 15.5 708 15.3 Unknown 199 4.1 199 4.3 Total 4856 100 4607 100

* Excludes patients with GDM

2.1.3 Diabetes Type

Most patients (66%) had type 2 diabetes. One in four patients (26%) had type 1 diabetes (Figure 5). Figure 5 - Diabetes type

0%10%20%30%40%50%60%70%80%90%

100%

T1DM T2DM GDM Don't know Other

Diabetes Type

2012 2014 2016 2018

18

2.1.4 Diabetes Duration

The median duration of diabetes was 12 years. Of patients presenting for an initial visit, the majority had been diagnosed in the previous year (Figure 6). Figure 6 - Initial visit by diabetes duration

2.1.5 Management Methods

Management methods varied based on diabetes type and were similar to previous audits (Table 6). Most (91%) of patients with T1DM were managed with insulin alone. Insulin and tablets were used by 8%, and a small proportion (<1%) reported use of adjuvant non-insulin injectables. Among patients with T2DM (Figure 7), the majority of patients were on insulin (57%), either alone (10%), in combination with tablets (41%), in combination with injectables (1%) or in combination with tablets and non-insulin injectables (6%). One third (33%) were managed with tablets only and a small proportion (5%) were managed with diet alone. In patients with GDM, insulin only remains the mainstay of pharmacological treatment. However, comparison to previous audits suggests an upwards trend in the use of tablets, and in the use of more complex regimens including both insulin and tablets.

0%

10%

20%

30%

40%

50%

<1 1 2-4 5-9 10+Duration of Diabetes (years)

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Table 6 - Treatment by diabetes type

Category 2012 (%)

2014 (%)

2016 (%)

2018 (%)

T1DM Diet only 0.0 0.1 0.0 0.0 Tablets only 0.5 0.4 0.3 0.0 Insulin only 93.8 93.0 90.9 91.4 Insulin & tablets 5.0 5.5 6.9 7.6 Insulin & injectables* NA NA NA 0.6 Insulin, tablets & injectables NA 0.7 0.4 0.4 Injectables only NA 0.3 0.9 NA Injectables & tablets NA 0.0 0.1 NA Nil 0.0 0.0 0.1 NA Unstated 0.7 0.0 0.5 0.0

T2DM Diet only 10.4 7.6 4.5 5.0 Tablets only 37.0 30.7 31.4 32.6 Insulin only 13.0 15.4 15.1 9.6 Insulin & tablets 38.5 39.1 36.1 40.5 Insulin & injectables NA NA NA 0.8 Insulin, tablets & injectables NA 1.9 7.2 6.3 Injectables only NA NA NA 0.2 Injectables & tablets NA 5.0 5.2 5.0 Nil 0.3 0.1 0.0 NA Unstated 0.7 0.1 0.0 0.0

GDM Diet only 73.0 54.9 62.5 52.6 Tablets only 1.6 4.5 2.9 7.2 Insulin only 20.6 33.8 27.4 30.9 Insulin & tablets 1.6 5.3 6.7 8.4 Insulin & injectables NA NA NA 0.0 Insulin, tablets & injectables NA 0.0 0.0 0.8 Injectables only NA NA NA 0.0 Injectables & tablets NA 1.5 0.0 0.0 Nil 0.0 0.0 0.5 NA Unstated 3.2 0.0 0.0 0.0

*Injectable therapies other than insulin, i.e. incretin mimetics Note: ‘Nil’ management method was an option in past audits (2012-2016), but was removed in 2018 ‘NA’ indicates that data is unavailable or insufficient to calculate statistics for the variable

20

Figure 7 - Management methods in patients with type 2 diabetes

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Diet only Tabletsonly

Insulin only Insulin &tablets

Insulin &injectables

Insulin,tablets &

injectables

Injectablesonly

Injectables& tablets

Management Method

2012 2014 2016 2018

21

2.1.6 Glycaemic Control

The mean HbA1c (%) of all patients was 8.2±1.8 and slightly higher in those with type 1 diabetes (8.5±1.6) than those with type 2 diabetes (8.2±1.8). The values were similar to those of previous audits. The box plots below present the glycated haemoglobin distribution in patients with type 1 diabetes (figure 8) and patients with type 2 diabetes (figure 9). The shaded box area depicts the range of HbA1c for the middle 50% of patients (that is, from the 25th percentile to the 75th percentile HbA1c). The black line that bisects the boxes is the 50th percentile (median) HbA1c. Lines extend from the ends of the boxes to the minimum and maximum HbA1c respectively. Figure 8 - Glycaemic control in patients with type 1 diabetes

Figure 9 - Glycaemic control in patients with type 2 diabetes

02468

101214161820

2012 2014 2016 2018

HbA1c (%)

Year

0

2

4

6

8

10

12

14

16

18

20

2012 2014 2016 2018

HbA1c (%)

Year

22

2.2 Lifestyle

2.2.1 Physical Activity

Less than half (46%) of patients reported that they engage in sufficient physical activity, where sufficient physical activity is 150 total minutes per week (as classified by The National Physical Activity Guidelines for Australians)2. Insufficient physical activity (0-150 total minutes per week) was recorded by 39% and 15% identified as sedentary (0 total minutes per week). There has been little change compared to the last 3 collections (Figure 10). Figure 10 - Physical activity

2.2.2 Vaccination Status

In 2018 65% of patients reported that they had been vaccinated against influenza in the last 12 months. Those aged 60 years and over were most likely to be vaccinated against influenza, with over three quarters (77%) in this age group reporting vaccination. There has been a small increase in vaccination rates across age groups <20-39 years and ≥60 years compared to 2016 (Figure 11). Figure 11 - Influenza vaccination in the last 12 months by age group

0%

10%

20%

30%

40%

50%

Sufficient Insufficient Sedentary

Physical Activity Sufficiency

2012 2014 2016 2018

0%10%20%30%40%50%60%70%80%90%

100%

<20 20-39 40-59 60+Age Group (years)

2012 2014 2016 2018

23

13% of patients reported that they had received the pneumococcal vaccination in the last 12 months (Figure 12). In the last 12 months more patients with type 2 diabetes were vaccinated against influenza and pneumococcal than those with type 1 diabetes, which is likely to be reflective of the age difference between patients with type 1 and type 2 diabetes (Figure 13). Figure 12 - Pneumococcal vaccination in the last 12 months by age group

Figure 13 - Vaccination status in the last 12 months by diabetes type

0%

10%

20%

30%

40%

50%

<20 20-39 40-59 60+Age Group (years)

2012 2014 2016 2018

0%10%20%30%40%50%60%70%80%90%

100%

2012 2014 2016 2018Year

Influenza Vaccination - T2DM

Influenza Vaccination - T1DM

Pneumococcal Vaccination - T2DM

Pneumococcal Vaccination - T1DM

24

2.2.3 Smoking Status

In 2018 13% of patients identified as current smokers, 36% as past smokers and 51% as never smokers. There was no change in the percentage of current and past smokers and never smokers compared to 2016. (Figure 14). Figure 14 - Smoking status

Of the current smokers, the majority (76%) stated that they had tried to stop smoking. The most common method of cessation in past smokers was stopping with no intervention (79%), nicotine replacement therapies (8%) followed by medication (6%). Hypnosis and acupuncture were infrequently used (1.4% and 0.1% respectively) (Figure 15). Figure 15 - Methods of smoking cessation of past smokers

0%

10%

20%

30%

40%

50%

2012 2014 2016 2018Year

Current Smoker Past Smoker Never Smoked

0%

20%

40%

60%

80%

100%

Just stopped -No

Intervention

Hypnosis Medication Acupuncture NicotineReplacement

Other

Method of cessation

2012 2014 2016 2018

25

2.3 Medication Use The majority of patients report that they usually take all of their medications (93%). A minority reported that they ‘ever forget to take their medications’ (27%), with few patients stopping when they feel better (5%) or stopping when they feel worse (7%) (Table 7). Table 7 - Medication use

Category 2012

n=1892 2014

n=2681 2016

n=3930 2018

n=4856 2018*

n=4607 n % n % n % n % n %

Ever forget to take medications 433 23.9 720 27.3 1051 26.8 1128 26.7 1086 26.7

Usually take all medications 1565 87.7 2393 91.9 3569 92.1 3942 93.4 3810 93.5

Sometimes stop taking medications when feeling better

142 8.0 161 6.2 236 6.1 212 5.1 202 5.0

Sometimes stop taking medications when feeling worse

142 8.0 187 7.2 274 7.1 273 6.5 268 6.6

* Excluding patients with GDM Note: for these calculations, those who indicated ‘Not applicable’ were excluded from the denominator

Over one in four patients use complementary therapy. Of patients reporting this, only (84%) had told their doctor or educator about use of complementary therapy (Table 8).

Table 8 - Use of complementary therapy

Category 2012

n=1892 2014

n=2681 2016

n=3930 2018

n=4856 2018*

n=4607 n % n % n % n % n %

Use of complementary therapy 585 32.9 703 26.9 1071 27.7 1174 26.9 1060 25.6

Disclosed use of complementary therapy to doctor/educator

502 86.7 579 82.6 917 86.0 973 83.8 863 82.4

* Excluding patients with GDM

26

2.4 Patient Self-Care Practices About one third of patients reported having difficulties following their recommended diet (35%), with the most common reason in all patients being ‘I don’t have enough time to prepare healthy meals’ and ‘It costs too much to eat well’. About half of those with type 1 diabetes who reported difficulties in following their recommended diet, stated that it is too hard to count carbohydrates and weigh food (Table 9). Table 9 - Patient dietary practices

Category 2012

n=1892 2014

n=2681 2016

n=3930 2018

n=4856 2018*

n=4607 n % n % n % n % n %

Difficulties following recommended diet 724 39.6 797 30.2 1400 35.7 1572 35.4 1491 35.6

Insufficient time to prepare healthy meals 258 37.0 261 33.7 460 33.2 530 33.9 494 33.3

Too costly to eat well 313 45.0 256 32.7 422 30.4 482 30.8 459 30.9

Don't know what foods are best to eat 230 33.2 233 29.8 392 28.2 398 25.4 380 25.6

Eat out a lot and find it hard to eat well 163 23.5 178 22.9 312 22.5 342 21.9 319 21.5

If T1DM-too hard to count carbs/weigh food

97 74.0 87 52.7 176 56.6 159 53.5 159 50.8

* Excluding patients with GDM While 70% of patients reported that they check their blood glucose as often as recommended, 26% do not and 4% were unsure of how often they should be monitoring. Of those using insulin and injectable medications 96% reported that they rotate their injection sites (Table 10). Table 10 - Patient self-care practices

Category 2012

n=1892 2014

n=2681 2016

n=3930 2018

n=4856 2018*

n=4607 N % n % n % n % n %

Check blood glucose level as recommended

NA NA 1915 72.4 2677 68.5 3061 69.8 2836 68.5

Rotate injection site NA NA 1776 95.6 2680 95.6 2906 96.0 2818 95.9

* Excluding patients with GDM

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2.5 Health Services Utilisation Reporting on health professional attendance in the last 12 months revealed 74% attended a diabetes educator and 70% a diabetes specialist. Only 57% had seen a podiatrist and 46% had attended a dietitian. Less than half had seen a dentist (46%) and very few patients had seen a psychologist (13%), social worker (7%) or exercise physiologist (10%). A total of 78% had seen either an optometrist or an ophthalmologist and 25% had seen both an optometrist and ophthalmologist. There has been an increase in attendances to optometrist, podiatrist, dentist and exercise physiologist compared with previous collections (Figure 16). Optometrist/ophthalmologist attendance was greater when patients with GDM were excluded (82% compared to 78%), as was podiatrist attendance (60% compared to 57%). Figure 16 - Health services utilisation (over last 12 months)

A total of 74% of patients (76% after excluding patients with GDM) utilised the services of three or more health professionals for the care of their diabetes, other than a diabetes specialist (Figure 17).

Figure 17 - Number of health services utilised (other than diabetes specialist)

0%

20%

40%

60%

80%

100%

Health Service

2012 2014 2016 2018

0%

10%

20%

30%

40%

50%

0 1 2 3 4 5 6 7 8 9

Number of Health Services

2012 2014 2016 2018

28

In general, the likelihood of having attended various health professionals in the previous 12 months was increased with increasing duration of diabetes (Table 11). However, the likelihood of having attended a diabetes educator or dietician in the previous 12 months was greatest in those with shorter duration of diabetes, and in those presenting for a follow-up visit rather than an initial visit (Figures 18 and 19).

Table 11 - Health professional attendance by duration of diabetes

Category Diabetes Duration

<1 year 1 year 2-4 years 5-9 years >10 years n % n % n % n % n %

Educator 434 85.9 180 86.1 295 75.1 499 72.6 1751 71.1 Diabetes specialist 198 39.2 124 59.3 249 63.2 462 67.2 1941 78.8 Optometrist 210 41.7 143 69.1 264 67.9 485 71.5 1782 73.1 Ophthalmologist 46 9.1 43 20.7 93 23.7 189 27.6 1127 45.9 Podiatrist 102 20.2 102 48.8 204 51.8 391 57.2 1581 64.4 Dietitian 357 70.7 149 71.3 180 45.7 303 44.2 1000 40.7 Dentist 193 38.4 90 43.5 180 46.4 320 47.3 1149 47.1 Psychologist 38 7.5 39 18.7 54 13.7 112 16.4 330 13.4 Social worker 24 4.8 21 10.0 23 5.8 46 6.7 178 7.2 Exercise physiologist 35 6.9 28 13.4 36 9.2 75 10.9 255 10.4

* Percentages refer to the proportion of patients within each duration category who reported attending a health professional within the previous 12 months

Figure 18 - Percentage seen by diabetes educator by diabetes duration & visit type

Figure 19 - Percentage seen by dietitian by duration of diabetes & visit type

0%

20%

40%

60%

80%

100%

<1 1 2-4 5-9 10+Duration of Diabetes (years)

Initial visit Follow-up visit

0%20%40%60%80%

100%

<1 1 2-4 5-9 10+Duration of Diabetes (years)

Initial visit Follow-up visit

29

2.6 Self-Rated Wellbeing Depression was ‘likely’ in 26% of all patients, a small decrease compared to past collections (27% in 2016, 29% in 2014 and 28% in 2012). ‘Likely depression’ affected 28% of patients with type 1 diabetes and 27% of patients with type 2 diabetes (Figure 20). Figure 20 - BCD: ‘Likely depression’ by diabetes type

2.6.2 Mental Health Treatment

Overall, 19% of patients reported current use of antidepressant medications and 9% were receiving psychologist/psychiatrist treatment, whilst 27% have received psychologist/psychiatrist treatment in the past (Table 12). These results were similar when patients with GDM were excluded from the analysis. Of patients with likely depression based on the BCD, 36% reported current use of antidepressant medications and 21% were receiving psychologist/psychiatrist treatment. Table 12 - Current or past psychology/psychiatry treatment and/or counselling

Category 2012

n=1892 2014

n=2681 2016

n=3930 2018

n=4856 2018

n=4607* n % n % % % n % n %

Current Yes 128 7.8 236 8.9 410 10.5 418 9.4 404 9.7 No 1518 92.2 2409 91.1 3512 89.5 4016 90.6 3781 90.3 Total 1646 100 2645 100 3922 100 4434 100 4185 100 Past Yes 381 23.2 601 22.7 1039 26.5 1187 26.8 1132 27.0 No 1264 76.8 2041 77.3 2883 73.5 3248 73.2 3054 73.0 Total 1645 100 2642 100 3922 100 4435 100 4186 100

* Excluding patients with GDM

0%

10%

20%

30%

40%

50%

T1DM T2DM GDM Don't know OtherDiabetes Type

30

2.6.3 Self-Assessment of Health Status

The Own Health State Rating was recorded in 88% of patients, with a mean 66.7±19.9. The Own Health State Rating was similar for patients with type 1 diabetes (67.9±19.2) and type 2 diabetes (65.6±20.1) and highest in those with GDM (74.5±15.9). The mean Own Health State Ratings by diabetes type was similar to previous collections (Figure 21).

In patients with type 2 diabetes, the mean and (±SD) Own Health Rating (67.8±19.2) was higher in 2018 than in previous years with the exception of 2016 indicating a general trend towards improved health state as perceived by patients (test for trend, p=0.03). A similar trend was evident in patients with type 1 diabetes Own Health Rating (65.8±19.2) which was higher in 2018 than in previous years with the exception of 2016 (test for trend, p=0.01). However, there was no evidence of a trend in the Own Health Rating in the GDM cohort.

Figure 21 - Mean Own Health State Rating by diabetes type

In patients with type 2 diabetes, Own Health State Rating was comparatively low in patients on insulin alone (62.5±21.4, n=1040). Those managed by diet only reported the highest Own Health State Ratings (73.5±18.4, n=159) (Figure 22).

Figure 22 - Mean Own Health State Rating by management method in type 2 diabetes

* Undetermined significance due to small sample size (n=7)

0

20

40

60

80

100

T1DM T2DM GDMDiabetes Type

2012 2014 2016 2018

0102030405060708090

100

Diet only Tablets Injectables* Injectables& tablets

Insulin Insulin &tablets

Insulin &injectables

Insulin &tablets &

injectables

Rating

Management Method

31

2.6.4 Diabetes Distress

Results of the DDS2 screening scale and the DDS17 questionnaire (Table 13):

• Of those screened, 1534 patients (36%) screened positive on the DDS2 screening scale (one or both questions ≥3), indicating that these patients should complete the full DDS17 questionnaire

• Of these, 1333 (87%) completed the DDS17 questionnaire • Additionally, 149 (5%) patients, who should not have completed the DDS17 (both

screening scale scores <3) went on to complete the DDS17 (results not included in analysis)

• The DDS screening questions were shown to be an effective screening tool, given that 47% of those with positive screening questions had at least one individual DDS17 score in the high distress range

Table 13 - DDS17 questionnaire data by screening question score

Category 2012

n=1892 2014

n=2681 2016

n=3930 2018

n=4856 2018*

n=4607 n % n % n % n % n %

DDS2 screen completed 1560 82.5 2594 96.8 3897 99.2 4284 88.2 4051 87.9

Positive DDS2 screen (of those screened) 626 40.1 1032 39.8 1512 38.8 1534 35.8 1493 36.9

DDS17 completed (of those screening positive)

561 89.6 963 93.3 1372 90.7 1333 86.9 1301 87.1

DDS17 completed (of those screening negative)

160 17.1 35 2.2 65 2.7 149 5.4 140 5.5

At least one individual DDS17 score in high distress category (of those screening positive)

353 62.9 553 57.4 754 55.0 688 51.6 673 51.7

At least one individual DDS17 score in high distress category (of those screening negative)

9 5.6 3 8.6 4 6.2 11 7.4 10 7.1

* Excluding patients with GDM

32

Table 14 details the DDS17 results including subscale scores by diabetes type and year of collection, in those who fulfilled the DDS2 Screening scale questions and completed the DDS17 questionnaire: • The mean (±SD) Total DDS17 was 2.2 (±0.9) indicating a mean score in the moderate

distress range • For the subscale scores, mean Emotional Burden score was highest (2.7±1.2), followed by

Regimen-related Distress (2.5±1.1), Interpersonal Distress (2.0±1.2) and Physician-related Distress (1.5±0.9)

• Diabetes distress from 2016 to 2018, as indicated by the mean Total DDS17 score for all patients, did not substantially change (2.3±0.9 vs 2.2±0.9)

Table 14 - Mean DDS17 scores by diabetes type and year

Category

2012 n=1892

2014 n=2681

2016 n=3930

2018 n=4856

n % Mean±SD n %

Mean±SD n % Mean±SD n %

Mean±SD

DDS17Q completed 561 89.6 963 93.3 1372 90.7 1333 86.9 Total DDS17 score All 556 2.4±0.9 963 2.3±0.8 1364 2.3±0.9 1333 2.2±0.9 T1DM 185 2.3±0.7 301 2.3±0.8 464 2.4±0.9 434 2.3±0.8 T2DM 355 2.5±0.9 625 2.3±0.9 835 2.3±0.9 835 2.2±0.9 GDM 9 1.9±0.6 26 1.8±0.5 43 2.0±0.9 32 2.0±0.7 Emotional burden All 556 2.9±1.2 963 2.8±1.2 1370 2.8±1.2 1332 2.7±1.2 T1DM 185 2.8±1.1 301 3.0±1.2 466 2.9±1.2 433 2.9±1.2 T2DM 355 2.9±1.3 625 2.8±1.2 839 2.8±1.2 835 2.7±1.2 GDM 9 2.8±1.0 26 2.2±0.9 43 2.3±0.8 32 2.6±1.1 Physician-related distress All 556 1.6±1.0 963 1.5±0.9 1369 1.5±0.9 1331 1.5±0.9 T1DM 185 1.5±0.8 301 1.4±0.7 465 1.5±0.9 434 1.5±0.9 T2DM 355 1.6±1.1 625 1.5±0.9 839 1.5±0.9 833 1.5±0.9 GDM 9 1.0±0.0 26 1.1±0.5 43 1.2±0.5 32 1.4±1.0 Regimen-related distress All 555 2.8±1.2 963 2.6±1.2 1371 2.6±1.1 1333 2.5±1.1 T1DM 185 2.7±1.2 301 2.7±1.1 466 2.7±1.1 434 2.6±1.1 T2DM 354 2.8±1.3 625 2.6±1.2 840 2.6±1.1 835 2.5±1.1 GDM 9 1.9±0.8 26 2.1±0.8 43 1.9±0.7 32 2.1±1.0 Interpersonal distress All 555 2.2±1.3 963 2.0±1.2 1371 2.0±1.2 1333 2.0±1.2 T1DM 185 2.1±1.1 301 2.0±1.2 466 2.0±1.2 434 2.1±1.2 T2DM 354 2.2±1.4 625 2.0±1.2 840 2.0±1.2 835 2.0±1.3 GDM 9 1.9±0.9 26 1.6±0.7 43 1.7±0.9 32 1.6±0.8

Note: Only those eligible to complete the DDS17 (i.e. positive DDS2 screen) were analysed

33

Key findings regarding high distress (score≥3) in each field: • Of the patients who screened positive in the DDS2 screening scale questions and

completed the DDS17 questionnaire in 2018: • 19% had a mean Total DDS17 score in the high distress range (Figure 23) • 38% reported high distress in the Emotional Burden subscale (Figure 24) • Only 8% reported high distress in the Physician-related Distress subscale • Overall, a greater proportion of patients with type 1 diabetes had a Total DDS17

score in the high distress category compared to patients with type 2 diabetes (20% vs 16%)

Figure 23 - Total DDS17 score by diabetes type

Figure 24 - Emotional burden score by diabetes type

0%

20%

40%

60%

80%

100%

T1DM T2DM GDMDiabetes Type

Little/No Distress Moderate Distress High Distress

0%

20%

40%

60%

80%

100%

T1DM T2DM GDMDiabetes Type

Little/No Distress Moderate Distress High Distress

34

Figure 25 - Physician-related distress by diabetes type

Figure 26 - Regimen-related distress by diabetes type

Figure 27 - Interpersonal distress by diabetes type

0%

20%

40%

60%

80%

100%

T1DM T2DM GDMDiabetes Type

Little/No Distress Moderate Distress High Distress

0%

20%

40%

60%

80%

100%

T1DM T2DM GDMDiabetes Type

Little/No Distress Moderate Distress High Distress

0%

20%

40%

60%

80%

100%

T1DM T2DM GDMDiabetes Type

Little/No Distress Moderate Distress High Distress

35

2.7 Subgroup analysis - Centre type Table 15 - Centre type

Item no. on data collection form

Field

Centres of Excellence & Tertiary

Care

Secondary & Primary

Care

(n=3712) (n=1144) % / Mean+SD

Demographics Age (calculated) 54.1±17.6 60.8±16.2 1.2 Sex - males 52.3 48.0 1.4 Initial visit 17.5 20.9 1.5 Aboriginal/Torres Strait Islander 4.9 3.2 1.6 Interpreter required 5.1 2.5 1.7 DVA 1.3 1.8 1.8 NDSS 91.8 91.5 Diabetes type and management 2.2 Type of diabetes T1DM 29.5 14.2 T2DM 61.4 79.7 GDM 5.2 4.9 Don't know 2.3 0.3 Other 1.6 1.0 Duration of diabetes (calculated) (median(IQR)) 12 (5 to 21) 10 (3 to 18) 2.3 Management method Diet only 5.2 11.2 Tablets 18.6 34.5 Insulin 37.1 19.0 Insulin & tablets 30.4 27.8 Insulin & injectables 0.6 0.7 Injectables 0.2 0.0 Injectables & tablets 3.2 3.6 Insulin & tablets & injectables 4.7 3.2

2.3.1 How long ago insulin started (only patients using insulin)

<1 year 16.1 13.3 1-5 years 22.4 23.8 >5 years 61.5 62.9 2.4 Physical activity Sufficient 46.6 45.4 Insufficient 37.4 41.9 Sedentary 16.0 12.7 2.5 Flu vaccination 62.1 71.4 2.6 Pneumococcal vaccination 13.8 10.7

36

Item no. on data collection form

Field

Centres of Excellence & Tertiary

Care

Secondary & Primary

Care

(n=3712) (n=1144) % / Mean+SD

2.7 Smoking status Current smoker 13.4 11.9 Past smoker 35.7 37.0 Never smoked 50.9 51.2 2.7.1 Current smoker - Tried to stop smoking 74.5 80.7 2.7.2 Past smoker - Methods to stop smoking

Just stopped 79.9 77.0 Medication 5.1 8.3 Nicotine replacement 7.7 9.5 Hypnosis 1.6 1.0 Acupuncture 0.1 0.2 Other 2.8 6.2 2.8.1 Glycated haemoglobin (%) 8.3±1.8 7.9±1.8 2.8.2 Glycated haemoglobin (mmol/mol) 67.6±20.0 62.9±19.0 Medication Use 3.1 Ever forget to take medication 27.3 24.9 3.2 Usually take all medications 93.8 91.9

3.3 Sometimes stop taking medication when feeling better 5.2 4.7

3.4 Sometimes stop taking medication when feeling worse 6.3 7.2

3.5 Use complementary therapy or dietary supplement or OTC Rx 26.9 26.8

3.5.1 Told doctor/educator about complementary, dietary supplement, OTC Rx (if applicable) 83.6 84.4

Health Professional Attendances 4.1 Podiatrist 54.1 63.6 4.2 Diabetes educator 72.9 77.6 4.3 Dietician 45.4 48.4 4.4 Psychologist 14.5 9.6 4.5 Social worker 7.7 4.8 4.6 Diabetes specialist 82.0 34.0 4.7 Ophthalmologist 38.7 26.6 4.8 Optometrist 67.2 72.5 4.9 Dentist 45.6 45.9 4.10 Exercise physiologist 9.8 10.9 Patient Self-Care Practices 5.1 Difficulties following recommended diet 36.2 33.3 5.1.1 Don't have enough time to prepare healthy meals 35.2 30.0 5.1.2 Costs too much to eat well 31.8 27.4

37

Item no. on data collection form

Field

Centres of Excellence & Tertiary

Care

Secondary & Primary

Care

(n=3712) (n=1144) % / Mean+SD

5.1.3 Don't know what foods are best to eat 24.6 28.2 5.1.4 Eat out a lot and find it hard to eat well 23.1 18.2 5.1.5 If T1DM - It is too hard to count carb/weigh food 52.0 60.4 5.2 Check blood glucose level as often as recommended 70.7 67.2 5.3 Rotate injection site, if on injectables or insulin 96.2 95.1 BCD 6A.1 Having restless or disturbed nights 50.9 47.2 6A.2 Feeling unhappy or depressed 31.9 30.4 6A.3 Feeling unable to overcome difficulties 18.8 19.0 6A.4 Dissatisfied with their way of doing things 23.9 21.1 Treatment 6B.1 Taking antidepressants 18.4 19.1 6B.2 Psych. Treatment/counselling - past 27.6 24.5 6B.3 Psych. Treatment/counselling - current 9.8 8.4 Quality of Life Assessment 7.1 Own health state rating (0-100) 65.9±20.0 68.9±19.4 7.2 Screening scale Q1 2.1±1.2 1.9±1.2 7.3 Screening scale Q2 2.1±1.3 2.0±1.3 Diabetes Distress Scale 17 (where Screening scale Q1 or Q2 ≥3) 7.4 DDS17 questionnaire completed 85.6 91.4 7.4.1 Total DDS17 Score 2.2±0.8 2.3±0.9 7.4.2 Emotional Burden 2.7±1.2 2.7±1.2 7.4.3 Physician-related Distress 1.5±0.9 1.5±1.0 7.4.4 Regimen-related Distress 2.5±1.1 2.6±1.1 7.4.5 Interpersonal Distress 2.0±1.2 2.1±1.4

38

2.8 Subgroup analysis - GDM at a glance Table 16 - Demographic data (GDM)

Category 2012 2014 2016 2018 Number of patients 126 133 208 249 Age (years) 32.3±5.4 33.2±9.3 30.7±5.1 32.1±5.4 Initial visit (%) 43.5 32.3 47.6 32.1 Aboriginal/Torres Strait Islander (%) 17.2 3.8 6.7 6.0 NDSS member (%) 84.0 93.2 75.5 85.4

Table 17 - Country of birth (GDM)

Country n (249) % Australia 164 65.9 India 19 7.6 New Zealand 12 4.8 Iraq 6 2.4 China 4 1.6 Syria 4 1.6 Other 40 16.1 Unstated 0 0.0

Table 18 - Treatment (GDM)

Treatment n % Diet only 131 52.6 Tablets only 18 7.2 Insulin only 77 30.9 Insulin & tablets 21 8.4 Insulin & injectables* 0 0.0 Insulin, tablets & injectables 2 0.8 Injectables only 0 0.0 Injectables & tablets 0 0.0 Unstated 0 0.0

* Injectable therapies other than insulin, i.e. incretin mimetics

Table 19 - Glycated haemoglobin (GDM)

Glycated haemoglobin

2012 2014 2016 2018 n Mean±SD n Mean±SD n Mean±SD n Mean±SD

HbA1c (%) 25 5.6±0.6 15 7.0±2.2 90 5.3±0.7 68 5.2±0.4 HbA1c (mmol/mol) NA NA NA NA 86 35.1±9.2 56 33.6±3.9

Table 20 - Physical activity (GDM)

Physical activity n % Sufficient 153 61.4 Insufficient 83 33.3 Sedentary 13 5.2

39

Table 21 - Smoking status (GDM)

Smoking status n % Current 17 6.8 Past 65 26.1 Never 167 67.1

Table 22 - Patient dietary practices (GDM)

Category n % Difficulties following recommended diet 81 32.7 Insufficient time to prepare healthy meals 36 44.4 Too costly to eat well 23 28.4 Don't know what foods are best to eat 18 22.2 Eat out a lot and find it hard to eat well 23 28.4

Table 23 - Patient self-care practices (GDM)

Category n % Check blood glucose level as recommended 225 91.5 Rotate injection site (if applicable) 88 97.8

Table 24 - Health service utilisation (GDM)

Category n % Educator 228 91.9 Diabetes specialist 115 46.4 Optometrist 44 17.7 Ophthalmologist 6 2.4 Podiatrist 8 3.2 Dietitian 206 83.1 Dentist 98 39.4 Psychologist 18 7.2 Social worker 9 3.6 Exercise physiologist 8 3.2

Table 25 - Mean Own Health State Rating (GDM)

Mean Own Health State Rating 2012 2014 2016 2018 Rating (Mean±SD) 72.7±16.7 70.8±17.1 70.2±20.4 74.5±15.9

Table 26 - DDS (GDM)

DDS2 n % Completed DDS2 233 93.6 Screened positive on DDS2 41 17.6 DDS17 DDS17 completed (of those who screened positive) 32 78.0 DDS17 scoring Mean±SD Total DDS17 Score 2.0±0.7 Emotional Burden 2.6±1.1 Physician-related distress 1.4±1.0 Regimen-related distress 2.1±1.0 Interpersonal distress 1.6±0.8

40

2.9 Questionnaire Results Results of feedback from participating sites to the specific questions related to the data collection process (Questionnaire 1) are summarised in Table 27, from responses measured on a Likert Scale (Appendix 2).

• Questionnaire 1 relates to the data collection process • Questionnaire 2 relates to the comments on the Individual Site Reports (to be

administered after reports are distributed) • Free text responses to questions and to other items were reviewed individually and will

be utilised to refine the data collection instrument and reporting process to assist in running future audits

The results in Table 27 from 35 respondents indicate that there was approval of the data collection process from ANDA-AQSMA 2018, including information, data definitions, formatting, ease of completion and time to complete the form. Responses showed higher satisfaction with the 2018 process compared to previous collections. This is particularly encouraging given that a number of the participating sites in 2018 were new to the audit. The higher satisfaction with the 2018 process compared to previous years may be partially due to the introduction of the web-based data entry application, REDCap. The time to complete the form and the format will be reviewed to facilitate further improvements in future collections.

Table 27 - Questionnaire 1 (Data collection process) responses

Data Collection Process

2012 (n=29)

2014 (n=32)

2016 (n=34)

2018 (n=35)

Information package/letters 3.6±1.0 3.9±0.8 4.1±1.1 4.4±0.7

Data definitions 3.6±1.1 4.0±0.9 4.3±0.9 4.5±0.8

Format (layout of data items) 3.2±1.3 3.5±1.2 3.9±0.8 4.0±1.0

Ease of completion 3.3±1.1 3.6±0.9 3.6±0.9 4.1±1.0

Time to complete the form 2.9±1.0 3.5±0.9 3.0±1.4 3.3±1.3 Note: 5-point Likert scale where 1=Poor and 5=Excellent

41

3. Discussion The aim of ANDA is to provide a high quality audit program. This is achieved by the collection, collation, analysis and reporting of clinical diabetes data in specialist diabetes services. In doing so, the underlying objectives are:

• Provide an individual audit report for participants • Utilise different technologies to collect and collate data • Assess participant responses • Generate a pooled data collection report of standardised data • Encourage progress towards annual collection • Constantly update and refine

This cross-sectional audit provides a ‘snapshot’ of the self-management and wellbeing of patients being cared for in services specialising in diabetes care in Australia. A comparison with previous years’ data reveals a degree of ‘stability’ of the findings which suggests that these data do reliably reflect the clinical status of individuals with diabetes cared for by these services. These data could therefore be used as a basis on which to gauge the effectiveness of diabetes management or intervention strategies aimed at improving health outcomes. There were minimal missing data, owing to the success of the validation process and the diligence of those involved in the collection. No difficulties with respect to the technical aspects of ANDA-AQSMA were encountered. Limitations of ANDA-AQSMA

• It is acknowledged that some variables have smaller sample sizes given some participating sites provided incomplete data for these fields

• A number of fields rely on patient self-reporting, which may introduce recall bias • Administration of the questionnaire by medical professionals may introduce bias, especially in relation to the Physician-related Distress section of the DDS17

Site feedback on activity Feedback received from the ANDA-AQSMA 2018 Post Data Collection Questionnaire highlighted the time-consuming nature of the paper based form completion as the major issue associated with data collection. Feedback also acknowledged improvements in the format of this year’s data collection form compared to previous years.

Potential areas of improvement for this activity

• A concerted effort by diabetes services to acquire electronic databases to facilitate routine data collection and communication with other healthcare professionals, in

addition to participation in research and quality initiatives such as ANDA-AQSMA. If sites had in-house databases, the potential would exist to extract data more frequently and provide comparative audit reports, perhaps on an annual basis

• That further improvements in the format of the data collection be supported to ensure this exercise remains relevant for participating sites. This should include consideration of targeted data collection of key additional quality indicators in the future and introduction of a longitudinal follow-up

42

4. Conclusion ANDA-AQSMA provides a ‘snapshot’ of education and self-care practices of patients attending services in diabetes care across Australia. This is the largest ANDA self-management audit to date, with data collected on 4856 adult patients from 60 diabetes centres across Australia. All states and territories were represented. This audit focuses on lifestyle management, health service access, education and wellbeing of people with diabetes. In general, patients reported good adherence to evidence-based recommendations across various domains of diabetes self-management. Most patients reported that they rarely forget to take their medication as prescribed (93%) and that they rotate their injection sites where applicable (96%). Health service utilisation generally increased with increasing duration of diabetes, but the likelihood of having visited a diabetes educator in the last 12 months was particularly high among the recently diagnosed (≤1 year). Areas for improvement include:

• Engagement in sufficient physical activity (≥150 mins/week), as less than half (46%) of patients reported sufficient physical activity

• Improved adherence to dietary recommendations, as one third of patients (35%) reported difficulty in this area. This was most commonly due to the perceived time and cost associated with following dietary recommendations, and difficulty counting carbohydrates and weighing food in those with T1DM

• Blood glucose monitoring, as 26% of patients did not test their blood glucose as often as recommended

• Smoking cessation, as 13% of patients are current smokers. This is unchanged from previous audits. A significant proportion (76%) of current smokers reported past attempts to quit and thus may be receptive to further attempts to assist smoking cessation

The above issues may be addressed by increased access to a range of health care professionals, including diabetes educators, dietitians, podiatrists and exercise physiologists or specialised exercise programs within services specialising in diabetes care to educate patients with diabetes regarding the importance of preventive care. Such multi-disciplinary initiatives may be most effective in promoting education and self-care measures in people with diabetes, thereby minimising the incidence and severity of diabetes related complications and associated morbidity and mortality in the future. As in previous collections, there was demonstrated a high prevalence of ‘likely depression’ as measured by the BCD© and notable diabetes-specific distress related to ‘Emotional Burden’ as measured by the Diabetes Distress Scale 17. Of concern, only 43% of patients with likely depression were currently receiving psychological/psychiatric treatment or antidepressant therapy and only 36% reported current antidepressant therapy. This highlights the importance of addressing emotional and psychological health in people with diabetes managed in services specialising in diabetes care.

43

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statement of the Australian Diabetes Society: individualisation of glycated haemoglobin targets for adults with diabetes mellitus. The Medical journal of Australia. 2009;191(6):339-44.

2. National Heart Foundation of Australia physical activity recommendations for people with cardiovascular disease. Briffa T, Maiorana A, Allan R, et al. On behalf of the Executive Working Group and National Forum Participants. Sydney (Australia): National Heart Foundation of Australia; January 2006.

3. International Diabetes Federation. IDF Diabetes Atlas, 6th edn. Brussels, Belgium: International Diabetes Federation, 2013.

4. Department of Health. Immunisation (2018) http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-influenza#flu.

5. Speight J. Managing diabetes and preventing complications: what makes the difference? The Medical journal of Australia. 2013;198(1):16-7.

6. Clarke D.M., McKenzie D.P., Marshall R.J., Smith G.C. The construction of a brief case- finding instrument for depression in the physically ill. Integrative Psychiatry 1994; 10: 117-123.

7. Polonsky WH, Fisher L, Earles J, Dudl RJ, Lees J, Mullan J, et al. Assessing psychosocial distress in diabetes: development of the diabetes distress scale. Diabetes care. 2005;28(3):626-31.

8. Fisher L, Glasgow RE, Mullan JT, Skaff MM, Polonsky WH. Development of a brief diabetes distress screening instrument. Annals of family medicine. 2008;6(3):246-52.

9. Fisher L, Hessler DM, Polonsky WH, Mullan J. When is diabetes distress clinically meaningful?: establishing cut points for the Diabetes Distress Scale. Diabetes care. 2012;35(2):259-64.

10. Australian Government Department of Health. Australian National Diabetes Strategy 2016-2020.

11. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of biomedical informatics. 2009;42(2):377-81.

12. Diabetes dataset (clinical) [National Health Data Dictionary {NHDD}] National Health Data Committee 2003.Other Data Set Specification, Diabetes(clinical), National Health Data Dictionary.Version12.AIHWcat.No.HWI47.Canberra:Australian Institute of Health and Welfare.

13. Meta data Online Registry [‘METeOR’]-Diabetes (clinical) Data Set Specification. [see AIHW website]: http://meteor.aihw.gov.au/content/index.phtml/itemId/304865.

14. Hawthorne G, Richardson J, Day NA. A comparison of the Assessment of Quality of Life (AQoL) with four other generic utility instruments. Annals of medicine. 2001;33(5):358-70.

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Australian National Diabetes Audit ANDA-AQSMA 2018

Appendix 1

Protocol Data Collection form

Data Definitions Data Dictionary

ANDA-AQSMA 2018 Guide REDCap Data Entry Manual

Self-Assessment of Health Status Diabetes Distress Scale 17

Diabetes Distress Scale 17 Scoring Sheet

Final Report

45

46

Australian National Diabetes Audit

Protocol

Final Protocol dated March 2018 Email: anda@nadc.net.au

47

Table of Contents

Acknowledgement 2 Synopsis 3 1. Diabetes care in Australia 4 2. The Dataset 6 3. ANDA Software/Database 6 4. ANDA Coordination 6 5. ANDA Methodology 7

5.1 Survey period 7

5.2 Ethics 7 5.3 Survey population 7

5.4 Data Verification and Validation 8 5.5 Data analysis/reporting 8

5.6 Post survey/reporting feedback 8 6. Funding 8 7. Milestones 9 8. References 9

Acknowledgement

The Australian Government Department of Health has funded the conduct of the Australian National Diabetes Audit (ANDA) from 2013-2021

ANDA Project Executive

Professor Sophia Zoungas - Project Lead Mr Sanjeeva Ranasinha - Biostatistician A/Professor Arul Earnest - Senior Biostatistician Ms Trieu-Anh Truong - Data Management Officer Ms Eleanor Danek - BMedSci student Ms Elspeth Lilburn - ANDA Secretariat Ms Natalie Wischer - NADC CEO A/Professor Sofianos Andrikopoulos - ADS CEO

ANDA Scientific Advisory Committee

Professor Sophia Zoungas - Chair A/Professor Wendy Davis A/Professor Barbora deCourten Mr Georges Dwyer Professor Jeff Flack Professor Jenny Gunton Ms Gloria Kilmartin Professor Jane Speight Ms Natalie Wischer A/Professor Jencia Wong

48

Synopsis

The Australian National Diabetes Audit (ANDA) is a well-established, important biennial, quality activity facilitated by the National Association of Diabetes Centres (NADC), in services providing care for people with diabetes across Australia in all States and Territories. Participating diabetes centres, endocrinologists and other diabetes health care professionals receive an individualised report of their patient data to compare with other diabetes centres.

In addition to the primary output audit report received by participating centres, the pooled national report is an important source of cross-sectional data on the clinical status and outcomes of individuals attending services providing diabetes care across the country.

There are two ANDA audits that alternate each year:

• ANDA-AQCA (Australian Quality Clinical Audit). This audit focuses on clinical indicators knownto impact on the care of the person with diabetes.

• ANDA-AQSMA (Australian Quality Self-Management Audit). This audit is more focused on self-management and diabetes distress and collects data related to diabetes education, self-carepractices and quality of life.

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Diabetes care in Australia

The National Association of Diabetes Centres (NADC) established in 1994 is a national collective of diabetes centres brought together by a common desire to see improvement in the standard of diabetes care in Australia. With a focus on proactive maintenance of good health and prevention of complications, NADC diabetes centres aim to provide integrated care and to bridge the gap between the acute care hospital system, and the long-term chronic care provided by primary care and community-based services.

Supported by the Australian Diabetes Society (ADS), the NADC facilitates the ANDA initiative as part of monitoring and improving quality of care after considering the outcomes of the Diabetes Control and Complications Trial (DCCT)1 and the United Kingdom Prospective Diabetes Study (UKPDS) 2-5. The DCCT found that maintenance of good glycaemic control significantly reduces diabetes related complications in patients with type 1 diabetes, while the UKPDS showed that maintenance of good glycaemic and blood pressure control reduced the long-term complications of type 2 diabetes. Both strategies require a multidisciplinary team approach including specialist care to achieve better outcomes for people with diabetes.

Consequently, the NADC was created to establish and promote effective health care practice and, ultimately, to achieve better outcomes for people with diabetes. In particular, key strategies were identified including the development of standards of care and quality review initiatives, information provision, and training and support for health professionals in specialist multidisciplinary settings.

Overview of NADC member centres

The NADC promotes mechanisms for improving the standard of care available to people with or at risk of diabetes through services providing diabetes care.

Are there differences between the diabetes centres that participate in ANDA?

There are 6 membership levels of NADC:

1. Centres of ExcellenceRecognised diabetes centres that have demonstrated excellence in education, research, servicedelivery, practice/policy development and education. These centres must be tertiary levelfacilities.

2. Tertiary Care Diabetes ServicesNADC centres that have the full range of diabetes service providers including endocrinologists,diabetes nurse educators, dietitians and podiatrists on staff (full-time) and who havedemonstrated a high standard of care through service delivery and organisational capacity andhave been accredited by the NADC.

3. Secondary Care Diabetes ServicesThese services have a range of full and/or part-time diabetes staff but often do not have anendocrinologist as part of their usual team. They may be working toward accreditation as aTertiary Care Diabetes Service.

4. Primary Care Diabetes ServicesThese centres have part-time staff and work closely with the local general practitioners toprovide care for people with diabetes.

5. Pharmacy Diabetes ServicesThese centres have staff that have received training and/or have expertise in diabetes and workclosely with the local general practitioners and allied health staff to provide additional care andservices for people with diabetes.

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NADC Pharmacy Diabetes Service membership is offered to groups of professional healthcare workers who have an active involvement in diabetes care provided in the pharmacy context, and are committed to the goals and objectives of the NADC and to monitoring the outcomes of their service, but do not have the full complement of services or resources of a larger diabetes service.

6. Network MembersThe NADC Network membership is offered to Primary Health Networks (PHNs) and PrimaryCare Partnerships (PCPs) around Australia. PHNs and PCPs work directly with generalpractitioners, other primary health care providers, secondary care providers and hospitals, tofacilitate improved outcomes for patients. PHNs and PCPs are committed to providing efficientand effective primary health care, with objectives that align closely with those of the NADC.

Who will access the various diabetes services?

Most patients referred to Tertiary Care Diabetes Services, including Centres of Excellence, are referred by their general practitioners so that they may receive specialist assessment and treatment. Given this role, it is probable that people attending Tertiary Care Diabetes Services will be those whose diabetes is less likely to be managed well. In considering the outcomes of this data collection, it is important to remember that whilst Tertiary Care Diabetes Services will provide assessment and treatment, ongoing responsibility for management of diabetes remains with the person with diabetes and their general practitioner.

Development of ANDA Quality Clinical Indicators

There has been longstanding worldwide interest in developing suitable diabetes datasets and methods of data collection to capture appropriate diabetes outcomes for quality improvement. As a result, collection, analysis and reporting of standardised diabetes datasets is now widely practised. The European Association for the Study of Diabetes (EASD) Study Group DO IT (Diabetes care Optimisation through Information Technology)6 undertook much work aimed at improving the quality of diabetes care through the appropriate use of information technology, including promoting the collection, analysis and reporting of the DiabCare dataset7-8 for audit and benchmarking purposes. From this has come the DiabCare Q-Net initiative9.

A similar initiative, the NSW Diabetes Outcomes Workshop (NDOW), was undertaken in Australia in September 1993 with funding from the NSW Health Department10-11. Forty-five stakeholders including diabetes health professionals, Health Department officials and consumers met for a one-day workshop and agreed on a dataset of 59 health outcome data elements that covered demographic, acute and chronic complications and self-care practice areas of diabetes care. These items became known as the NDOW dataset, and subsequently these data items have become widely promulgated for collection (using standardised definitions) across Australia.

In 1997 the Australian Diabetes Society (ADS) Council accepted a recommendation to adopt the NDOW dataset as its Diabetes Outcomes dataset, and formed a sub-committee (now named the National Diabetes Data Working Group (NDDWG)). This sub-committee managed the dataset and promoted quality diabetes care in Australia, through the National Diabetes Outcomes Quality Review INitiative, (NDOQRIN). The NDDWG has taken a subset of the NDOW dataset and has promoted its collection as a minimum dataset (for quality diabetes care) in a variety of clinical practice settings.

After diabetes was named the 5th National Health Priority Area in 199612, work followed to improve diabetes care in Australia including the commissioning of the National Diabetes Strategy to update and replace the National Action Plan. One aspect reviewed was the need for local data on which appropriate planning could be carried out and assessment of the effect of initiatives could be undertaken. Consequently, several initiatives indicated the need for reliable data in Australia (including diabetes indicators work), as noted in the National Health Priority Areas Report: Diabetes Mellitus

51

199812. However, data on clinical aspects of diabetes, including outcomes data, were deficient in Australia as highlighted in The National Diabetes Strategy and Implementation Plan report13.

The NDDWG continued to promulgate the NDOQRIN dataset, and in 2002 was successful in having it accepted as the first clinical dataset to be included in the National Health Data Dictionary and Knowledgebase, Version 12. This dataset has since been enhanced, and is now online as part of the AIHW – Metadata Online Registry (‘METeOR’) as the Diabetes (clinical) Data Set Specification14.

1. The Dataset

The NDOQRIN diabetes dataset has considerable compatibility with similar international datasets15-17 The NDOQRIN dataset was enhanced and used as the basis of this national initiative, aimed at improving diabetes care through a structured approach to patient management18. This was achieved by linking the minimum dataset to the NSW Clinical Management Guidelines for Diabetes19, with subsequent enhancements to the dataset over the years. This minimum dataset is suitable for use in primary care (where it is known as the ‘Recommended GP Subset of the NDOQRIN Dataset’), specialist practice and diabetes centre settings. Enhancements and deletion/addition of data fields have occurred over the years to reflect feedback from participating centres on collections.

Currently the dataset remains a one page scannable form with required written data kept to a minimum, most fields being yes/no or other choice options. The data definitions provide definitions for each data field, including all valid field types.

The data dictionary has been updated and is made available to all sites.

2. ANDA Software/Database

An application of Teleform© scannable/faxable software has been integrated with a Microsoft SQL Server 2010 running under a Windows 7 operating system20-21. The Teleform© Designer module allows paper forms to be designed and printed. Once completed by sites, forms can be mailed to the ANDA Secretariat at the Alfred Centre, 5th Floor, 99 Commercial Road, Melbourne 3004.

The Teleform© Reader module assesses each form and either accepts the form (transferring data to an intermediate Access© data file), or suspends the form for verification of one or more data items that the Reader software cannot confidently identify. The Teleform© Verifier module allows an on-screen version of the scanned image to be viewed and corrections made where necessary. Once such corrections are made and accepted, data from these forms are also transferred to the database. Data in this file are then appended to the permanent database file. Concurrent Operating System and Software Versions are Windows 7, Access 2003 & Teleform V10.9.

Reports have been developed on a user-friendly interface to enable data reporting. This includes data verification reports to ensure complete and valid data capture.

Any data extracted from practitioner or site in-house databases will be transferred via a secure file transfer protocol (SFTP) for collation and analysis alongside scanned form data. Data will be stored in the central ANDA Database, a Microsoft Access© database held in password protected files on computers stored in a locked room at the School of Public Health and Preventive Medicine, Monash University.

Alternatively, participating sites may enter data directly into REDCap (Research Electronic Data Capture)22, a secure web application, stored on a secure Monash University server. Assigned staff members will be allocated a unique username to access the database. After data entry completion, sites will need to download a pdf version for every patient, print and file at local site.

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4. ANDA Coordination

ANDA coordination and conduct is overseen by the ANDA Secretariat and operational group based at the Division of Metabolism, Ageing and Genomics, School of Public Health and Preventive Medicine, Monash University in partnership with Monash Health.

5. ANDA Methodology

ANDA will consist of the following steps:

1. Initial call for expressions of interest from diabetes centres (potential sites).2. Formal invitations to participate and site acceptances (participating sites).3. Allocation of unique site codes by the ANDA Secretariat in a double blind manner and

distribution of data collection forms.4. Data collection by participating sites.5. Data entry, cleaning, collation and validation (including missing data query resolution).6. Data analysis and reporting.

The ANDA Secretariat will invite diabetes centres (all levels of NADC membership) and specialist endocrinologists in private practice to participate in the ANDA collection.

All contact and correspondence with participating centres/specialist endocrinologists will only occur through the ANDA Secretariat.

The ANDA Secretariat will provide participating centres and specialist endocrinologists with their unique site code and hold the only copy of this code.

Sites that have participated in past surveys will use their previously allocated unique site code. Sites that have not participated in past surveys will be allocated a new unique site code.

The central data management/analysis unit will generate ‘Master Copies’ of the forms uniquely numbered for each site. The forms will then be provided to the ANDA Secretariat who will upload them onto Basecamp Classic, a project management and collaboration system, in a secure file transfer web folder which has been set up for each individual site. Each participating site will be instructed to make copies (as many as required) of their unique form for use in the survey.

All sites will receive a “Guide to completing ANDA Forms” with instructions on how the forms should be completed and the data field definitions.

5.1 Survey period Centres will conduct the survey over 4 consecutive weeks (May or June). Note: For centres not able to collect data on more than 30 participants, the survey can be extended for another four weeks (May and June).

5.2 Ethics This project has received Human Research Ethics Low Risk approval from the Monash Health Human Research Ethics Committee. However, the onus is on each centre to seek advice regarding local ethics requirements.

5.3 Survey population All consecutive patients attending the centre/service over the 4-week survey interval (recommended 100 patients per site).

Sites will be advised to complete a data collection form for each patient attending the centre. All completed forms will be copied by the sites and stored locally in a secure place. The original forms will

53

then be sent to the ANDA Secretariat at the Alfred Centre, 5th Floor, 99 Commercial Road, Melbourne 3004. The ANDA Secretariat will check and collate the original forms and deliver them to the data management centre for processing.

Sites with computerised databases will have the alternative option of extracting the appropriate data in an electronic and de-identified form and providing it directly to the ANDA Secretariat through a secure web based data transfer process.

5.4 Data Verification and Validation As in previous years every effort will be made to ensure data completeness and correctness, with specific “validation reports” generated for each site.

These validation reports will contain lists of missing or potentially invalid data, as well as possible duplicate individual entries and will be forwarded to the sites by the ANDA Secretariat. Sites will then have 4 weeks to respond to these validation reports.

Once returned to the ANDA Secretariat, they will be forwarded to the data management centre where any additional or corrected data items will be entered/corrected respectively, in the pooled database, prior to final data analysis.

Where duplicates are identified, these will be reviewed and the first entered record retained, supplemented by any additional data in the second record that was missing in the original. The second entered record will then be deleted.

5.5 Data analysis/reporting In analysing the data, as in past surveys, the previous specified data assumptions, decisions and data manipulations will be observed. Data analysis and reporting will include:

AQCA & AQSMA Pooled data report • Pooled data• Data frequency counts• Missing data• Descriptive report (data tables and graphs)• Comparative statistics by year of collection (AQCA only)

AQCA & AQSMA Individual Site data report • Site report at a glance• National benchmarking report• Historical comparison report• Descriptive report (data tables and graphs)• Data compared against Clinical Management Guidelines for Diabetes (AQCA only)

5.6 Post survey/reporting feedback Participating sites will be asked to complete two questionnaires:

• At completion of the data collection phase to assess the project overall – July• After receipt of the reports to assess the adequacy of the individual site reports – January

6. Funding

The Australian Government Department of Health has funded the conduct of ANDA from 2013-2021.

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7. Milestones

The major project milestones are summarised below:

ANDA Milestones

Revise ANDA dataset - February Initial call for expressions of interest - March

Formal invitations received, collation of site acceptances - April

Allocation of site codes - April Generation and distribution of data collection forms - April

Data collection - May-June

Study assessment: Post Data Collection Questionnaire Data received from sites with in-house databases - June-July

Data entry and validation - July-September

Missing data reports forwarded to sites - July-September Integration of returned missing data - September

Final data analysis - October-November

Draft Pooled Data Report - December Final Site Data Analysis Reports forwarded to sites - January

Final Pooled Data Report - January

Study assessment: Site Report Assessment Questionnaire

8. References

1) The Diabetes Control and Complications Trial Research Group. The effect of intensive treatmentof diabetes on the development and progression of long-term complications in insulin- dependent diabetes mellitus. N Engl J Med. 1993;1993(329):977-86.

2) UK Prospective Diabetes Study Group: Intensive blood-glucose control with sulphonylureas orinsulin compared with conventional treatment and risk of complications in patients with type 2diabetes (UKPDS 33). Lancet. 1998;351:832-853.

3) UK Prospective Diabetes Study Group: Effect of intensive blood-glucose control with metforminon complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet.1998;352:854-865.

4) UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascularand microvascular complications in type 2 diabetes (UKPDS 38). BMJ. 1998;317:703-713.

5) UK Prospective Diabetes Study Group: Efficacy of atenolol and captopril in reducing risk of bothmacrovascular and microvascular complications in type 2 diabetes (UKPDS 39). BMJ.1998;317:713-720.

6) DO IT Study Group. Report of the EASD Study Group DO IT 1990/1991. Diabetologia 1991; 34(2): I.

7) Piwernetz K, Home PD, Snorgaard O, Antsiferov M, Staehr-Johansen K, Krans M. Monitoring thetargets of the St Vincent Declaration and the implementation of quality management indiabetes care: the DIABCARE initiative. The DIABCARE Monitoring Group of the St VincentDeclaration Steering Committee. Diabetic Medicine. 1993 May 1;10(4):371-7.

8) Krans HMJ, Porta M, Keen H. Monitoring instruments for quality improvement in diabetes care.G Ital Diabetologia. 1993;10:371-7.

55

9) Piwernetz K, Bruckmeier A, Staehr-Johansen K, Krans H. DiabCare Quality Network in Europe.Diabetes, Nutrition & Metabolism. 1993;6:311-314.

10) Diabetes Australia NSW & NSW Department of Health. Report on the 1993 NSW DiabetesOutcomes Workshop (NDOW). NSW: NSW Department of Health; 1993 Sep.

11) Rattray A, Colagiuri S, Churches T, Flack JR. NSW diabetes outcomes workshop (NDOW) datacollection. Proceedings of the Australian Diabetes Society Meeting; 1995 Sep; Melbourne.Australian Diabetes Society; 1998.

12) AIHW. National Health Priority Areas Report: Diabetes Mellitus 1998. Canberra ACT:Commonwealth Department of Health and Aged Care, and the Australian Institute of Healthand Welfare; 1999. 186 p. AIHW Cat. No. PHE 10.

13) Colagiuri S, Colagiuri R, Ward J. The National Diabetes Strategy and Implementation Plan 1998.Canberra, ACT: Diabetes Australia; 1998. 281 p.

14) Meteor metadata online registry [Internet]. Canberra ACT: NDDWG; 2005. Diabetes (clinical)NBPDS Diabetes (clinical) NBPDS; [cited 2017 Nov 20]. Available from:http://meteor.aihw.gov.au/content/index.phtml/itemId/304865.

15) Fleming BB, Greenfield S, Engelgau MM, Pogach LM, Clauser SB, Parrott MA. The DiabetesQuality Improvement Project: moving science into health policy to gain an edge on thediabetes epidemic. Diabetes Care. 2001;24(10):1815-20.

16) NBHW. Quality and efficiency of diabetes care in Sweden: national performance assessment.Stockholm Sweden: NBHW; 2011 May 18. Contract No.: 2014-3-18.

17) NICE. NICE quality and outcomes framework indicator: diabetes mellitus London: NICE; 2017.Available from: https://www.nice.org.uk/standards-and-indicators/qofindicators?categories=&page=2.

18) Bonney M, Harris MF, Priddin D. National Divisions Diabetes Program: Recommended GPSubset of the NDOQRIN Dataset. 1999.

19) NSW Department of Health. Principles of Care and Guidelines for the Clinical Management ofDiabetes Mellitus v1.3. Sydney NSW: NSW Department of Health; 1996. 35 p.

20) Flack JR, Colagiuri S, Churches T, Brandon P. Integrated software to record, analyse, report andaudit clinical diabetes data. Proceedings of Computers in Diabetes ’98; 1998 Sep; Barcelona,Spain. Diabetes Nutrition & Metabolism 1998; 11:43.

21) Churches T, Flack JR, Colagiuri S, Brandon P. Integrated software to record, analyse, report andaudit clinical diabetes data. Proceedings of the Australian Diabetes Society Meeting; 1998 Aug;Perth. Australian Diabetes Society; 1998.

22) Paul A. Harris, Robert Taylor, Robert Thielke, Jonathon Payne, Nathaniel Gonzalez, Jose G.Conde, Research electronic data capture (REDCap) - A metadata-driven methodology andworkflow process for providing translational research informatics support, J Biomed Inform.2009 Apr;42(2):377-81.

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2.5 Have you had a flu vaccination in the last 12 months?

4.2 Diabetes

Diet only

Tablets

InsulinInsulin & tablets

Insulin & injectables InjectablesInjectables & tablets

Insulin & tablets & injectables

ANDA-AQSMA 2018

Section 1. Patient Demographics

Section 2. Diabetes Type & Management & Lifestyle Issues

1.3 Date of visit

Site ID Staff initials(optional)

MedicalRecord No.

1.1 Date of birth

No Yes1.4 Initial visit

No Yes

No Yes1.5 Aboriginal/Torres Strait Islander

Male Female1.2 Sex d d m m y y y y

if FEMALE 1.2.1 Currently pregnant

Type 1 Type 2 GDM Don't know Other2.1 Year of diagnosis 2.2 Type of diabetes

2.3 Management method

Current smokerPast smokerNever smoked

2.7 Smoking status

d d m m y y y y

ANDA-AQSMA 2018 Data Collection Form version 1.0

/ // / 2 0 1 8

No Yes1.6 Interpreter required No Yes1.7 DVA patient

No Yes

2.6 Have you had a pneumococcal vaccination in the last 12 months? No Yes

if CURRENT 2.7.1 Have you tried to stop smoking?if PAST 2.7.2 Which of the following methods did you use?

No Yes

Australian National Diabetes Audit - Australian Quality Self Management Audit

No Yes1.8 NDSS member

1.9 Country of birth

3.2 Do you usually take all your medications?

3.3 Do you sometimes stop taking your medications when you feel better?

3.5 Are you using a complementary therapy or dietary supplement or over the counter (OTC) Rx?

3.5.1 Have you told your doctor or educator about using

3.4 Do you sometimes stop taking your medications when you feel worse?

3.1 Do you ever forget to take your medications?

if YES 3.1.1 How many times per week?

Section 3. Medication Use

5.1 Do you have difficulties following your recommended diet?

5.1.1 I don't have enough time to prepare healthy meals

5.1.2 It costs too much to eat well

Section 5. Patient Self Care Practices

5.1.3 I don't know what foods are best to eat

5.1.4 I eat out a lot and find it hard to eat well

if YES Do the following apply?

5.1.5 If Type 1 - it is too hard to count carbs/weigh food

Has the patient attended any of the following in the last12 months?

No Yes

4.8 Optometrist

4.7 Ophthalmologist

4.6 Diabetes Specialist

4.5 Social Worker

4.4 Psychologist

4.3 Dietitian

4.1 Podiatrist

Section 4. Health Professional Attendances

4.10 Exercise

4.9 Dentist

Section 7. Quality of Life Assessment

No Yes

Over the last couple of weeks has the patient been:No Yes

6A.4 Dissatisfied with their way of doing things?

6A.3 Feeling unable to overcome difficulties?

6A.2 Feeling unhappy or depressed?

6A.1 Having restless or disturbed nights?

Section 6A. BCD

6B.2 Psych. treatment/counselling - past?

6B.1 Is the patient taking antidepressants?

6B.3 Psych. treatment/counselling - now?

No YesSection 6B. Treatment

%.2.8.1 Most recent HbA1c result (%) mmol/mol

Just stopped - no intervention

Medication

Nicotine replacement

Hypnosis

Acupuncture

Other

<1yr

1-5yrs

>5yrs2.3.1 How long ago

was insulin started?

if on INSULIN

Sufficient Insufficient Sedentary2.4 Physical activity sufficiency

if YES

5.2 Do you check your blood glucose level as often as recommended?No Yes Unsure of recommended testing

5.3 If you are on injectables or insulin, do you rotate your injection site?

Not availableNot available2.8.2 Most recent

HbA1c result (mmol/mol)

(Select all that apply)

Part A: Self-assessment of health status

7.1 Own health state rating (0-100)

No Yes7.4 DDS 17 questionnaire completed

Part B: Diabetes Distress Scale 17 (complete if Screening Scale Q1 or Q2 is ≥ 3)

7.4.1 Total DDS 17 Score .7.4.2 Emotional Burden (A) .7.4.3 Physician-related

Distress (B) .7.4.4 Regimen-related Distress (C) .7.4.5 Interpersonal

Distress (D) .

Did not complete

Did not completeDid not complete

7.2 Screening Scale Q1

7.3 Screening Scale Q2} if Q1 or Q2 is ≥ 3,

complete Part B

if YES

Page 1 of 1

Unknown

Educator

Physiologist

No Yes N/A

No Yes N/A

No Yes N/A

complementary, dietary supplement or OTC Rx?

(Select one option)

17817

57

ANDA‐AQSMA 2018 DATA DEFINITIONS 

Section 1. Patient Demographics 

Medical Record No.  (Compulsory field). Record some identifier such as UR number, or the first 2 letters of the first name and surname and month and year of birth (e.g. FFSSMMYY) to enable you to check your records if there is a question regarding the data 

Site ID  Unique site identifier (assigned by ANDA Secretariat) 

Staff initials (optional)  Initials of the staff member completing the form 

Date of birth  Record as DD/MM/YYYY 

Sex  Mark Male or Female indicating phenotypic (physical) sex at birth 

Currently pregnant  If sex is female, mark Yes or No  

Date of visit  Record the date the patient attended as DD/MM/2018 

Initial visit  Mark No or Yes indicating if this is an initial visit assessment 

Aboriginal/Torres Straits Islander 

Mark No or Yes indicating Aboriginal/Torres Strait Islander background 

Interpreter required  Record No or Yes for the requirement for interpreter services as perceived by the patient 

DVA patient  Eligible people whose medical care charges are met by the Department of Veterans’ Affairs (DVA) 

NDSS member  Record No or Yes if the patient is a member of the NDSS 

Country of birth  Record the patient’s country of birth 

Section 2. Diabetes Type & Management & Lifestyle Issues 

Year of diagnosis  Record as YYYY of first diagnostic blood glucose estimation or mark as Unknown 

Type of diabetes  Mark Type1 (IDDM), Type2 (NIDDM), GDM, Don't know or Other to indicate the clinical 

classification of diabetes 

Management Method (choose one option only) 

Mark as Diet only, Tablets, Insulin & tablets, Injectables & tablets, Insulin & tablets & injectables, Insulin & injectables, Insulin or Injectables to indicate the management method.  Injectables include injected anti‐hyperglycaemic agents not including insulin (e.g. GLP‐1 analogues) 

If on insulin: How long ago was insulin started 

<1 year insulin was started within the past year 1‐5 years insulin was started between 1 and 5 years ago > 5 years insulin was started more than 5 years ago 

Physical activity  Physical activity is calculated in ‘total minutes per week’ by summing the total minutes of walking, moderate and/or vigorous physical activity  in a usual 7‐day period. Vigorous physical activity  is weighted by a  factor of  two to account  for  its greater intensity. Intensity of physical activity is defined by The National Physical Activity Guidelines for Australians: Moderate physical activity  causes  a  slight  but  noticeable  increase  in  breathing  and  heart  rate,  the person  can comfortably  talk  but  not  sing. Vigorous physical activity causes the person to ‘huff and puff,’ talking in full sentences between breaths is difficult Sufficient physical activity for health benefit is equal to or more than 150 total minutes per week      Insufficient physical activity is more than 0 minutes, but less than 150 total minutes per week        Sedentary is where there has been no moderate and/or vigorous physical activity per week 

Flu vaccination  Has the patient had a flu vaccination in the last 12 months? (No/Yes) 

Pneumococcal vaccination 

Has the patient had a pneumococcal vaccination in the last 12 months? (No/Yes) 

Smoking status  Mark Current smoker, Past smoker or Never smoked to indicate smoking of any tobacco material Current smoker=regular smoking over the past 3 months, past smoker=no regular smoking for 1 month or more, never smoked=never smoked any tobacco material 

If current smoker  Has the patient tried to stop smoking? (No/Yes) 

If past smoker (Select all that apply) 

Indicate the method/s (No intervention or Medication, Nicotine replacement, Hypnosis, Acupuncture and/or Other) used to stop smoking 

HbA1c result   Record absolute result (% and mmol/mol) of the most recent HbA1c result in the last 6 months 

Page 1 of 2 

58

ANDA‐AQSMA 2018 DATA DEFINITIONS 

Section 3. Medication Use 

Medication use practices  Ask the questions as listed and indicate response (No/Yes) or mark N/A if the patient is not prescribed tablets. If the patient does not forget to take their medication weekly (e.g. fortnightly), record 0. (Only answer if patient ever forgets to take their medications) 

Complementary therapy  Is the patient using a complementary therapy (herbal/homeopathic/vitamin or mineral supplement) or dietary supplement or over the counter (OTC) Rx? (No/Yes) 

Told doctor/diabetes educator  Has the patient told their diabetes doctor or diabetes educator about using complementary therapy or OTC Rx? (No/Yes) 

Medication use practices  Ask the questions as listed and indicate response (No/Yes) or mark N/A if the patient is not prescribed tablets 

Section 4. Health Professional Attendances 

Podiatrist  Record if the patient attended in the last 12 months (No/Yes) 

Diabetes Educator  Record if the patient attended in the last 12 months (No/Yes) 

Dietitian  Record if the patient attended in the last 12 months (No/Yes) 

Psychologist  Record if the patient attended in the last 12 months (No/Yes) 

Social Worker  Record if the patient attended in the last 12 months (No/Yes) 

Diabetes Specialist  Record if the patient attended in the last 12 months (No/Yes) 

Ophthalmologist  Record if the patient attended in the last 12 months (No/Yes) 

Optometrist  Record if the patient attended in the last 12 months (No/Yes) 

Dentist  Record if the patient attended in the last 12 months (No/Yes) 

Exercise Physiologist  Record if the patient attended in the last 12 months (No/Yes) 

Section 5. Patient Self Care Practices 

Do you have difficulties following your recommended diet? 

Indicate whether the patient has difficulties following recommended diet (No/Yes) If YES, ask the patient whether the following options apply to them. Mark No/Yes to each of the options 

Do you check your blood glucose level as often as recommended? 

Mark which one of the options describes the patient’s usual practice (No/Yes/Unsure of recommended testing) 

Do you rotate your injection site?  Does the patient routinely change the site of injection for injectables or insulin? (No/Yes) or mark N/A if the patient is not on injectables or insulin 

Section 6A. Brief Case Find For Depression (BCD) Copyright 1993 Monash University Department of Psychology Medicine 

Been having restless or disturbed nights?  (No/Yes) 

Been feeling unhappy or depressed?  (No/Yes) 

Been feeling unable to overcome difficulties?  (No/Yes) Problems of life that have been worrying you 

Been dissatisfied with the way of doing things?  (No/Yes) Things that you have had to do at home or at work 

Section 6B. Treatment 

Is the patient taking antidepressants?  Is the patient taking antidepressant medication (not prescribed for peripheral neuropathy)? (No/Yes) 

Psych treatment/counselling – past?  Has the patient had psychiatric treatment/counselling in the past? (No/Yes) 

Psych treatment/counselling – now?  Is the patient currently having psychiatric treatment/counselling? (No/Yes) 

Section 7. Quality of Life Assessment 

Own Health State Rating  Record the absolute result of the patient’s Own Health State Rating (0‐100) from  Self Assessment of Health Status. If the questionnaire was not completed, mark Did not complete  

Screening Scale Q1 & Q2  All patients to complete Self Assessment of Health Status questionnaire. Record the ACTUAL SCORE reported in the Screening Scale Q1 & Q2. If the Screening Scale Q1 or Q2 were not completed, mark Did not complete 

DDS17 questionnaire completed  Was the DDS 17 questionnaire completed by the patient? (No/Yes) Administer DDS17 only if Screening Scale Q1 or Q2 is ≥3 

Total DDS Score  Record the ‘Mean item score’ calculated on the DDS17 Scoring Sheet 

Emotional Burden (A)  Record the ‘Mean item score’ calculated on the DDS17 Scoring Sheet 

Physician‐related Distress (B)  Record the ‘Mean item score’ calculated on the DDS17 Scoring Sheet 

Regimen‐related Distress (C)  Record the ‘Mean item score’ calculated on the DDS17 Scoring Sheet 

Interpersonal Distress (D)  Record the ‘Mean item score’ calculated on the DDS17 Scoring Sheet 

Page 2 of 2 

59

ANDA‐AQSMA 2018 Data Dictionary

Item No. Question Field Name Field Type Format Code ConstraintsMedical Record Number PatientID TEXT alphanumeric Compulsory fieldSite ID SiteID TEXT NNN Compulsory field (leading 0 required)Staff initials (optional) GPID TEXT alphanumeric Optional field

1.1 Date of birth DOB DATE DD/MM/YYYY Must be before CreatD

1.2 Sex Sex NUMERIC N1 = Male2 = Female Compulsory field

1.2.1 Currently pregnant Pregnant_Current NUMERIC N0 = No1 = Yes Required only if Sex = 2

1.3 Date of visit CreatD DATE DD/MM/YYYY Must be between May and June this year

1.4 Initial visit Initial_Visit NUMERIC N0 = No1 = Yes Compulsory field

1.5 Aboriginal/Torres Strait Islander Indigen NUMERIC N0 = No1 = Yes Compulsory field

1.6 Interpreter required Interpret NUMERIC N0 = No1 = Yes Compulsory field

1.7 DVA patient DVA NUMERIC N0 = No1 = Yes Compulsory field

1.8 NDSS member NDSS NUMERIC N0 = No1 = Yes Compulsory field

1.9 Country of birth Country TEXT alphanumeric Compulsory field

Section 1. Patient Demographics

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ANDA‐AQSMA 2018 Data Dictionary

Item No. Question Field name Field Type Format Code Constraints2.1 Year of diagnosis YearDx NUMERIC NNNN Must be between DOB and CreatD

2.1 Year of diagnosis ‐ unknown YearDxNA NUMERIC N0 = No1 = Yes Must not be null if YearDx is null

2.2 Type of diabetes DiabType NUMERIC N

1 = Type 12 = Type 23 = GDM4 = Don't know5 = Other Compulsory field

2.3 Management method RxMethod NUMERIC N

1 = Diet2 = Tablets3 = Insulin4 = Insulin & tablets5 = Insulin & injectables6 = Injectables7 = Injectables & tablets8 = Insulin & tablets & injectables Compulsory field

2.3.1 How long ago was insulin started InsStarted NUMERIC N

1 = <1yr2 = 1‐5yrs3 = >5yrs Required only if RxMethod = 3, 4, 5 or 8

2.4 Physical activity sufficiency PhysicalActivity_Sufficiency NUMERIC N

1 = Sufficient2 = Insufficient3 = Sedentary Compulsory field

2.5 Flu vaccination in last 12 months Vaccination_Flu NUMERIC N0 = No1 = Yes Compulsory field

2.6

Pneumococcal vaccination in last 12 months Vaccination_Pneumococcal NUMERIC N

0 = No1 = Yes Compulsory field

2.7 Smoking status Smoking_Status NUMERIC

1 = Current2 = Past3 = Never Compulsory field

2.7.1 Tried to stop smoking Smoker_TriedToStop NUMERIC N0 = No1 = Yes Required only if Smoking_Status = 1

2.7.2

Cessation method: Just stopped ‐ no intervention Smoker_Past_JustStopped NUMERIC N

0 = No1 = Yes Required only if Smoking_Status = 2

2.7.2 Cessation method: Medication Smoker_Past_Medication NUMERIC N0 = No1 = Yes Required only if Smoking_Status = 2

2.7.2

Cessation method: Nicotine replacement Smoker_Past_Nicotine NUMERIC N

0 = No1 = Yes Required only if Smoking_Status = 2

Section 2. Diabetes Type & Management & Lifestyle Issues

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ANDA‐AQSMA 2018 Data Dictionary

Item No. Question Field name Field Type Format Code Constraints

2.7.2 Cessation method: Hypnosis Smoker_Past_Hypnosis NUMERIC N0 = No1 = Yes Required only if Smoking_Status = 2

2.7.2 Cessation method: Acupuncture Smoker_Past_Acupuncture NUMERIC N0 = No1 = Yes Required only if Smoking_Status = 2

2.7.2 Cessation method: Other Smoker_Past_Stopped_Other NUMERIC N0 = No1 = Yes Required only if Smoking_Status = 2

2.8.1 HbA1c result (%) HbA1cPercent NUMERIC NN.N Must be between 5 ‐ 20

2.8.1 HbA1c result (%) ‐ not available HbA1cPercentNA NUMERIC N0 = No1 = Yes Must not be null if HbA1cPercent is null

2.8.2 HbA1c result (mmol/mol) HbA1cMmol NUMERIC NNN Must be between 31 ‐ 195

2.8.2

HbA1c result (mmol/mol) ‐ not available HbA1cMmolNA NUMERIC N

0 = No1 = Yes Must not be null if HbA1cMmol is null

Item No. Question Field name Field Type Format Code Constraints

3.1 Forget to take medications Medications_Forget NUMERIC N

0 = No1 = Yes2= Not applicable Compulsory field

3.1.1 How many times per week Forget_Meds_HowManyTimes NUMERIC NN Required only if Medications_Forget = 1

3.2 Usually take all medications Medications_Careless NUMERIC N

0 = No1 = Yes2= Not applicable Compulsory field

3.3

Sometimes stop taking when feeling better Medications_Better_Stop NUMERIC N

0 = No1 = Yes2= Not applicable Compulsory field

3.4

Sometimes stop taking when feeling worse Medications_Worse_Stop NUMERIC N

0 = No1 = Yes2= Not applicable Compulsory field

3.5

Using complementary therapy or dietary supplement or OTC Rx ComplementaryRxUsed NUMERIC N

0 = No1 = Yes Compulsory field

3.5.1

Told doctor or educator about using complementary, dietary supplement or OTC Rx ComplementaryRxToldDr NUMERIC N

0 = No1 = Yes Required only if ComplementaryRxUsed = 1

Section 3. Medication Use

Section 2. Diabetes Type & Management & Lifestyle Issues (cont'd)

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ANDA‐AQSMA 2018 Data Dictionary

Item No. Question Field name Field Type Format Code Constraints

4.1 Podiatrist Podiat NUMERIC N0 = No1 = Yes Compulsory field

4.2 Diabetes Educator DiabEduc NUMERIC N0 = No1 = Yes Compulsory field

4.3 Dietitian Dietitn NUMERIC N0 = No1 = Yes Compulsory field

4.4 Psychologist Psychologist NUMERIC N0 = No1 = Yes Compulsory field

4.5 Social Worker SocialWorker NUMERIC N0 = No1 = Yes Compulsory field

4.6 Diabetes Specialist DiabetesSpecialist NUMERIC N0 = No1 = Yes Compulsory field

4.7 Ophthalmologist Ophthalmologist NUMERIC N0 = No1 = Yes Compulsory field

4.8 Optometrist Optometrist NUMERIC N0 = No1 = Yes Compulsory field

4.9 Dentist Dentist NUMERIC N0 = No1 = Yes Compulsory field

4.10 Exercise Physiologist Exercise_Physiologist NUMERIC N0 = No1 = Yes Compulsory field

Section 4. Health Professional Attendances

Version 1.1 Page 4 of 6 63

ANDA‐AQSMA 2018 Data Dictionary

Item No. Question Field name Field Type Format Code Constraints

5.1

Difficulties following recommended diet Diet_Difficulty NUMERIC N

0 = No1 = Yes Compulsory field

5.1.1

Don't have enough time to prepare healthy meals Diet_Difficulty_Time NUMERIC N

0 = No1 = Yes Required only if Diet_Difficulty = 1

5.1.2 Costs too much to eat well Diet_Difficulty_Cost NUMERIC N0 = No1 = Yes Required only if Diet_Difficulty = 1

5.1.3

Don't know what foods are best to eat Diet_Difficulty_BestFoods NUMERIC N

0 = No1 = Yes Required only if Diet_Difficulty = 1

5.1.4

Eat out a lot and find it hard to eat well Diet_Difficulty_EatOut NUMERIC N

0 = No1 = Yes Required only if Diet_Difficulty = 1

5.1.5 If type 1 ‐ too hard to count carbs Diet_Difficulty_Type1 NUMERIC N

0 = No1 = Yes2= Not applicable

Required only if Diet_Difficulty = 1 & DiabType = 1

5.2

Check blood glucose as often as recommended Check_glucose NUMERIC N

0 = No1 = Yes2 = Unsure of recommended testing Compulsory field

5.3 Rotate injection site Rotate NUMERIC N

0 = No1 = Yes2= Not applicable Required only if RxMethod = 3, 4, 5, 6, 7 or 8

Item No. Question Field name Field Type Format Code Constraints

6A.1 Restless or disturbed nights RestlessNight NUMERIC N0 = No1 = Yes Compulsory field

6A.2 Feeling unhappy or depressed FeelingDepressed NUMERIC N0 = No1 = Yes Compulsory field

6A.3

Feeling unable to overcome difficulties FeltUnable NUMERIC N

0 = No1 = Yes Compulsory field

6A.4

Dissatisfied with their way of doing things BeenDissatisfied NUMERIC N

0 = No1 = Yes Compulsory field

Item No. Question Field name Field Type Format Code Constraints

6B.1

Is the patient taking antidepressants OnAntidepressant NUMERIC N

0 = No1 = Yes Compulsory field

6B.2

Psych. Treatment/counselling ‐ past PsychiatricTreatmentPrev NUMERIC N

0 = No1 = Yes Compulsory field

6B.3

Psych. Treatment/counselling ‐ now PsychiatricTreatmentCurrent NUMERIC N

0 = No1 = Yes Compulsory field

Section 6A. BCD

Section 6B. Treatment

Section 5. Patient Self Care Practices

Version 1.1 Page 5 of 6 64

ANDA‐AQSMA 2018 Data Dictionary

Item No. Question Field name Field Type Format Code Constraints7.1 Own health state rating OwnHealthStateRating NUMERIC NNN Compulsory field

7.1

Own health state rating ‐ did not complete RatingDNC NUMERIC N

0 = No1 = Yes

Must not be null if OwnHealthStateRating is null

7.2 Screening Scale Q1 DDS_Screen_Q1 NUMERIC N Compulsory field

7.2

Screening Scale Q1 ‐ did not complete DDSScreenQ1DNC NUMERIC N

0 = No1 = Yes Must not be null if DDS_Screen_Q1 is null

7.3 Screening Scale Q2 DDS_Screen_Q2 NUMERIC N Compulsory field

7.3

Screening Scale Q2 ‐ did not complete DDSScreenQ2DNC NUMERIC N

0 = No1 = Yes Must not be null if DDS_Screen_Q2 is null

7.4 DDS 17 Questionnaire completed DDS17Q_Done NUMERIC N0 = No1 = Yes

Required only if either DDS_Screen_Q1 or DDS_Screen_Q2 > 3

7.4.1 Total DDS 17 Score Total_DDS_Score NUMERIC N.N Required only if DDS17Q_Done = 17.4.2 Emotional Burden Emot_Burden NUMERIC N.N Required only if DDS17Q_Done = 17.4.3 Physician‐related distress Phys_rel_Burden NUMERIC N.N Required only if DDS17Q_Done = 17.4.4 Regimen‐related distress Regimen_rel_Burden NUMERIC N.N Required only if DDS17Q_Done = 17.4.5 Interpersonal distress Interpers_Distress NUMERIC N.N Required only if DDS17Q_Done = 1

Item No. Question Field name Field Type Format Code CalculationPatient age Age NUMERIC NN.NN (CreatD‐DOB)/365.25

BCD Depression Likely ‐ part A LikelyDepA NUMERIC N

LikelyDepA=1 if RestlessNight=1 | FeelingDepressed=1LikelyDepA=2 if RestlessNight=2 & FeelingDepressed=2

BCD Depression Likely ‐ part B LikelyDepB NUMERIC N

LikelyDepB=1 if FeltUnable=1 | BeenDissatisfied=1LikelyDepB=2 if FeltUnable=2 & BeenDissatisfied=2

BCD Depression Likely BCDCalc NUMERIC N0 = No1 = Yes BCDCalc=1 if LikelyDepA=1 & LikelyDepB=1

Either DDS screening questions have a score of 3 or more DDS_Over2 NUMERIC N

0 = No1 = Yes

DDS_Over2=1 if DDS_Screen_Q1>2 | DDS_Screen_Q2>2

Any of the DDS17 scores is equal to or more than 3 DDS_Indiv_over2 NUMERIC N

0 = No1 = Yes

DDS_Indiv_over2=1 if Emot_Burden >=3|Phys_rel_Burden>=3| Interpers_Distress>=3| Regimen_rel_Burden>=3

Derived Fields

Section 7. Quality of Life Assessment

Version 1.1 Page 6 of 6 65

Australian National Diabetes Audit –Australian Quality Self Management Audit 

(ANDA‐AQSMA) 2018 Guide

66

4 Step Process

Pre‐reading Prepare & print Complete Photocopy 

& Submit

67

Pre‐reading– Protocol– Data Collection Form(paper‐based or web‐based)

– Data Definitions– Self Assessment of Health Status(Appendix 1)

– Diabetes Distress Scale 17 (DDS17)(Appendix 2)

– DDS 17 Scoring Sheet – paper andelectronic(Appendix 3)

68

Prepare and print• Data Collection Form• Self Assessment of Health Status (Appendix 1)• Diabetes Distress Scale 17 (Appendix 2)• DDS Scoring Sheet – paper or electronic(Appendix 3)

69

Complete formsData Collection Form

• Collect patient data during the consultation directly from the patient and/or through patient medical records up to section 7

70

Quality of Life AssessmentPart A: Self Assessment of Health Status (Appendix 1)

Transpose results on to Data Collection Form 

• Patient to complete SelfAssessment of HealthStatus form

• If Q1 or Q2 score isgreater than or equal to3, patient to completeDDS17 questionnaire

620 9 0

71

Quality of Life AssessmentPart B: Diabetes Distress Scale 17 (Appendix 2)

72

Quality of Life AssessmentDiabetes Distress Scale 17 Scoring Sheet (Appendix 3)

OR

Appendix 3a Appendix 3b73

Calculate the DDS 17 Score(Paper‐based)

4+2+1+4…+4

4+1+2+3+4

3+3+4

2.8

2.8

3.3

3.0

2.9

x

x

3+5+2+4+1

2+4+2+2

2    9 2    52    8 3    0

3    3x

Transpose scores to Data Collection Form 

74

Calculate the DDS 17 Score(Electronic)

Transpose results on to Data Collection Form 

Enter scores from the DDS17 form directly into the electronic DDS 17 

Scoring Sheet

2    9 2    52    8 3    0

3    3x

Print a copy to file with the patient record

75

We consider a mean item score of 3 or higher (moderate distress) as a level of distress worthy of clinical attention. 

We also suggest reviewing the patient’s responses across all items, regardless of mean item scores.

If any single item scored 3 or greater we recommend making time to address this with the patient, and make referral to additional services as appropriate, 

e.g. psychology, social work, pharmacy or physician.

Recommendation

76

Store in a secure location at your local site:‐ A copy of the completed Data Collection Form‐ The original Self Assessment of Health Status Form(Appendix 1)

‐ The original Diabetes Distress Scale 17 Questionnaire(Appendix 2)

‐ The original paper‐based DDS 17 Scoring Sheet(Appendix 3) 

Send to the ANDA secretariat: ‐ The original completed ANDA‐AQSMA Data Collection Forms

Photocopy & Submit

77

Data Collection Overview

78

Questions?Contact the ANDA Secretariat, Elspeth Lilburn on 

anda@nadc.net.au

Thank‐you!

79

Australian National Diabetes Audit ‐ 

Australian Quality Self Management Audit (ANDA‐AQSMA) 

Data Entry Manual 

Author: Trieu‐Anh Truong Document version: 1.1 Date created: 16 April 2018 Last updated: 19 April 2018 REDCap Version: 8.1.9 © 2018 Vanderbuilt University  

80

ANDA‐AQSMA Data Entry Manual, April 2018 v1.1    Page 2 of 10 

Revision History Date Modified  Modified By  Version  Details 16/4/2018  Trieu‐Anh Truong  1.0  Initial document 19/4/2018  Trieu‐Anh Truong  1.1  Addition of Revision History table 

Addition of Section 6. Export Data To Print 

Abbreviations 

ANDA  Australian National Diabetes Audit AQSMA  Australian Quality Self Management Audit CRF  Case Report Form eCRF  electronic Case Report Form ID  Identification MHTP  Monash Health Translation Precinct REDCap  Research Electronic Data Capture URL  Uniform Resource Locator  

81

ANDA‐AQSMA Data Entry Manual, April 2018 v1.1    Page 3 of 10 

Contents Revision History ...................................................................................................................................... 2 

Abbreviations .......................................................................................................................................... 2 

1. REDCap: Research Electronic Data Capture .................................................................................... 4

1.1 About REDCap ............................................................................................................................... 4 

2. Accessing the ANDA Database ........................................................................................................ 4

2.1 Login URL ....................................................................................................................................... 4 

2.2 User Accounts ............................................................................................................................... 4 

2.3 Passwords ..................................................................................................................................... 5 

3. Home Screen ................................................................................................................................... 5

3.1 Home ............................................................................................................................................. 5 

3.1.1 My Projects ............................................................................................................................ 5 

3.1.2 My Profile ............................................................................................................................... 6 

3.1.3 Log out ................................................................................................................................... 6 

4. Menu and Workspace ..................................................................................................................... 7

5. Data Entry ....................................................................................................................................... 7

5.1 Add/Edit Records .......................................................................................................................... 7 

5.1.2 Entering Data ......................................................................................................................... 8 

5.2 Record Status Dashboard .............................................................................................................. 8 

5.2.1 Legend for status icons .......................................................................................................... 9 

6. Export Data To Print ........................................................................................................................ 9

6.1 Individual Patient Record .............................................................................................................. 9 

6.1.1 Record Home Page ................................................................................................................. 9 

6.2 All Patients’ Records ................................................................................................................... 10 

7. Data Completion & Troubleshooting ............................................................................................ 10

8. References .................................................................................................................................... 10

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1. REDCap: Research Electronic Data Capture 1.1 About REDCap REDCap is a secure web application for building and managing online surveys and databases electronically. REDCap was created in 2004 at Vanderbilt University1.  Use of the REDCap system is governed by an End User Licence Agreement between Monash University and Vanderbilt University. The REDCap application (database and web server) are hosted at Monash University. All communication between client (user’s browser) and server (registry system) occurs on secure channel, commonly referred to as Secure Sockets Layer (SSL). SSL ensures that all data is encrypted by a private key on the server before it is sent on a wire to the client where it is decrypted by a public key. This ensures the data are not compromised in transit. The ANDA database has been developed to assist participating sites with real‐time electronic data capture. 

 

2. Accessing the ANDA Database 2.1 Login URL Type the URL below in your internet browser (Firefox, Chrome, Safari or Internet Explorer) to access the ANDA database. 

https://redcap.mhtp.org.au/ 

 

2.2 User Accounts To obtain access to the ANDA database, site coordinators are required to provide the ANDA secretariat with the following details of staff members completing the forms: 

First name  Surname  E‐mail address  Site name  Site ID 

Each staff member at your site will be provided with an individual user account and will only be able to see patients from your site. 

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2.3 Passwords When your account has been created, you will receive an e‐mail from redcap@monash.edu (also check your spam folder) containing your login details:  

Your username URL link to the ANDA database

When you click on the link from the e‐mail for the first time, you will be required to set your own password. 

REDCap password requirements include: 

Length between 10 and 15 characters Comprised of only letters, numbers and underscores (i.e. no special characters) Contains at least one upper case letter, one lower case letter and one number

You will also be asked to set a challenge question and answer that can be used to help you if you forget your password.  

*** YOUR LOGIN DETAILS SHOULD BE KEPT PRIVATE AND NOT BE SHARED *** 

N.B. If REDCap detects inactivity after 30 minutes, you will automatically be logged out. You will also be required to change your password every 90 days.  

3. Home Screen3.1 Home The Home screen is where you will be able to access: My Projects , My Profile and Log out icon. 

3.1.1 My Projects This page lists all the REDCap MHTP projects that you have access to. 

Click the project title to access the database

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3.1.2 My Profile  (Optional) To update your profile, password or preferences, click on ‘My Profile’, located on 

the right hand side of the Home screen 

 

 

3.1.3 Log out It is recommended that you always log out using the ‘Log out’ link after data entry completion. 

 

Your session will time out after 30 minutes of inactivity, requiring you to log in again to continue. 

 

   

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4. Menu and Workspace The main menu is located on the left hand side of the screen. 

The workspace is located on the right hand side of the screen. 

 

 

 

 

 

5. Data Entry 5.1 Add/Edit Records  From the menu, under the ‘Data Collection’ heading, click ‘Add/Edit Records’ to create a 

new participant ID  From the workspace, enter the ‘Medical Record No.’ or select a record from the existing 

drop down list to edit a record previously entered  Using the mouse, click away from the text box or press ‘enter’ on the keyboard. You will 

automatically be taken to the data collection form (also known as electronic Case Report Form (eCRF)) 

 

Workspace 

Menu 

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5.1.2 Entering Data  Enter data in all required fields (*) Under the ‘Form Status’ section, change  the ‘Complete?’ question from ‘Incomplete’

(default) to ‘Complete’ if all data has been entered. (Note: Ignore ‘Unverified’ status as it isnot applicable to ANDA)

Click ‘Save & Exit Form’

5.2 Record Status Dashboard  From the menu, under the ‘Data Collection’ heading, click ‘Record Status Dashboard’ to

access an overview of all patients’ data entry progress From the workspace, click on the patient ID to go to their ‘Record Home Page’ or Click on the coloured circle to return to the patient’s eCRF

All entered patients 

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5.2.1 Legend for status icons 

6. Export Data To Print There are 2 ways to export patients’ entered data:

As an individual patient record in a pdf file All patient records in a single pdf file at the end of data collection

The file will contain the actual page format as you would see it on the data entry page

6.1 Individual Patient Record 

From the menu, under the ‘Data Collection’ heading, go to the patient’s ‘Record Home Page’either by selecting the patient from the ‘Record Status Dashboard’ page or the ‘Add/EditRecords’ page

6.1.1 Record Home Page  To print a hard copy of data entered, click on the ‘Choose action for record’ drop down

arrow Click ‘Download PDF of record data for all instruments’

Not applicable to ANDA 

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Open and print the downloaded pdf file File the hard copy at your local site

6.2 All Patients’ Records  To print a hard copy of data entered for all patients, from the menu, under the ‘Application’

heading, click ‘Data Exports, Reports, and Stats’ In the workspace, click on the ‘Other Export Options’ tab Click on the pdf icon to download a file with all patients’ entered data

Open and print the downloaded pdf file File the hard copy at your local site

7. Data Completion & Troubleshooting Contact the ANDA Secretariat (anda@nadc.net.au)

At the completion of your data collection In the event of troubleshooting, send any queries and a print screen of any pop‐up

errors

8. References1. Paul A. Harris, Robert Taylor, Robert Thielke, Jonathon Payne, Nathaniel Gonzalez, Jose G.

Conde, Research electronic data capture (REDCap) ‐ A metadata‐driven methodology andworkflow process for providing translational research informatics support, J Biomed Inform.2009 Apr;42(2):377‐81.

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Appendix 1ANDA‐AQSMA 2018 

Australian National Diabetes Audit Australian Quality Self Management Audit 

Self Assessment of Health Status

Date:  

Name:  

Own Health State Rating (0‐100) 

We would like you to indicate on the scale to the right how good or bad your own health state is today, in your opinion. 

Please do this by drawing a  line from the grey box below to whichever point on the scale indicates how good or bad your health state is today. 

Best imaginable health state 

Screening Scale Questions 

Listed in the table below are two potential problem areas that people with diabetes may experience. Consider the degree to which each of the two items may have distressed or bothered you during the past month and circle the appropriate number. 

Please note that we are asking you to indicate the degree to which  each  item may  be  bothering  you  in  your  life,  NOT whether  the  item  is merely  true  for  you.  If  you  feel  that particular item is not a bother or problem for you, you would circle  “1”.  If  it  is very bothersome  to  you,  you might circle “6”. 

Your Own Health State 

Today 

Not a Problem 

A Slight Problem 

A Moderate Problem 

Somewhat Serious Problem 

A Serious Problem 

A Very Serious Problem 

Q1. Feeling overwhelmed by the demands of living with diabetes. 

1  2  3  4  5  6 

Q2. Feeling that I am often failing with my diabetes routine. 

1  2  3  4  5  6 

Worst imaginable health state 

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ANDA‐AQSMA 2018 Australian National Diabetes Audit  

Australian Quality Self Management Audit 

Diabetes Distress Scale 17 

DIRECTIONS: Living with diabetes can sometimes be  tough. There may be many problems and hassles  concerning  diabetes  and  they  can  vary  greatly  in  severity.  Problems may  range  from minor hassles to major life difficulties. Listed below are 17 potential problem areas that people with diabetes may experience. Consider  the degree  to which each of  the 17  items may have distressed or bothered you DURING THE PAST MONTH and circle the appropriate number. 

Please note that we are asking you to indicate the degree to which each item may be bothering you in your life, NOT whether the item is merely true for you. If you feel that a particular item is not a bother or a problem  for you, you would circle “1”.  If  it  is very bothersome  to you, you might circle “6”. 

Patient Name: Date: 

Page 1 of 2 

Appendix 2

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ANDA‐AQSMA 2018 Australian National Diabetes Audit  

Australian Quality Self Management Audit 

Diabetes Distress Scale 17 

Page 2 of 2 

Appendix 2

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ANDA‐AQSMA 2018 Australian National Diabetes Audit  

Australian Quality Self Management Audit 

Diabetes Distress Scale 17 Scoring Sheet 

Instructions for scoring 

The DDS17 yields a Total Diabetes Distress Scale score plus four sub scale scores; A to D, each addressing  

a different kind of distress. 

To score, simply sum the patient’s responses to the appropriate items and divide by the number of items 

in that scale. Use the table below as an aide to your calculations. 

We  consider  a mean  item  score  of  3  or  higher  (moderate  distress)  as  a  level  of  distress  worthy  of 

clinical attention. Place a tick in the box to the right of the calculation table to highlight an above‐range 

value. We also suggest reviewing the patient’s responses across all items, regardless of mean item scores. 

If any single item scored 3 or greater we recommend making time to address this with the patient, and 

make referral to additional services as appropriate, e.g. psychology, social work, pharmacy, or physician. 

Please note:  It  is  recommended  that DDS17 values  are NOT  calculated  if  four or more questions have 

been  left unanswered  in  that  section. DDS17 sub scores  (A‐D)  should not be calculated  if  two or more 

questions have been left unanswered in that section. 

Patient Name:  Date:

Total DDS Score: 

a. Sum of 17 item scores: Questions 1 to 17:

b. Divide by number of items (17) 17 

A. Emotional Burden 

a. Sum of  5 item scores: Questions 1, 3, 8, 11, 14

b. Divide by number of items (5) 5 

c. Mean item score: A =  □ 3 or greater

B. Physician‐related Distress: 

a. Sum of  4 item scores: Questions 2, 4, 9, 15

b. Divide by number of items (4) 4 

c. Mean item score: B =  □ 3 or greater

C. Regimen‐related Distress: 

a. Sum of  5 item scores: Questions 5, 6, 10, 12, 16

b. Divide by number of items (5) 5 

c. Mean item score: C =  □ 3 or greater

D. Interpersonal Distress: 

a. Sum of  3 item scores: Questions 7, 13, 17

b. Divide by number of items (3) 3 

c. Mean item score: D =  □ 3 or greater

c. Mean item score: Total =  □ 3 or greater

Calculations  Scores 3 or above 

Appendix 3 

93

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Australian National Diabetes Audit ANDA-AQSMA 2018

Appendix 2

Post Data Collection Questionnaire Individual Site Report Questionnaire

Final Report

95

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ANDA-AQSMA 2018 Australian National Diabetes Audit

Australian Quality Self Management Audit

Post Data Collection Questionnaire

Thank you for completing the data collection phase of the project. We would now greatly appreciate your anonymous comments to the following brief questionnaire. Please mark your response to each question on the 1 – 5 “Likert” Scale or circle N/A (Not Applicable).

[A] Please comment on the “How to fill in ANDA-AQSMA Forms” information package/letters you received about the data collection project:

N/A [1] Poor / Insufficient [5] Excellent / Fully explained

Information Package/Letters 1________2________3________4________5

Comments: _________________________________________________________________

___________________________________________________________________________

[B] Please comment on the Data Definitions Forms:

N/A [1] Unclear / Confusing [5] Clear / Concise

Data Definitions Forms 1________2________3________4________5

Comments: _________________________________________________________________

___________________________________________________________________________

[C] Please comment on the following aspects of the Data Collection Forms:

[C1] Format (layout of data items) [1] Unclear / Confusing [5] Clear / Concise

1________2________3________4________5

Comments: _________________________________________________________________

___________________________________________________________________________

[C2] Ease of completion [1] Difficult [5] Easy

1________2________3________4________5

Comments: _________________________________________________________________

___________________________________________________________________________

97

[C3] Time to complete the form [1] Took too long [5] Time not excessive

1________2________3________4________5

Comments: _________________________________________________________________

___________________________________________________________________________

[D] Please list any Data items you feel should have ALSO been collected in ANDA-AQSMA.

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

[E] Please list any Data items you feel should NOT have been collected in ANDA-AQSMA.

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

[G] Any other comments: ___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Thank you for taking the time to complete this questionnaire.

Please email to: Elspeth Lilburn anda@nadc.net.au

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ANDA‐AQSMA 2018 Australian National Diabetes Audit  

Australian Quality Self Management Audit 

Individual Site Report Questionnaire 

Thank you again for participating in the ANDA‐AQSMA 2018 data collection project.   We would now greatly appreciate your anonymous comments to this brief questionnaire. 

Please mark your response to each question on the 1 ‐ 5 Likert Scale. 

[A] Please comment on your overall impression of the Individual Site Final Report you received: 

Individual Site Final Report   [1] Poor/Limited Use   [5] Excellent/Useful 

1_________2_________3_________4_________5 

Comments: _______________________________________________________________ 

_________________________________________________________________________ 

[B] Please comment on the following aspects /sections of the REPORT: 

[i] Explanatory Information [1] Unclear/Confusing   [5] Clear/Concise/Instructive 

1_________2_________3_________4_________5 

Comments: ________________________________________________________________ 

__________________________________________________________________________ 

[ii] 3 Year Comparative Data                                                                If Applicable Yes / No / N/A 

Is the comparative 2012, 2014 & 2016 Patient Outcomes and Missing Data Useful? 

[1] Unclear/Confusing   [5] Clear/Concise/Instructive 

1_________2_________3_________4_________5 

Comments: _________________________________________________________________ 

___________________________________________________________________________ 

[iii] Worked Examples  

[1] Unclear/Confusing   [5] Clear/Concise/Instructive 

1_________2_________3_________4_________5 

Comments: ___________________________________________________________________ 

_____________________________________________________________________________ 

99

[iv] National Benchmarking Report[1] Unclear/Confusing   [5] Clear/Concise/Instructive 

1_________2_________3_________4_________5 

Comments: __________________________________________________________________ 

____________________________________________________________________________ 

[v] Comparative Statistics by Site  [1] Unclear/Confusing   [5] Clear/Concise/Instructive 

1_________2_________3_________4_________5 

Comments: __________________________________________________________________ 

____________________________________________________________________________ 

[C] Please list any Data / Information you feel should have ALSO been reported. 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

[D] Please list any Data / Information you feel should NOT have been reported. 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

[E] Any other comments [in particular, how are you making use of your report?]. 

_____________________________________________________________________________ 

_____________________________________________________________________________ 

Thank you for taking the time to complete this questionnaire. 

Please email to:  Elspeth Lilburn anda@nadc.net.au 

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Australian National Diabetes Audit ANDA-AQSMA 2018

Appendix 3

Frequency Count Data

Final Report

101

102

Item Field Category Total % Relative %* Median Mean SD Min Max

1.1

DOB 4855 100.0% 100.0%

Missing 1 0.0%

Sum 4856 100.0% 100.0%

Age 4855 100.0% 100.0% 58.8 55.7 17.5 18.0 95.7

Missing 1 0.0%

Sum 4856 100.0% 100.0%

1.2

Male 2474 50.9% 51.3%

Female 2350 48.4% 48.7%

Missing 32 0.7%

Sum 4856 100.0% 100.0%

1.2.1

Yes 305 26.7% 29.2%

No 739 64.7% 70.8%

Missing 99 8.7%

Sum 1143 100.0% 100.0%

1.3

Visit date 4856 100.0% 100.0%

Missing 0 0.0%

Sum 4856 100.0% 100.0%

1.4

Yes 887 18.3% 18.3%

No 3963 81.6% 81.7%

Missing 6 0.1%

Sum 4856 100.0% 100.0%

1.5

Yes 198 4.1% 4.5%

No 4248 87.5% 95.5%

Missing 410 8.4%

Sum 4856 100.0% 100.0%

1.6

Yes 205 4.2% 4.5%

No 4374 90.1% 95.5%

Missing 277 5.7%

Sum 4856 100.0% 100.0%

1.7

Yes 64 1.3% 1.4%

No 4379 90.2% 98.6%

Missing 413 8.5%

Sum 4856 100.0% 100.0%

SECTION 1. PATIENT DEMOGRAPHICS

Date of birth

Age (calculated)

Sex

Date of visit

Initial visit

Aboriginal/Torres Strait Islander

Interpreter required

DVA patient

*Relative % = % of the total excluding the missing values

Currently pregnant (females aged 18‐55 years)

103

Item Field Category Total % Relative %* Median Mean SD Min Max

1.8

Yes 4042 83.2% 91.7%

No 366 7.5% 8.3%

Missing 448 9.2%

Sum 4856 100.0% 100.0%

1.9

Country 4657 95.9% 100.0%

Missing 199 4.1%

Sum 4856 100.0% 100.0%

NDSS member

Country of birth

*Relative % = % of the total excluding the missing values

SECTION 1. PATIENT DEMOGRAPHICS (con't)

104

Item Field Category Total % Relative %* Median Mean SD Min Max

2.1

Year 4596 94.6% 100.0% 2006 2004 11.7 1945 2018

Missing 260 5.4%

Sum 4856 100.0% 100.0%

Duration of diabetes Median Min Max

Duration 4596 94.6% 100.0% 12 0 73

Missing 260 5.4%

Sum 4856 100.0% 100.0%

2.2

T1DM 1258 25.9% 25.9%

T2DM 3191 65.7% 65.7%

GDM 249 5.1% 5.1%

Don't know 88 1.8% 1.8%

Other 70 1.4% 1.4%

Missing 0 0.0%

Sum 4856 100.0% 100.0%

2.3

Diet Only 320 6.6% 6.6%

Tablets 1084 22.3% 22.3%

Injectables 7 0.1% 0.1%

Injectables & 

Tablets160 3.3% 3.3%

Insulin 1594 32.8% 32.8%

Insulin & 

Tablets 1448 29.8% 29.8%

Insulin & 

Tablets & 

Injectables211 4.3% 4.3%

Insulin & 

Injectables32 0.7% 0.7%

Missing 0 0.0%

Sum 4856 100.0% 100.0%

2.3.1

<1 year 500 15.2% 15.6%

1‐5 years 725 22.1% 22.6%

>5 years 1979 60.2% 61.8%

Missing 81 2.5%

Sum 3285 100.0% 100.0%

SECTION 2. DIABETES TYPE & MANAGEMENT & LIFESTYLE ISSUES

Year of diagnosis

Type of diabetes

Management method

How long ago was insulin started

*Relative % = % of the total excluding the missing values

IQR

5 ‐ 20

105

Item Field Category Total % Relative %* Median Mean SD Min Max

2.4

Sufficient 2048 42.2% 46.3%

Insufficient 1708 35.2% 38.6%

Sedentary 671 13.8% 15.2%

Missing 429 8.8%

Sum 4856 100.0% 100.0%

2.5

Yes 2842 58.5% 64.5%

No 1567 32.3% 35.5%

Missing 447 9.2%

Sum 4856 100.0% 100.0%

2.6

Yes 572 11.8% 13.0%

No 3826 78.8% 87.0%

Missing 458 9.4%

Sum 4856 100.0% 100.0%

2.7

Current 602 12.4% 13.1%

Past 1660 34.2% 36.0%

Never 2350 48.4% 51.0%

Missing 244 5.0%

Sum 4856 100.0% 100.0%

2.7.1

Yes 437 72.6% 76.0%

No 138 22.9% 24.0%

Missing 27 4.5%

Sum 602 100.0% 100.0%

2.7.2

Yes 1314 79.2% 79.2%

No 346 20.8% 20.8%

Sum 1660 100.0% 100.0%

2.7.2

Yes 98 5.9% 5.9%

No 1562 94.1% 94.1%

Sum 1660 100.0% 100.0%

*Relative % = % of the total excluding the missing values

Influenza vaccination

Pneumococcal vaccination

Smoking status

Current smoker ‐ Tried to stop smoking

Past smoker ‐ Method of cessation ‐ No Intervention

Past smoker ‐ Method of cessation ‐ Medication

Physical activity

SECTION 2. DIABETES TYPE & MANAGEMENT & LIFESTYLE ISSUES (con't)

106

Item Field Category Total % Relative %* Median Mean SD Min Max

2.7.2

Yes 135 8.1% 8.1%

No 1525 91.9% 91.9%

Sum 1660 100.0% 100.0%

2.7.2

Yes 24 1.4% 1.4%

No 1636 98.6% 98.6%

Sum 1660 100.0% 100.0%

2.7.2 Past smoker ‐ Method of cessation ‐ Acupuncture

Yes 2 0.1% 0.1%

No 1658 99.9% 99.9%

Sum 1660 100.0% 100.0%

2.7.2 Past smoker ‐ Method of cessation ‐ Other

Yes 61 3.7% 3.7%

No 1599 96.3% 96.3%

Sum 1660 100.0% 100.0%

2.8 HbA1c (%) 

HbA1c % 4239 87.3% 100.0% 7.9 8.2 1.8 4.1 19.0

Missing 617 12.7%

Sum 4856 100.0% 100.0%

2.8 HbA1c (mmol/mol) 

HbA1c 

mmol/mol3637 74.9% 100.0% 64.0 66.3 19.8 24.0 176.0

Missing 1219 25.1%

Sum 4856 100.0% 100.0%

*Relative % = % of the total excluding the missing values

Past smoker ‐ Method of cessation ‐ Hypnosis

SECTION 2. DIABETES TYPE & MANAGEMENT & LIFESTYLE ISSUES (con't)

Past smoker ‐ Method of cessation ‐ Nicotine Replacement

107

Item Field Category Total % Relative %* Median Mean SD Min Max

3.1

Yes 1128 23.2% 25.4%

No 3098 63.8% 69.7%

Not applicable 221 4.6% 5.0%

Missing 409 8.4%

Sum 4856 100.0% 100.0%

3.1.1

Times forget 1118 99.1% 100.0% 1.0 1.6 1.6 0.0 19.0

Missing 10 0.9%

Sum 1128 100.0% 100.0%

3.2

Yes 3942 81.2% 89.8%

No 281 5.8% 6.4%

Not applicable 169 3.5% 3.8%

Missing 464 9.6%

Sum 4856 100.0% 100.0%

3.3

Yes 212 4.4% 4.8%

No 3977 81.9% 90.6%

Not applicable 200 4.1% 4.6%

Missing 467 9.6%

Sum 4856 100.0% 100.0%

3.4

Yes 273 5.6% 6.2%

No 3921 80.7% 89.3%

Not applicable 197 4.1% 4.5%

Missing 465 9.6%

Sum 4856 100.0% 100.0%

3.5

Yes 1174 24.2% 26.9%

No 3192 65.7% 73.1%

Not applicable 0 0.0% 0.0%

Missing 490 10.1%

Sum 4856 100.0% 100.0%

3.5.1

Yes 973 82.9% 83.8%

No 188 16.0% 16.2%

Missing 13 1.1%

Sum 1174 100.0% 100.0%

SECTION 3. MEDICATION USE

Ever forget to take medications

How many times patient forgot medications per week

Medications ‐ Usually take all your medications

Medications ‐ Stop taking when you feel better

Medications ‐ Stop taking when you feel worse

Medications ‐ Using complementary therapy, dietary supplement or over the counter

Medications ‐ Told doctor/educator of complementary therapy, dietary supplement or over the counter 

use

*Relative % = % of the total excluding the missing values

108

Item Field Category Total % Relative %* Median Mean SD Min Max

4.1

Yes 2512 51.7% 56.6%

No 1929 39.7% 43.4%

Missing 415 8.5%

Sum 4856 100.0% 100.0%

4.2

Yes 3297 67.9% 74.1%

No 1153 23.7% 25.9%

Missing 406 8.4%

Sum 4856 100.0% 100.0%

4.3

Yes 2051 42.2% 46.2%

No 2393 49.3% 53.8%

Missing 412 8.5%

Sum 4856 100.0% 100.0%

4.4

Yes 590 12.1% 13.3%

No 3850 79.3% 86.7%

Missing 416 8.6%

Sum 4856 100.0% 100.0%

4.5

Yes 308 6.3% 6.9%

No 4133 85.1% 93.1%

Missing 415 8.5%

Sum 4856 100.0% 100.0%

4.6

Yes 3102 63.9% 69.7%

No 1351 27.8% 30.3%

Missing 403 8.3%

Sum 4856 100.0% 100.0%

4.7

Yes 1577 32.5% 35.6%

No 2859 58.9% 64.4%

Missing 420 8.6%

Sum 4856 100.0% 100.0%

4.8

Yes 3021 62.2% 68.6%

No 1385 28.5% 31.4%

Missing 450 9.3%

Sum 4856 100.0% 100.0%

Attended diabetes specialist

Attended ophthalmologist

Attended optometrist

*Relative % = % of the total excluding the missing values

Attended social worker

SECTION 4. HEALTH PROFESSIONAL ATTENDANCES

Attended podiatrist

Attended diabetes educator

Attended dietitian

Attended psychologist

109

Item Field Category Total % Relative %* Median Mean SD Min Max

4.9

Yes 2013 41.5% 45.7%

No 2392 49.3% 54.3%

Missing 451 9.3%

Sum 4856 100.0% 100.0%

4.10

Yes 449 9.2% 10.1%

No 3988 82.1% 89.9%

Missing 419 8.6%

Sum 4856 100.0% 100.0%

Attended exercise physiologist

*Relative % = % of the total excluding the missing values

SECTION 4. HEALTH PROFESSIONAL ATTENDANCES (con't)

Attended dentist

110

Item Field Category Total % Relative %* Median Mean SD Min Max

5.1

Yes 1572 32.4% 35.4%

No 2863 59.0% 64.6%

Missing 421 8.7%

Sum 4856 100.0% 100.0%

5.1.1

Yes 530 33.7% 33.9%

No 1033 65.7% 66.1%

Missing 9 0.6%

Sum 1572 100.0% 100.0%

5.1.2

Yes 482 30.7% 30.8%

No 1084 69.0% 69.2%

Missing 6 0.4%

Sum 1572 100.0% 100.0%

5.1.3

Yes 398 25.3% 25.4%

No 1166 74.2% 74.6%

Missing 8 0.5%

Sum 1572 100.0% 100.0%

5.1.4

Yes 342 21.8% 21.9%

No 1221 77.7% 78.1%

Missing 9 0.6%

Sum 1572 100.0% 100.0%

5.1.5

Yes 159 53.5% 53.5%

No 138 46.5% 46.5%

Missing 0 0.0%

Sum 297 100.0% 100.0%

5.2 Check blood glucose level as often as recommended

Yes 3061 63.0% 69.8%

No 1155 23.8% 26.3%

Unsure 170 3.5% 3.9%

Missing 470 9.7%

Sum 4856 100.0% 100.0%

5.3 Rotate injection site (patients on injections or insulin)

Yes 2906 84.2% 93.6%

No 121 3.5% 3.9%

Not applicable 77 2.2% 2.5%

Missing 348 10.1%

Sum 3452 100.0% 100.0%

Diet ‐ I don't know what foods are best to eat

Diet ‐ I eat out a lot and find it hard to eat well

*Relative % = % of the total excluding the missing values

Diet ‐ If T1DM, it is too hard to count carbs/weigh food

SECTION 5. PATIENT SELF CARE PRACTICES

Diet ‐ Difficulties following recommended diet

Diet ‐ Not enough time to prepare healthy meals

Diet ‐ It costs too much to eat well

111

Item Field Category Total % Relative %* Median Mean SD Min Max

6A.1 Having restless or disturbed nights

Yes 2213 45.6% 49.9%

No 2219 45.7% 50.1%

Missing 424 8.7%

Sum 4856 100.0% 100.0%

6A.2 Feeling unhappy or depressed

Yes 1395 28.7% 31.5%

No 3036 62.5% 68.5%

Missing 425 8.8%

Sum 4856 100.0% 100.0%

6A.3

Yes 835 17.2% 18.8%

No 3595 74.0% 81.2%

Missing 426 8.8%

Sum 4856 100.0% 100.0%

6A.4

Yes 1026 21.1% 23.2%

No 3405 70.1% 76.8%

Missing 425 8.8%

Sum 4856 100.0% 100.0%

Likely 1163 23.9% 26.2%

Unlikely 3272 67.4% 73.8%

Missing 421 8.7%

Sum 4856 100.0% 100.0%

6B.1

Yes 825 17.0% 18.6%

No 3615 74.4% 81.4%

Missing 416 8.6%

Sum 4856 100.0% 100.0%

6B.2

Yes 1187 24.4% 26.8%

No 3248 66.9% 73.2%

Missing 421 8.7%

Sum 4856 100.0% 100.0%

6B.3

Yes 418 8.6% 9.4%

No 4016 82.7% 90.6%

Missing 422 8.7%

Sum 4856 100.0% 100.0%

Feeling unable to overcome difficulties

SECTION 6. BCD & TREATMENT

Dissatisfied with their way of doing things

*Relative % = % of the total excluding the missing values

Depression likely

Taking antidepressants

Psych. treatment/counselling ‐ past

Psych. treatment/counselling ‐ now

112

Item Field Category Total % Relative %* Median Mean SD Min Max

7.1 Own Health State Rating

Rating 4260 87.7% 100.0% 70.0 64.3 19.9 0.0 100.0

Missing 596 12.3%

Sum 4856 100.0% 100.0%

7.2 Screening Scale Q1

Score 4284 88.2% 100.0% 2.0 2.0 1.2 1.0 6.0

Missing 572 11.8%

Sum 4856 100.0% 100.0%

7.3 Screening Scale Q2

Score 4278 88.1% 100.0% 2.0 2.1 1.3 1.0 6.0

Missing 578 11.9%

Sum 4856 100.0% 100.0%

Screening Scale Q1 or Q2  ≥3

Yes 1534 35.8% 100.0%

No 2750 64.2%

Sum 4284 100.0% 100.0%

7.4 DDS 17 questionnaire completed (if DDS2 Screening Scale positive)

Yes 1333 86.9% 86.9%

No 201 13.1% 13.1%

Sum 1534 100.0% 100.0%

7.4.1

Total score 1333 86.9% 100.0% 1.9 2.2 0.9 1.0 6.0

Missing 201 13.1%

Sum 1534 100.0% 100.0%

7.4.2

Score 1332 86.8% 100.0% 2.4 2.6 1.2 1.0 6.0

Missing 202 13.2%

Sum 1534 100.0% 100.0%

7.4.3 DDS 17 Physician‐related distress

Score 1331 86.8% 100.0% 1.0 1.5 0.9 1.0 6.0

Missing 203 13.2%

Sum 1534 100.0% 100.0%

7.4.4 DDS 17 Regimen‐related distress

Score 1333 86.9% 100.0% 2.2 2.4 1.1 1.0 6.0

Missing 201 13.1%

Sum 1534 100.0% 100.0%

7.4.5 DDS 17 Interpersonal distress

Score 1333 86.9% 100.0% 1.3 1.9 1.2 1.0 6.0

Missing 201 13.1%

Sum 1534 100.0% 100.0%

DDS 17 total score

DDS 17 Emotional burden

*Relative % = % of the total excluding the missing values

SECTION 7. QUALITY OF LIFE ASSESSMENT

113

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Appendix 4

Missing Data

Final Report

115

116

1. Overall missing data

0 and ≤5  (%) 

>5 and ≤10(%) 

>10 and ≤15 (%) 

>15 and ≤20(%) 

>20 and ≤40(%) 

>40(%)

Missing data  25.8  56.5  17.7  0.0  0.0  0.0 

2. Missing data by field

Item no. 

Field 

2018  2016  2014  2012 

(n=4856)  (n=3930)  (n=2681)  (n=1892) 

n  %  n  %  n  %  n  % 

Staff ID (optional)  2204  45.4  2169  55.2  1661  62.0  0  0.0 

Demographics 

1.1  Date of birth  1  0.0  0  0.0  1  0.0  23  1.2 

1.2  Sex of individual  32  0.7  8  0.2  3  0.1  9  0.5 

1.2.1 Currently pregnant  (females aged 18‐55 years) 

99  8.7  3  0.3  4  0.6  46  8.7 

1.3  Date of visit  0  0.0  0  0.0  11  0.4  0  0.0 

1.4  Initial visit  6  0.1  9  0.2  7  0.3  22  1.2 

1.5  Aboriginal/Torres Strait Islander  410  8.4  11  0.3  2  0.1  145  7.7 

1.6  Interpreter required  277  5.7  8  0.2  6  0.2  212  11.2 

1.7  DVA patient  413  8.5  16  0.4  19  0.7  158  8.4 

1.8  NDSS member  448  9.2  78  2.0  22  0.8  240  12.7 

1.9  Country of birth  199  4.1  3  0.1  7  0.3  NA  NA 

Diabetes type, management and lifestyle issues 

2.1  Year of diagnosis  260  5.4  16  0.4  7  0.3  19  1.0 

2.2  Type of diabetes  0  0.0  8  0.2  4  0.1  5  0.3 

2.3  Management method  0  0.0  5  0.1  1  0.0  17  0.9 

2.3.1  Insulin duration  81  2,5  41  1.5  9  0.5  NA  NA 

2.4  Physical activity  429  8.8  8  0.2  179  6.7  45  2.4 

2.5  Vaccination ‐ Flu in past 12 months  447  9.2  36  0.9  26  1.0  32  1.7 

2.6 Vaccination ‐ Pneumococcal in past 12 months 

458  9.4  37  0.9  55  2.1  50  2.6 

2.7  Smoking status  244  5.0  2  0.1  18  0.7  10  0.5 

2.7.1 Tried to stop smoking (current smokers only) 

27  4.5  6  1.2  0  0.0  6  2.2 

2.7.2  Past smoker ‐ method of cessation  54  3.3  7  0.5  NA  NA  NA  NA 

2.8.1  HbA1c (%)  335  6.9  335  8.5  195  7.3  350  18.5 

2.8.2  HbA1c (mmol/mol)  438  9.0  438  11.1  203  7.6  NA  NA 

HbA1c (% or mmol/mol)  582  12.0  NA  NA  NA  NA  NA  NA 

Medication use

3.1 Medications ‐ ever forget to take medications 

409  8.4  11  0.3  48  1.8  78  4.1 

3.1.1 Medications ‐ How many times do you forget medications per week (only patients who forget) 

10  0.9  42  4.0  32  4.4  3  0.7 

3.2 Medications ‐ Usually take all your medications 

464  9.6  54  1.4  77  2.9  107  5.7 

117

Item no. 

Field 

2018  2016  2014  2012 

(n=4856)  (n=3930)  (n=2681)  (n=1892) 

n  %  n  %  n  %  n  % 

3.3 Medications ‐ Do you stop taking when feeling better 

467  9.6  57  1.5  75  2.8  116  6.1 

3.4 Medications ‐ Do you stop taking whenfeeling worse 

465  9.6  58  1.5  74  2.8  117  6.2 

3.5 Complementary therapy or dietary supplement use 

490  10.1  59  1.5  71  2.6  114  6.0 

3.5.1 Complementary therapy ‐ told doctor or educator of use (only patients who are on complementary therapy) 

13  1.1  5  0.5  2  0.3  6  1.0 

Health professional attendances 

4.1  Attended podiatrist  415  8.5  5  0.1  47  1.8  61  3.2 

4.2  Attended diabetes educator  406  8.4  3  0.1  6  0.2  60  3.2 

4.3  Attended dietitian  412  8.5  6  0.2  8  0.3  63  3.3 

4.4  Attended psychologist  416  8.6  8  0.2  45  1.7  64  3.4 

4.5  Attended social worker  415  8.5  8  0.2  46  1.7  72  3.8 

4.6  Attended diabetes specialist  403  8.3  2  0.1  35  1.3  60  3.2 

4.7  Attended ophthalmologist  420  8.6  10  0.3  44  1.6  70  3.7 

4.8  Attended optometrist  450  9.3  9  0.2  48  1.8  101  5.3 

4.9  Attended dentist  451  9.3  10  0.3  51  1.9  62  3.3 

4.10  Attended exercise physiologist  419  8.6  9  0.2  49  1.8  83  4.4 

Patient self‐care practices 

5.1 Diet ‐ Difficulties followingrecommended diet 

421  8.7  3  0.1  40  1.5  62  3.3 

5.1.1 Diet ‐ Not enough time to prepare healthy meals 

9  0.6  13  0.9  22  2.8  27  3.7 

5.1.2  Diet ‐ It costs too much to eat well  6  0.4  11  0.8  14  1.8  28  3.9 

5.1.3 Diet ‐ Don't know what best foods areto eat 

8  0.5  12  0.9  16  2.0  31  4.3 

5.1.4 Diet ‐ Eat out a lot and find it hard toeat well 

9  0.6  12  0.9  21  2.6  30  4.1 

5.1.5 Diet ‐ Too hard to count carbohydrates (only if Type 1) 

0  0.0  7  2.2  5  2.9  7  5.1 

5.2  Check blood glucose as recommended  470  9.7  24  0.6  35  1.3  NA  NA 

5.3  Rotate injection site  348  10.1  51  1.8  35  1.8  NA  NA 

BCD 

6A.1 BCD ‐ Having restless or disturbed nights 

424  8.7  11  0.3  44  1.6  238  12.6 

6A.2  BCD ‐ Feeling unhappy or depressed  425  8.8  12  0.3  44  1.6  240  12.7 

6A.3 BCD ‐ Feeling unable to overcome difficulties 

426  8.8  13  0.3  46  1.7  240  12.7 

6A.4 BCD ‐ Dissatisfied with their way of doing things 

425  8.8  14  0.4  48  1.8  246  13.0 

6B.1  On antidepressants  416  8.6  7  0.2  30  1.1  242  12.8 

6B.2 Psychiatric treatment/counselling ‐Past 

421  8.7  8  0.2  39  1.5  247  13.1 

6B.3 Psychiatric treatment/counselling ‐ Current 

422  8.7  8  0.2  36  1.3  246  13.0 

118

Item no. 

Field 

2018  2016  2014  2012 

(n=4856)  (n=3930)  (n=2681)  (n=1892) 

n  %  n  %  n  %  n  % 

Quality of life assessment     

7.1  QOL ‐ Own Health State Rating  596  12.3  40  1.0  93  3.5  271  14.3 

7.2  DDS Screening Scale Q1  572  11.8  33  0.8  87  3.2  332  17.5 

7.3  DDS Screening Scale Q2  578  11.9  33  0.8  90  3.4  332  17.5 

  If DDS2 Screening Scale positive (n=1534): 

                       

7.4.1  DDS Total DDS score  201  13.1  148  9.8  69  6.7  70  11.2 

7.4.2  DDS Emotional burden  202  13.2  142  9.4  69  6.7  70  11.2 

7.4.3  DDS Physician‐related burden  203  13.2  143  9.5  69  6.7  70  11.2 

7.4.4  DDS Regimen‐related burden  201  13.1  141  9.3  69  6.7  71  11.3 

7.4.5  DDS Interpersonal distress  201  13.1  141  9.3  69  6.7  71  11.3 

 

 

 

119

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Australian National Diabetes Audit ANDA-AQSMA 2018

Appendix 5

Descriptive Report

Final Report

121

122

Descriptive Report Index

125

126

127

128

129

130

133

134

135

138

139

141

142

143

145

146

147

148

149

150

151

152

153

154

155

156

157

158

159

160

161

Country of birth by diabetes type

NDSS member by diabetes type

Initial visit by diabetes type

Currently pregnant by diabetes type

Section 1. Patient Demographics

Aborignal/Torres Strait Islander status by diabetes type

Attended dietitian by diabetes type

Smoking status by diabetes type

HbA1c (%) by diabetes type

HbA1c (%) by patient gender and diabetes type 

HbA1c (%) by initial visit and diabetes type 

Section 3. Medication Use

Section 2. Diabetes Type & Management & Lifestyle Issues

Tried to stop smoking (current smokers) by diabetes type

Method of cessation (past smokers) by diabetes type

Medication use ‐ Forget to take medications by diabetes type

Medication use ‐ Stop taking when feeling better by diabetes type

Medication use ‐ Stop taking when feeling worse by diabetes type

Medication use ‐ Use of complementary therapy by diabetes type

Section 4. Health Professional Attendances

Pneumococcal vaccination by diabetes type

Influenza vaccination by diabetes type

Physical activity status by diabetes type

Attended podiatrist by diabetes type

Attended diabetes educator by diabetes type

Medication use ‐ Frequency of forgetting medications by diabetes type

Medication use ‐ Usually take all medications diabetes type

Complementary therapy use ‐ Told doctor or diabetes educator by diabetes type

Attended psychologist by diabetes type

Attended social worker by diabetes type

Attended diabetes specialist by diabetes type

Attended ophthalmologist by diabetes type

Attended optometrist by diabetes type

Attended dentist by diabetes type

Attended exercise physiologist by diabetes type

123

162

164

167

168

169

170

171

172

173

174

176

178

180

182

Positive DDS2 Screening Scale by diabetes type

Total DDS17 score by diabetes type

Emotional Burden by diabetes type

Physician‐related distress by diabetes type

Regimen‐related distress by diabetes type

Interpersonal distress by diabetes type

Own Health State Rating by diabetes type

Section 5. Patient Self‐Care Practices

Difficulty following recommended diet by diabetes type

Blood glucose monitoring as recommended by diabetes type

Past psychiatric treatment/counselling by diabetes type

Current psychiatric treatment/counselling by diabetes type

Rotation of injection site by diabetes type

Section 6. BCD & Treatment

Likely depression by diabetes type

Antidepressant use by diabetes type

Section 7. Quality of Life Assessment

124

n % n % n % n % n % n % n %

Yes 113 9.0% 662 20.8% 80 32.1% 19 21.6% 13 18.6% NA NA 887 18.3%

No 1143 91.0% 2525 79.2% 169 67.9% 69 78.4% 57 81.4% NA NA 3963 81.7%

X‐axis: All sites (Descending order)

T1DM T2DM

Initial visit by diabetes type

GDM Don't know Other TotalMissing

0%

20%

40%

60%

80%

100%

Initial visit ‐ All patients

0%

20%

40%

60%

80%

100%

Initial visit ‐ T1DM

0%

20%

40%

60%

80%

100%

Initial visit ‐ T2DM

0%

20%

40%

60%

80%

100%

Initial visit ‐ GDM

125

n % n % n % n % n % n % n %

Australian born 961 80.9% 2068 66.3% 164 65.9% 20 55.6% 47 70.1% NA NA 3260 70.0%

Non‐Australian born 227 19.1% 1049 33.7% 85 34.1% 16 44.4% 20 29.9% NA NA 1397 30.0%

X‐axis: All sites (Descending order)

T1DM Other MissingGDM Don't know TotalT2DM

Country of birth by diabetes type

0%

20%

40%

60%

80%

100%

Australian born ‐ All patients

0%

20%

40%

60%

80%

100%

Australian born ‐ T1DM

0%

20%

40%

60%

80%

100%

Australian born ‐ T2DM

0%

20%

40%

60%

80%

100%

Australian born ‐ GDM

126

n % n % n % n % n % n % n %

Yes 30 2.7% 152 5.0% 15 6.0% 0 0.0% 1 1.6% NA NA 198 4.5%

No 1063 97.3% 2858 95.0% 234 94.0% 30 100.0% 63 98.4% NA NA 4248 95.5%

X‐axis: All sites (Descending order)

GDM Don't know Other Total

Aborignal/Torres Strait Islander status by diabetes type

T1DM T2DM Missing

0%

20%

40%

60%

80%

100%

Aborignal/Torres Strait Islander = Yes ‐ All patients

0%

20%

40%

60%

80%

100%

Aborignal/Torres Strait Islander = Yes ‐ T1DM

0%

20%

40%

60%

80%

100%

Aborignal/Torres Strait Islander = Yes ‐ T2DM

0%

20%

40%

60%

80%

100%

Aborignal/Torres Strait Islander = Yes ‐ GDM

127

n % n % n % n % n % n % n %

Yes 1052 97.0% 2702 90.5% 210 85.4% 24 82.8% 54 85.7% NA NA 4042 91.7%

No 32 3.0% 284 9.5% 36 14.6% 5 17.2% 9 14.3% NA NA 366 8.3%

X‐axis: All sites (Descending order)

NDSS member by diabetes type

TotalT1DM T2DM GDM Don't know Other Missing

0%

20%

40%

60%

80%

100%

NDSS member ‐ All patients

0%

20%

40%

60%

80%

100%

NDSS member ‐ T1DM

0%

20%

40%

60%

80%

100%

NDSS member ‐ T2DM

0%

20%

40%

60%

80%

100%

NDSS member ‐ GDM

128

n % n % n % n % n % n % n %

Yes 24 5.9% 27 7.4% 249 100.0% 3 37.5% 2 14.3% NA NA 305 29.2%

No 382 94.1% 340 92.6% 0 0.0% 5 62.5% 12 85.7% NA NA 739 70.8%

*Females aged 18‐55 years

X‐axis: All sites (Descending order)

T1DM T2DM GDM Don't know Other TotalMissing

Currently pregnant* by diabetes type

0%

20%

40%

60%

80%

100%

Currently pregnant ‐ All patients

0%

20%

40%

60%

80%

100%

Currently pregnant ‐ T1DM

0%

20%

40%

60%

80%

100%

Currently pregnant ‐ T2DM

0%

20%

40%

60%

80%

100%

Currently pregnant ‐ GDM

129

n % n % n % n % n % n % n %

Sufficient 669 61.2% 1175 39.3% 153 61.4% 16 53.3% 35 56.5% NA NA 2048 46.3%

Insufficient 343 31.4% 1253 41.9% 83 33.3% 10 33.3% 19 30.6% NA NA 1708 38.6%

Sedentary 82 7.5% 564 18.9% 13 5.2% 4 13.3% 8 12.9% NA NA 671 15.2%

X‐axis: All sites (Descending order)

Physical activity status by diabetes type

T1DM T2DM GDM Don't know Other TotalMissing

0%

20%

40%

60%

80%

100%

Sufficient ‐ All patients

0%

20%

40%

60%

80%

100%

Sufficient ‐ T1DM

0%

20%

40%

60%

80%

100%

Sufficient ‐ T2DM

0%

20%

40%

60%

80%

100%

Sufficient ‐ GDM

130

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Insufficient ‐ All patients

0%

20%

40%

60%

80%

100%

Insufficient ‐ T1DM

0%

20%

40%

60%

80%

100%

Insufficient ‐ T2DM

0%

20%

40%

60%

80%

100%

Insufficient ‐ GDM

131

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Sedentary ‐ All patients

0%

20%

40%

60%

80%

100%

Sedentary ‐ T1DM

0%

20%

40%

60%

80%

100%

Sedentary ‐ T2DM

0%

20%

40%

60%

80%

100%

Sedentary ‐ GDM

132

n % n % n % n % n % n % n %

Yes 621 57.0% 2031 68.2% 133 53.4% 16 53.3% 41 67.2% NA NA 2842 64.5%

No 468 43.0% 949 31.8% 116 46.6% 14 46.7% 20 32.8% NA NA 1567 35.5%

X‐axis: All sites (Descending order)

Influenza vaccination by diabetes type

TotalMissingT2DM GDM Don't know OtherT1DM

0%

20%

40%

60%

80%

100%

Influenza vaccination ‐ All patients

0%

20%

40%

60%

80%

100%

Influenza vaccination ‐ T1DM

0%

20%

40%

60%

80%

100%

Influenza vaccination ‐ T2DM

0%

20%

40%

60%

80%

100%

Influenza vaccination ‐ GDM

133

n % n % n % n % n % n % n %

Yes 93 8.6% 466 15.7% 7 2.8% 0 0.0% 6 10.0% NA NA 572 13.0%

No 994 91.4% 2507 84.3% 241 97.2% 30 100.0% 54 90.0% NA NA 3826 87.0%

X‐axis: All sites (Descending order)

Don't know Other Missing TotalT1DM T2DM GDM

Pneumococcal vaccination by diabetes type

0%

20%

40%

60%

80%

100%

Pneumococcal vaccination ‐ All patients

0%

20%

40%

60%

80%

100%

Pneumococcal vaccination ‐ T1DM

0%

20%

40%

60%

80%

100%

Pneumococcal vaccination ‐ T2DM

0%

20%

40%

60%

80%

100%

Pneumococcal vaccination ‐ GDM

134

n % n % n % n % n % n % n %

Current 195 16.6% 377 12.2% 17 6.8% 5 14.7% 8 12.1% NA NA 602 13.1%

Past 306 26.1% 1254 40.6% 65 26.1% 13 38.2% 22 33.3% NA NA 1660 36.0%

Never 671 57.3% 1460 47.2% 167 67.1% 16 47.1% 36 54.5% NA NA 2350 51.0%

X‐axis: All sites (Descending order)

Smoking status by diabetes type

GDM Don't know Other TotalMissingT1DM T2DM

0%

20%

40%

60%

80%

100%

Current smoker‐ All patients

0%

20%

40%

60%

80%

100%

Current smoker ‐ T1DM

0%

20%

40%

60%

80%

100%

Current smoker ‐ T2DM

0%

20%

40%

60%

80%

100%

Current smoker ‐ GDM

135

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Past smoker ‐ All patients

0%

20%

40%

60%

80%

100%

Past smoker ‐ T1DM

0%

20%

40%

60%

80%

100%

Past smoker ‐ T2DM

0%

20%

40%

60%

80%

100%

Past smoker ‐ GDM

136

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Never smoked ‐ All patients

0%

20%

40%

60%

80%

100%

Never smoked ‐ T1DM

0%

20%

40%

60%

80%

100%

Never smoked ‐ T2DM

0%

20%

40%

60%

80%

100%

Never smoked ‐ GDM

137

n % n % n % n % n % n % n %

Yes 140 76.9% 277 76.1% 13 76.5% 1 25.0% 6 75.0% NA NA 437 76.0%

No 42 23.1% 87 23.9% 4 23.5% 3 75.0% 2 25.0% NA NA 138 24.0%

X‐axis: All sites (Descending order)

TotalMissingGDM

Tried to stop smoking (current smokers) by diabetes type

T1DM T2DM Don't know Other

0%

20%

40%

60%

80%

100%

Tried to stop smoking ‐ All patients

0%

20%

40%

60%

80%

100%

Tried to stop smoking ‐ T1DM

0%

20%

40%

60%

80%

100%

Tried to stop smoking ‐ T2DM

0%

20%

40%

60%

80%

100%

Tried to stop smoking ‐ GDM

138

n % n % n % n % n % n % n %

Just Stopped ‐ no 

intervention231 75.5% 998 79.6% 56 86.2% 12 92.3% 17 77.3% NA NA 1314 79.2%

Medication 19 6.2% 74 5.9% 4 6.2% 0 0.0% 1 4.5% NA NA 98 5.9%

Nicotine 

replacement32 10.5% 97 7.7% 3 4.6% 0 0.0% 3 13.6% NA NA 135 8.1%

Hypnosis 4 1.3% 18 1.4% 2 3.1% 0 0.0% 0 0.0% NA NA 24 1.4%

Acupuncture 1 0.3% 1 0.1% 0 0.0% 0 0.0% 0 0.0% NA NA 2 0.1%

Other 12 3.9% 46 3.7% 2 3.1% 0 0.0% 1 4.5% NA NA 61 3.7%

X‐axis: All sites (Descending order)

Other TotalT1DM T2DM GDM

Method of cessation (past smokers) by diabetes type

MissingDon't know

0%

20%

40%

60%

80%

100%

Just stopped ‐ All patients

0%

20%

40%

60%

80%

100%

Medication ‐ All patients

139

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Nicotine replacement ‐ All patients

0%

20%

40%

60%

80%

100%

Hypnosis ‐ All patients

0%

20%

40%

60%

80%

100%

Acupuncture ‐ All patients

0%

20%

40%

60%

80%

100%

Other ‐ All patients

140

T1DM T2DM GDMDon't 

knowOther Missing Total

n 1158 2930 68 53 65 NA 4274

Mean HbA1c (%) 8.5 8.2 5.2 9.1 7.5 NA 8.2

SD 1.6 1.8 0.4 2.3 1.7 NA 1.8

Min 4.9 4.6 4.1 5.8 4.8 NA 4.1

Max 19.0 18.7 6.0 15.0 12.4 NA 19.0

X‐axis: All sites (Descending order)

HbA1c (%) by diabetes type

02468

10121416

Mean HbA1c ‐ All patients

02468

10121416

Mean HbA1c ‐ T2DM

02468

10121416

Mean HbA1c ‐ T1DM

02468

10121416

Mean HbA1c ‐ GDM

141

n Mean SD Min Max n Mean SD Min Max

T1DM 573 8.4 1.5 4.9 19.0 585 8.5 1.7 5.2 15.3

T2DM 1637 8.2 1.8 4.6 18.7 1284 8.2 1.8 4.6 18.2

GDM NA NA NA NA NA 68 5.2 0.4 4.1 6.0

Don't know 28 9.2 2.5 6.4 15.0 20 9.1 2.4 5.8 14.5

Other 41 7.8 1.7 5.2 12.4 23 6.9 1.5 4.8 11.1

Missing NA NA NA NA NA NA NA NA NA NA

Total 2279 8.2 1.8 4.6 19.0 1980 8.2 1.9 4.1 18.2

X‐axis: All sites (Descending order)

HbA1c ‐ FemaleHbA1c ‐ Male

HbA1c (%) by patient gender and diabetes type 

02468

10121416

Mean HbA1c ‐ Male

02468

10121416

Mean HbA1c ‐ Female

142

n Mean SD Min Max n Mean SD Min Max

T1DM 1054 8.4 1.6 4.9 19.0 102 9.1 1.9 5.9 15.0

T2DM 2340 8.1 1.7 4.6 18.7 588 8.7 2.1 4.9 18.2

GDM 58 5.2 0.4 4.5 6.0 10 5.2 0.5 4.1 5.7

Don't know 41 8.7 2.1 5.8 14.8 12 10.6 2.7 6.8 15.0

Other 53 7.7 1.6 5.4 12.4 12 6.7 1.8 4.8 11.1

Missing NA NA NA NA NA NA NA NA NA NA

Total 3546 8.1 1.7 4.5 19.0 724 8.7 2.2 4.1 18.2

X‐axis: All sites (Descending order)

HbA1c (%) when initial visit = YesHbA1c (%) when initial visit = No

 HbA1c (%) by initial visit and diabetes type

02468

10121416

Mean HbA1c & initial visit = No ‐ All patients

02468

10121416

Mean HbA1c & initial visit = No ‐ T1DM

02468

10121416

Mean HbA1c & initial visit = No ‐ T2DM

02468

10121416

Mean HbA1c & initial visit = No ‐ GDM

143

X‐axis: All sites (Descending order)

02468

10121416

Mean HbA1c & initial visit = Yes ‐ All patients

02468

10121416

Mean HbA1c & initial visit = Yes ‐ T1DM

02468

10121416

Mean HbA1c & initial visit = Yes ‐ T2DM

02468

10121416

Mean HbA1c & initial visit = Yes ‐ GDM

144

n % n % n % n % n % n % n %

Yes 279 26.6% 784 26.7% 42 27.5% 10 38.5% 13 22.0% NA NA 1128 26.7%

No 771 73.4% 2154 73.3% 111 72.5% 16 61.5% 46 78.0% NA NA 3098 73.3%

X‐axis: All sites (Descending order)

TotalT2DM GDM Don't know Other Missing

Medication use ‐ Forget to take medications by diabetes type

T1DM

0%

20%

40%

60%

80%

100%

Forget medications ‐ All patients

0%

20%

40%

60%

80%

100%

Forget medications ‐ T1DM

0%

20%

40%

60%

80%

100%

Forget medications ‐ T2DM

0%

20%

40%

60%

80%

100%

Forget medications ‐ GDM

145

n % n % n % n % n % n % n %

<3 times/week 216 78.5% 656 84.3% 35 83.3% 6 60.0% 12 92.3% NA NA 925 82.7%

> 3 times/week 59 21.5% 122 15.7% 7 16.7% 4 40.0% 1 7.7% NA NA 193 17.3%

Note: Of patients who reported ever forgetting medications

X‐axis: All sites (Descending order)

Medication use ‐ Frequency of forgetting medication by diabetes type (if ever forget)

T1DM T2DM GDM TotalDon't know Other Missing

0%

20%

40%

60%

80%

100%

Forget medications > 3 times ‐ All patients

0%

20%

40%

60%

80%

100%

Forget medications > 3 times ‐ T1DM

0%

20%

40%

60%

80%

100%

Forget medications > 3 times ‐ T2DM

0%

20%

40%

60%

80%

100%

Forget medications > 3 times ‐ GDM

146

n % n % n % n % n % n % n %

Yes 1005 94.3% 2731 93.3% 132 90.4% 23 88.5% 51 87.9% NA NA 3942 93.3%

No 61 5.7% 196 6.7% 14 9.6% 3 11.5% 7 12.1% NA NA 281 6.7%

X‐axis: All sites (Descending order)

MissingT2DM GDM Don't know Other Total

Medication use ‐ Usually take all medications by diabetes type

T1DM

0%

20%

40%

60%

80%

100%

Usually take all medications ‐ All patients

0%

20%

40%

60%

80%

100%

Usually take all medications ‐ T1DM

0%

20%

40%

60%

80%

100%

Usually take all medications ‐ T2DM

0%

20%

40%

60%

80%

100%

Usually take all medications ‐ GDM

147

n % n % n % n % n % n % n %

Yes 39 3.7% 158 5.4% 10 7.3% 1 3.8% 4 6.9% NA NA 212 5.1%

No 1019 96.3% 2752 94.6% 127 92.7% 25 96.2% 54 93.1% NA NA 3977 94.9%

X‐axis: All sites (Descending order)

Missing Total

Medication use ‐ Stop taking when feeling better by diabetes type

T1DM T2DM GDM Don't know Other

0%

20%

40%

60%

80%

100%

Stop medications when feeling better ‐ All patients

0%

20%

40%

60%

80%

100%

Stop medications when feeling better ‐ T1DM

0%

20%

40%

60%

80%

100%

Stop medications when feeling better ‐ T2DM

0%

20%

40%

60%

80%

100%

Stop medications when feeling better ‐ GDM

148

n % n % n % n % n % n % n %

Yes 54 5.1% 208 7.1% 5 3.6% 2 7.7% 4 6.9% NA NA 273 6.5%

No 1006 94.9% 2705 92.9% 132 96.4% 24 92.3% 54 93.1% NA NA 3921 93.5%

X‐axis: All sites (Descending order)

Total

Medication use ‐ Stop taking when feeling worse by diabetes type

T1DM T2DM GDM Don't know Other Missing

0%

20%

40%

60%

80%

100%

Stop medications when feeling worse ‐ All patients

0%

20%

40%

60%

80%

100%

Stop medications when feeling worse ‐ T1DM

0%

20%

40%

60%

80%

100%

Stop medications when feeling worse ‐ T2DM

0%

20%

40%

60%

80%

100%

Stop medications when feeling worse ‐ GDM

149

n % n % n % n % n % n % n %

Yes 251 23.2% 785 26.4% 114 52.3% 9 32.1% 15 25.0% NA NA 1174 26.9%

No 831 76.8% 2193 73.6% 104 47.7% 19 67.9% 45 75.0% NA NA 3192 73.1%

X‐axis: All sites (Descending order)

Missing TotalDon't know OtherT1DM T2DM

Medication use ‐ Use of complementary therapy by diabetes type

GDM

0%

20%

40%

60%

80%

100%

Use of complementary therapy ‐ All patients

0%

20%

40%

60%

80%

100%

Use of complementary therapy ‐ T1DM

0%

20%

40%

60%

80%

100%

Use of complementary therapy ‐ T2DM

0%

20%

40%

60%

80%

100%

Use of complementary therapy ‐ GDM

150

n % n % n % n % n % n % n %

Yes 198 79.2% 646 83.5% 110 97.3% 6 66.7% 13 86.7% NA NA 973 83.8%

No 52 20.8% 128 16.5% 3 2.7% 3 33.3% 2 13.3% NA NA 188 16.2%

Note: Of patients who reported complementary therapy use

X‐axis: All sites (Descending order)

TotalT1DM T2DM GDM Don't know

Complementary therapy use ‐ Told doctor or diabetes educator by diabetes type

Other Missing

0%

20%

40%

60%

80%

100%

Told doctor/educator about complementary therapy use‐ All patients

0%

20%

40%

60%

80%

100%

Told doctor/educator about complementary therapy use‐ T1DM

0%

20%

40%

60%

80%

100%

Told doctor/educator about complementary therapy use ‐ T2DM

0%

20%

40%

60%

80%

100%

Told doctor/educator about complementary therapy use ‐ GDM

151

n % n % n % n % n % n % n %

Yes 527 48.2% 1938 64.5% 8 3.2% 11 36.7% 28 45.2% NA NA 2512 56.6%

No 567 51.8% 1068 35.5% 241 96.8% 19 63.3% 34 54.8% NA NA 1929 43.4%

X‐axis: All sites (Descending order)

TotalT1DM T2DM GDM Don't know Other

Attended podiatrist by diabetes type

Missing

0%

20%

40%

60%

80%

100%

Attended podiatrist ‐ All patients

0%

20%

40%

60%

80%

100%

Attended podiatrist ‐ T1DM

0%

20%

40%

60%

80%

100%

Attended podiatrist ‐ T2DM

0%

20%

40%

60%

80%

100%

Attended podiatrist ‐ GDM

152

n % n % n % n % n % n % n %

Yes 906 82.5% 2098 69.7% 228 91.9% 20 66.7% 45 72.6% NA NA 3297 74.1%

No 192 17.5% 914 30.3% 20 8.1% 10 33.3% 17 27.4% NA NA 1153 25.9%

X‐axis: All sites (Descending order)

T2DM GDM Don't know Other Missing Total

Attended diabetes educator by diabetes type

T1DM

0%

20%

40%

60%

80%

100%

Attended diabetes educator ‐ All patients

0%

20%

40%

60%

80%

100%

Attended diabetes educator ‐ T1DM

0%

20%

40%

60%

80%

100%

Attended diabetes educator ‐ T2DM

0%

20%

40%

60%

80%

100%

Attended diabetes educator ‐ GDM

153

n % n % n % n % n % n % n %

Yes 539 49.2% 1253 41.7% 206 83.1% 16 53.3% 37 59.7% NA NA 2051 46.2%

No 557 50.8% 1755 58.3% 42 16.9% 14 46.7% 25 40.3% NA NA 2393 53.8%

X‐axis: All sites (Descending order)

Attended dietitian by diabetes type

T1DM T2DM GDM Don't know Other Missing Total

0%

20%

40%

60%

80%

100%

Attended dietitian ‐ All patients

0%

20%

40%

60%

80%

100%

Attended dietitian ‐ T1DM

0%

20%

40%

60%

80%

100%

Attended dietitian ‐ T2DM

0%

20%

40%

60%

80%

100%

Attended dietitian ‐ GDM

154

n % n % n % n % n % n % n %

Yes 213 19.5% 339 11.3% 18 7.2% 8 26.7% 12 19.4% NA NA 590 13.3%

No 882 80.5% 2665 88.7% 231 92.8% 22 73.3% 50 80.6% NA NA 3850 86.7%

X‐axis: All sites (Descending order)

Attended psychologist by diabetes type

T1DM T2DM GDM Don't know Other Missing Total

0%

20%

40%

60%

80%

100%

Attended psychologist ‐ All patients

0%

20%

40%

60%

80%

100%

Attended psychologist ‐ T1DM

0%

20%

40%

60%

80%

100%

Attended psychologist ‐ T2DM

0%

20%

40%

60%

80%

100%

Attended psychologist ‐ GDM

155

n % n % n % n % n % n % n %

Yes 50 4.6% 234 7.8% 9 3.6% 5 16.7% 10 16.1% NA NA 308 6.9%

No 1045 95.4% 2771 92.2% 240 96.4% 25 83.3% 52 83.9% NA NA 4133 93.1%

X‐axis: All sites (Descending order)

T1DM T2DM GDM Don't know Other Missing Total

Attended social worker by diabetes type

0%

20%

40%

60%

80%

100%

Attended social worker ‐ All patients 

0%

20%

40%

60%

80%

100%

Attended social worker ‐ T1DM

0%

20%

40%

60%

80%

100%

Attended social worker ‐ T2DM

0%

20%

40%

60%

80%

100%

Attended social worker ‐ GDM

156

n % n % n % n % n % n % n %

Yes 1015 92.4% 1904 63.2% 115 46.4% 18 60.0% 50 80.6% NA NA 3102 69.7%

No 83 7.6% 1111 36.8% 133 53.6% 12 40.0% 12 19.4% NA NA 1351 30.3%

X‐axis: All sites (Descending order)

Don't know Missing

Attended diabetes specialist by diabetes type

TotalOtherT1DM T2DM GDM

0%

20%

40%

60%

80%

100%

Attended diabetes specialist ‐ All patients

0%

20%

40%

60%

80%

100%

Attended diabetes specialist ‐ T1DM

0%

20%

40%

60%

80%

100%

Attended diabetes specialist ‐ T2DM

0%

20%

40%

60%

80%

100%

Attended diabetes specialist ‐ GDM

157

n % n % n % n % n % n % n %

Yes 445 40.6% 1100 36.7% 6 2.4% 8 26.7% 18 29.5% NA NA 1577 35.6%

No 650 59.4% 1901 63.3% 243 97.6% 22 73.3% 43 70.5% NA NA 2859 64.4%

X‐axis: All sites (Descending order)

Other Missing TotalT1DM T2DM GDM Don't know

Attended ophthalmologist by diabetes type

0%

20%

40%

60%

80%

100%

Attended ophthalmologist ‐ All patients

0%

20%

40%

60%

80%

100%

Attended ophthalmologist ‐ T1DM

0%

20%

40%

60%

80%

100%

Attended ophthalmologist ‐ T2DM

0%

20%

40%

60%

80%

100%

Attended ophthalmologist ‐ GDM

158

n % n % n % n % n % n % n %

Yes 762 69.8% 2158 72.5% 44 17.7% 15 50.0% 42 68.9% NA NA 3021 68.6%

No 329 30.2% 817 27.5% 205 82.3% 15 50.0% 19 31.1% NA NA 1385 31.4%

X‐axis: All sites (Descending order)

Other Missing TotalGDM Don't knowT1DM

Attended optometrist by diabetes type

T2DM

0%

20%

40%

60%

80%

100%

Attended optometrist ‐ All patients

0%

20%

40%

60%

80%

100%

Attended optometrist ‐ T1DM

0%

20%

40%

60%

80%

100%

Attended optometrist ‐ T2DM

0%

20%

40%

60%

80%

100%

Attended optometrist ‐ GDM

159

n % n % n % n % n % n % n %

Yes 592 54.2% 1278 43.0% 98 39.4% 13 43.3% 32 52.5% NA NA 2013 45.7%

No 501 45.8% 1694 57.0% 151 60.6% 17 56.7% 29 47.5% NA NA 2392 54.3%

X‐axis: All sites (Descending order)

T1DM T2DM GDM Don't know Other Missing Total

Attended dentist by diabetes type

0%

20%

40%

60%

80%

100%

Attended dentist ‐ All patients 

0%

20%

40%

60%

80%

100%

Attended dentist ‐ T1DM

0%

20%

40%

60%

80%

100%

Attended dentist ‐ T2DM

0%

20%

40%

60%

80%

100%

Attended dentist ‐ GDM

160

n % n % n % n % n % n % n %

Yes 86 7.9% 341 11.4% 8 3.2% 4 13.3% 10 16.4% NA NA 449 10.1%

No 1009 92.1% 2661 88.6% 241 96.8% 26 86.7% 51 83.6% NA NA 3988 89.9%

X‐axis: All sites (Descending order)

T1DM T2DM GDM Don't know Other Missing Total

Attended exercise physiologist by diabetes type

0%

20%

40%

60%

80%

100%

Attended exercise physiologist ‐ All patients

0%

20%

40%

60%

80%

100%

Attended exercise physiologist ‐ T1DM

0%

20%

40%

60%

80%

100%

Attended exercise physiologist ‐ T2DM

0%

20%

40%

60%

80%

100%

Attended exercise physiologist ‐ GDM

161

n % n % n % n % n % n % n %

313 28.7% 1149 38.2% 81 32.7% 10 34.5% 19 30.2% NA NA 1572 35.4%

124 39.6% 358 31.4% 36 44.4% 5 50.0% 7 38.9% NA NA 530 33.9%

91 29.1% 362 31.7% 23 28.4% 1 10.0% 5 26.3% NA NA 482 30.8%

60 19.2% 312 27.3% 18 22.2% 3 30.0% 5 27.8% NA NA 398 25.4%

78 24.9% 236 20.7% 23 28.4% 3 30.0% 2 11.1% NA NA 342 21.9%

159 50.8% NA NA NA NA NA NA NA NA NA NA 159 50.8%

X‐axis: All sites (Descending order)

Total

Insufficient time to prepare 

healthy meals

Costs too much to eat well

Too hard to count carbs 

(T1DM)

Eat out a lot and find it hard to 

eat well

Don't know what foods are 

best to eat

Difficulties following 

recommended diet

Other Missing

Difficulty following recommended diet by diabetes type

T1DM T2DM GDM Don't know

0%

20%

40%

60%

80%

100%

Difficulties following recommended diet ‐ All patients

0%

20%

40%

60%

80%

100%

Insufficient time to prepare healthy meals ‐ All patients

162

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Costs too much to eat well ‐ All patients

0%

20%

40%

60%

80%

100%

Don't know what foods are best to eat ‐ All patients

0%

20%

40%

60%

80%

100%

Eat out a lot ‐ All patients

0%

20%

40%

60%

80%

100%

Too hard to count carbs ‐ T1DM

163

n % n % n % n % n % n % n %

Yes 825 75.6% 1952 66.0% 225 91.5% 15 53.6% 44 69.8% NA NA 3061 69.8%

No 251 23.0% 865 29.2% 13 5.3% 11 39.3% 15 23.8% NA NA 1155 26.3%

Unsure of 

recommended 

testing

15 1.4% 141 4.8% 8 3.3% 2 7.1% 4 6.3% NA NA 170 3.9%

X‐axis: All sites (Descending order)

Missing TotalT1DM T2DM Don't know Other

Blood glucose monitoring as recommended by diabetes type

GDM

0%

20%

40%

60%

80%

100%

Check blood glucose as recommended ‐ All patients

0%

20%

40%

60%

80%

100%

Check blood glucose as recommended ‐ T1DM

0%

20%

40%

60%

80%

100%

Check blood glucose as recommended ‐ T2DM

0%

20%

40%

60%

80%

100%

Check blood glucose as recommended ‐ GDM

164

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Do not check blood glucose as recommended ‐ All patients

0%

20%

40%

60%

80%

100%

Do not check blood glucose as recommended ‐ T1DM

0%

20%

40%

60%

80%

100%

Do not check blood glucose as recommended ‐ T2DM

0%

20%

40%

60%

80%

100%

Do not check blood glucose as recommended ‐ GDM

165

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Unsure of recommended glucose testing ‐ All patients

0%

20%

40%

60%

80%

100%

Unsure of recommended glucose testing ‐ T1DM

0%

20%

40%

60%

80%

100%

Unsure of recommended glucose testing ‐ T2DM

0%

20%

40%

60%

80%

100%

Unsure of recommended glucose testing ‐ GDM

166

n % n % n % n % n % n % n %

Yes 1038 96.8% 1715 95.5% 88 97.8% 19 95.0% 46 93.9% NA NA 2906 96.0%

No 34 3.2% 81 4.5% 2 2.2% 1 5.0% 3 6.1% NA NA 121 4.0%

X‐axis: All sites (Descending order)

Missing

Rotation of injection site by diabetes type

TotalT1DM T2DM GDM Don't know Other

0%

20%

40%

60%

80%

100%

Rotate injection site ‐ All patients

0%

20%

40%

60%

80%

100%

Rotate injection site ‐ T1DM

0%

20%

40%

60%

80%

100%

Rotate injection site ‐ T2DM

0%

20%

40%

60%

80%

100%

Rotate injection site ‐ GDM

167

n % n % n % n % n % n % n %

Depression likely 303 27.7% 806 26.9% 25 10.0% 14 46.7% 15 24.2% NA NA 1163 26.2%

Depression unlikely 791 72.3% 2194 73.1% 224 90.0% 16 53.3% 47 75.8% NA NA 3272 73.8%

X‐axis: All sites (Descending order)

T1DM T2DM GDM Don't know Other Missing

Likely depression by diabetes type

Total

Note: Likely depression as determined by the Brief Case‐find for Depression (BCD) tool

0%

20%

40%

60%

80%

100%

Depression likely ‐ All patients

0%

20%

40%

60%

80%

100%

Depression likely ‐ T1DM

0%

20%

40%

60%

80%

100%

Depression likely ‐ T2DM

0%

20%

40%

60%

80%

100%

Depression likely ‐ GDM

168

n % n % n % n % n % n % n %

Yes 203 18.5% 596 19.8% 9 3.6% 7 23.3% 10 16.1% NA NA 825 18.6%

No 892 81.5% 2408 80.2% 240 96.4% 23 76.7% 52 83.9% NA NA 3615 81.4%

X‐axis: All sites (Descending order)

Antidepressant use by diabetes type

MissingT1DM T2DM GDM TotalDon't know Other

0%

20%

40%

60%

80%

100%

Taking antidepressant ‐ All patients

0%

20%

40%

60%

80%

100%

Taking antidepressant ‐ T1DM

0%

20%

40%

60%

80%

100%

Taking antidepressant ‐ T2DM

0%

20%

40%

60%

80%

100%

Taking antidepressant ‐ GDM

169

n % n % n % n % n % n % n %

Yes 364 33.3% 734 24.5% 55 22.1% 14 46.7% 20 32.3% NA NA 1187 26.8%

No 730 66.7% 2266 75.5% 194 77.9% 16 53.3% 42 67.7% NA NA 3248 73.2%

X‐axis: All sites (Descending order)

Past psychiatric treatment/counselling by diabetes type

T1DM T2DM GDM Don't know Other Missing Total

0%

20%

40%

60%

80%

100%

Past psychiatric treatment ‐ All patients

0%

20%

40%

60%

80%

100%

Past psychiatric treatment ‐ T1DM

0%

20%

40%

60%

80%

100%

Past psychiatric treatment ‐ T2DM

0%

20%

40%

60%

80%

100%

Past psychiatric treatment ‐ GDM

170

n % n % n % n % n % n % n %

Yes 131 12.0% 259 8.6% 14 5.6% 5 16.7% 9 14.5% NA NA 418 9.4%

No 962 88.0% 2741 91.4% 235 94.4% 25 83.3% 53 85.5% NA NA 4016 90.6%

X‐axis: All sites (Descending order)

Current psychiatric treatment/counselling by diabetes type

T1DM T2DM GDM Missing TotalDon't know Other

0%

20%

40%

60%

80%

100%

Current psychiatric treatment ‐ All patients

0%

20%

40%

60%

80%

100%

Current psychiatric treatment ‐ T1DM

0%

20%

40%

60%

80%

100%

Current psychiatric treatment ‐ T2DM

0%

20%

40%

60%

80%

100%

Current psychiatric treatment ‐ GDM

171

T1DM T2DM GDMDon't 

knowOther Missing Total

n 1060 2878 232 29 61 NA 4260

Mean Own Health 

State Rating67.9 65.6 74.5 58.4 68.8 NA 66.7

SD 19.2 20.1 15.9 25.5 22.2 NA 19.9

Min 0.0 0.0 10.0 4.0 0.0 NA 0.0

Max 100.0 100.0 100.0 100.0 100.0 NA 100.0

X‐axis: All sites (Descending order)

Own Health State Rating by diabetes type

0

20

40

60

80

100

Mean Own Health State Rating ‐ All patients

0

20

40

60

80

100

Mean Own Health State Rating ‐ T1DM

0

20

40

60

80

100

Mean Own Health State Rating ‐ T2DM

0

20

40

60

80

100

Mean Own Health State Rating ‐ GDM

172

n % n % n % n % n % n % n %

Positive DDS2 

Screening Scale489 45.8% 970 33.5% 41 17.6% 13 46.4% 21 34.4% NA NA 1534 35.8%

X‐axis: All sites (Descending order)

Missing

Positive DDS2 Screening Scale  by diabetes type

TotalT1DM T2DM GDM Don't know Other

0%

20%

40%

60%

80%

100%

Positive DDS2 Screening Scale ‐ All patients

0%

20%

40%

60%

80%

100%

Positive DDS2 Screening Scale ‐ T1DM

0%

20%

40%

60%

80%

100%

Positive DDS2 Screening Scale ‐ T2DM

0%

20%

40%

60%

80%

100%

Positive DDS2 Screening Scale ‐ GDM

173

n  % n  % n  % n  % n  % n  % n  %

491 914 41 12 26 NA 1484

2.2±0.8 2.2±0.9 1.8±0.7 2.6±0.9 1.9±1.1 NA±NA 2.2±0.9

237 48.3% 481 52.6% 28 68.3% 4 33.3% 18 69.2% NA NA 768 51.8%

158 32.2% 284 31.1% 10 24.4% 3 25.0% 5 19.2% NA NA 460 31.0%

n

Mean score±SD Little/no distress Moderate distress High distress 96 19.6% 149 16.3% 3 7.3% 5 41.7% 3 11.5% NA NA 256 17.3%

X‐axis: All sites (Descending order)

T1DM T2DM GDM Don't know Other Missing Total

Total DDS17 score by diabetes type

0.0

1.0

2.0

3.0

4.0

5.0

Mean Total DDS17 score ‐ All patients

0.0

1.0

2.0

3.0

4.0

5.0

Mean Total DDS17 score ‐ T1DM

0.0

1.0

2.0

3.0

4.0

5.0

Mean Total DDS17 score ‐ T2DM

0.0

1.0

2.0

3.0

4.0

5.0

Mean Total DDS17 score ‐ GDM

174

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Total DDS17 score: High distress ‐ All patients

0%

20%

40%

60%

80%

100%

Total DDS17 score: High distress ‐ T1DM

0%

20%

40%

60%

80%

100%

Total DDS17 score: High distress ‐ T2DM

0%

20%

40%

60%

80%

100%

Total DDS17 score: High distress ‐ GDM

175

n  % n  % n  % n  % n  % n  % n  %

490 914 41 12 26 NA 1483

2.7±1.2 2.6±1.2 2.3±1.1 3.2±1.2 2.5±1.3 NA±NA 2.6±1.2

139 28.4% 320 35.0% 18 43.9% 2 16.7% 12 46.2% NA NA 491 33.1%

162 33.1% 300 32.8% 11 26.8% 3 25.0% 8 30.8% NA NA 484 32.6%

n

Mean score±SD Little/no distress Moderate distress High distress 189 38.6% 294 32.2% 12 29.3% 7 58.3% 6 23.1% NA NA 508 34.3%

X‐axis: All sites (Descending order)

Emotional burden by diabetes type

T1DM T2DM GDM Don't know Other Missing Total

0.0

1.0

2.0

3.0

4.0

5.0

Mean emotional burden ‐ All patients

0.0

1.0

2.0

3.0

4.0

5.0

Mean emotional burden ‐ T1DM

0.0

1.0

2.0

3.0

4.0

5.0

Mean emotional burden ‐ T2DM

0.0

1.0

2.0

3.0

4.0

5.0

Mean emotional burden ‐ GDM

176

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Emotional burden: High distress ‐ All patients

0%

20%

40%

60%

80%

100%

Emotional burden: High distress ‐ T1DM

0%

20%

40%

60%

80%

100%

Emotional burden: High distress ‐ T2DM2

0%

20%

40%

60%

80%

100%

Emotional burden: High distress ‐ GDM

177

n  % n  % n  % n  % n  % n  % n  %

491 912 41 12 26 NA 1482

1.5±0.8 1.5±0.9 1.3±0.9 1.4±0.6 1.6±1.1 NA±NA 1.5±0.9

414 84.3% 744 81.6% 37 90.2% 10 83.3% 21 80.8% NA NA 1226 82.7%

37 7.5% 97 10.6% 3 7.3% 2 16.7% 3 11.5% NA NA 142 9.6%

n

Mean score±SD Little/no distress Moderate distress High distress 40 8.1% 71 7.8% 1 2.4% 0 0.0% 2 7.7% NA NA 114 7.7%

X‐axis: All sites (Descending order)

Physician‐related distress by diabetes type

T1DM T2DM GDM Don't know Other Missing Total

0.0

1.0

2.0

3.0

4.0

5.0

Mean physician‐related distress ‐ All patients

0.0

1.0

2.0

3.0

4.0

5.0

Mean physician‐related distress ‐ T1DM

0.0

1.0

2.0

3.0

4.0

5.0

Mean physician‐related distress ‐ T2DM

0.0

1.0

2.0

3.0

4.0

5.0

Mean physician‐related distress ‐ GDM

178

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Physician‐related distress: High distress ‐ All patients

0%

20%

40%

60%

80%

100%

Physician‐related distress: High distress ‐ T1DM

0%

20%

40%

60%

80%

100%

Physician‐related distress: High distress ‐ T2DM

0%

20%

40%

60%

80%

100%

Physician‐related distress: High distress ‐ GDM

179

n  % n  % n  % n  % n  % n  % n  %

491 914 41 12 26 NA 1484

2.5±1.1 2.4±1.1 1.9±0.9 2.7±1.0 1.9±1.2 NA±NA 2.4±1.1

177 36.0% 352 38.5% 28 68.3% 2 16.7% 18 69.2% NA NA 577 38.9%

160 32.6% 304 33.3% 7 17.1% 4 33.3% 5 19.2% NA NA 480 32.3%

n

Mean score±SD Little/no distress Moderate distress High distress 154 31.4% 258 28.2% 6 14.6% 6 50.0% 3 11.5% NA NA 427 28.8%

X‐axis: All sites (Descending order)

Regimen‐related distress by diabetes type

T1DM T2DM GDM Don't know Other Missing Total

0.0

1.0

2.0

3.0

4.0

5.0

Mean regimen‐related distress ‐ All patients

0.0

1.0

2.0

3.0

4.0

5.0

Mean regimen‐related distress ‐ T1DM

0.0

1.0

2.0

3.0

4.0

5.0

Mean regimen‐related distress ‐ T2DM

0.0

1.0

2.0

3.0

4.0

5.0

Mean regimen‐related distress ‐ GDM

180

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Regimen‐related distress: High distress ‐ All patients

0%

20%

40%

60%

80%

100%

Regimen‐related distress: High distress ‐ T1DM

0%

20%

40%

60%

80%

100%

Regimen‐related distress: High distress ‐ T2DM

0%

20%

40%

60%

80%

100%

Regimen‐related distress: High distress ‐ GDM

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n  % n  % n  % n  % n  % n  % n  %

491 914 41 12 26 NA 1484

2.0±1.2 1.9±1.2 1.6±0.8 3.3±1.7 1.8±1.2 NA±NA 1.9±1.2

290 59.1% 576 63.0% 29 70.7% 3 25.0% 17 65.4% NA NA 915 61.7%

89 18.1% 163 17.8% 6 14.6% 3 25.0% 6 23.1% NA NA 267 18.0%

n

Mean score±SD Little/no distress Moderate distress High distress 112 22.8% 175 19.1% 6 14.6% 6 50.0% 3 11.5% NA NA 302 20.4%

X‐axis: All sites (Descending order)

T1DM T2DM GDM Don't know Other Missing Total

Interpersonal distress by diabetes type

0.0

1.0

2.0

3.0

4.0

5.0

Mean interpersonal distress ‐ All patients

0.0

1.0

2.0

3.0

4.0

5.0

Mean interpersonal distress ‐ T1DM

0.0

1.0

2.0

3.0

4.0

5.0

Mean interpersonal distress ‐ T2DM

0.0

1.0

2.0

3.0

4.0

5.0

Mean interpersonal distress ‐ GDM

182

X‐axis: All sites (Descending order)

0%

20%

40%

60%

80%

100%

Interpersonal distress: High distress ‐ All patients

0%

20%

40%

60%

80%

100%

Interpersonal distress: High distress ‐ T1DM

0%

20%

40%

60%

80%

100%

Interpersonal distress: High distress ‐ T2DM

0%

20%

40%

60%

80%

100%

Interpersonal distress: High distress ‐ GDM

183

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Australian National Diabetes Audit ANDA-AQSMA 2018

Appendix 6

NADC Guide to Quality Improvement

Final Report

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NADC GUIDE TO QUALITY IMPROVEMENT

What should you do with the ANDA results?

Quality improvement is a critical factor in all levels of healthcare and plays an important part in the provision of

service. The onus of quality improvement in health is now the responsibility of all health care providers and not

just those in the Quality departments of our organisations. However, unless we measure what we do, and the

outcomes of our care, it will be difficult to know exactly what needs to improve and what impact our

improvements have had over time. Efforts to improve systems or processes must be driven by reliable data.

Data not only allows us to accurately identify problems, it also assists us in prioritising quality improvement

initiatives and enables objective assessment of whether change and improvement have indeed occurred after

change. Data helps us to understand, focus and improve our service by allowing us to compare our performance,

either against known standards or against our own prior results.

Collecting and analysing data are therefore critical to the function of quality improvement in any health service.

This guide demonstrates the fundamentals of using your data for quality improvement. The concepts are logical

and simple, and should apply to any practice.

The NADC encourages you and your organisation to take this opportunity to utilise the valuable information

provided to you in the final report of the 2018 ANDA-AQSMA audit.

The NADC hopes that the following guideline will aid the development of quality improvement

initiatives that can be reflected in your organisation's future results and patient outcomes.

To access NADC quality improvement tool templates including the PDSA worksheet and a detailed action

plan, please click the following link or go to: http://nadc.net.au/quality-improvement/

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THE STEPS OF QUALITY IMPROVEMENT Step 1: What is your centre aiming for?

You need to be clear, you need to be focused.

“If you aim at nothing, that’s what you will hit!”

Step 2: Assess your ANDA data

Where do you sit in comparison to other organisations?

• Can you do better? • Are you an outlier? • Why?

Again, reflect on what your centre aims for and is it achieving this aim?

Step 3: Deciding on your projects

Possible criteria for your Quality Improvement projects could be:

• Improvements that will be of most benefit to patients • Improvement actions that will have the biggest impact across the greatest number of areas • Improvement that are aligned with organisational strategic goals • Improvements that are most likely to succeed when all barriers are considered

Step 4: Rapid Cycle Model questions

The following is the rapid cycle model which gets you started by asking 3 questions:

1) What are you trying to accomplish? Using the questions of:

• What does the centre want to achieve? • How does this align with the organisation’s overall strategic goal?

Most organisations will align this with the following 6 overarching aims for improvement in health care:

• Safe • Effective • Patient-centred • Timely • Efficient • Equitable

As you answer this question you will develop your Aim Statement.

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2) How will you know that a change is an improvement?

The answer to this question helps determine your measures.

3) What changes can you make that will result in an improvement?

• What would give you the biggest bang for the organisation’s time and dollar investment?• Are there a few changes you can make that would be simple but effective that may be best

to do first?• Answering these questions moves you into testing the cycles as you begin to find solutions

and then make improvements upon them.• But remember: All improvement requires making changes but not all changes result in

improvement! Plan wisely!

4) How will you know that a change is an improvement?• Simple – ANDA data! You have it already! Keep participating!• Think about what other sources of information you have available• Benchmark with other like sized/type NADC Centres

Step 5: Deploy the PDSA cycle

After answering the previous key questions, move into the PDSA cycle.

The PDSA system is a simple but effective tool to guide your activity through the essential improvement elements (see Appendix 1)

ACT PLAN

STUDY DO

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Plan:

In the planning section you decide:

• What exactly you will do • Who will carry out the plan • When will it take place • Where • What do you predict will happen • What data/information will you collect to know whether there is an improvement? What will

you measure?

Do

So what do you do in the “Do” section?

• You carry out the plan • You document any unexpected events or problems • You begin analysis of data

Study

The STUDY component is where you:

• Complete the analysis of the data • Review and reflect on the results • Compare the data to predictions • Summarise what was learned

Act

The “A” step in the PDSA cycle is where you ACT on what you have planned, done and studied.

You decipher:

• What changes are to be made • What is the next cycle • And can you grow the improvements that have been made • The cycle doesn’t necessarily stop here!

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BARRIERS TO CHANGE Sometimes despite our best efforts we have barriers to change.

Be alert to the following change blocker?

• Absence of relevant data• Negative attitude• Fixed routines• Lack of quality improvement skills• Unsupportive culture re innovation, team work, change and short term clinical focus• Money• And the big issue for everyone = TIME!

CHANGE PRACTICE INVOLVES: • Keeping it simple• Starting small and build slowly• Being clear about what you want and how it can be achieved• Planning well• Involving key people• Selling your ideas and plans• Getting help!

CONCLUSION

Every system is perfectly designed to get the results it gets, so design your system for the results you want.

ANDA gives us an opportunity that needs to be more than a file on your PC or a wad of papers in your filing cabinet. It needs to be brought to life and be the catalyst for improvement in your organisation.

Put your data into action!

“If we always do what we have always done, then we will always get what we have always got”

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Appendix 1

PDSA WORKSHEET Organisation: __________________________________________ Date: _________________________

Department: __________________________________________ Coordinator: ___________________

AIM: (What is the overall goal you wish to achieve?)

____________________________________________________________________________

PLAN: (List the tasks that need to be made to made the change)

ACTION How will you achieve the goal? What steps do you need to take?

WHO Who is involved?

MESUARABLE How will you know that you have achieved the goal

ACHIEVABLE What resources and time to do this?

REALISTIC Are you sure you can really do this?

TIME LIMITED When can this realistically be achieved?

Do: Describe what actually happened when the changes were implemented

Study: Describe the measured results and how they compared to the predictions. Where goals met?

Act: Based on this PDSA cycle, what are the next steps to achieve the Goal/Aim statement?

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Australian National Diabetes Audit ANDA-AQSMA 2018

Appendix 7

NADC Diabetes Publications & Resource List 2018

Final Report

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Diabetes Publications & Resource List 2018 There are many resources available nationally that provide evidence based guidelines on how care should be provided and what outcomes should be achieved for people living with diabetes.

The following is a list of commonly used resources in Australia. The list also includes health care organisations involved in the provision of diabetes care. These links have been divided into topics. Please click on the topic of interest.

Contents Prevention, Prediabetes & Diagnostics .............................................................................................................................2

Hospital Guidelines ............................................................................................................................................................2

Obesity Management ........................................................................................................................................................2

Type 1 Diabetes .................................................................................................................................................................3

Type 2 Diabetes .................................................................................................................................................................3

Elderly / Aged Care / End of Life ........................................................................................................................................4

Consulting / Diabetes Education .......................................................................................................................................5

Renal Information ..............................................................................................................................................................6

Foot Care ...........................................................................................................................................................................6

Eye Care .............................................................................................................................................................................6

Nutrition / Diet ..................................................................................................................................................................7

Pregnancy ..........................................................................................................................................................................8

Aboriginal and Torres Strait Islander .................................................................................................................................9

CALD / Multilingual ............................................................................................................................................................9

Data / Research / Quality Improvement ........................................................................................................................ 10

HbA1c ............................................................................................................................................................................. 11

Subcutaneous Devices / Techniques .............................................................................................................................. 12

Driving............................................................................................................................................................................. 12

Workplace....................................................................................................................................................................... 13

NDSS ............................................................................................................................................................................... 13

Diabetes Related Organisations In Australia .................................................................................................................. 13

Australian Government Departments ............................................................................................................................ 13

Professional Associations & Organisations .................................................................................................................... 14

International Diabetes Associations ............................................................................................................................... 14

Support ........................................................................................................................................................................... 14

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Title Description / Link Prevention, Prediabetes & Diagnostics National Evidence Based Guideline for Case Detection and Diagnosis of Type 2 Diabetes

To read or download your copy, please click here

National Evidence Based Guideline for the Primary Prevention of Type 2 Diabetes

To read or download your copy, please click here

The Australian Diabetes Educators Association (ADEA) and the Australian Diabetes Society (ADS) Position Statement on Prediabetes

To read or download your copy, please click here

Australian Diabetes Society Position Statement:

The Prevention and Management of Type 2 Diabetes in the Context of Psychotic Disorders

To read or download your copy, please click here

Life! Program The Life! program is a free Victorian lifestyle modification program aimed at type 2 diabetes and cardiovascular disease risk reduction. Run by expert health professionals, the program is delivered as a group course or a telephone health coaching service. Find out more HERE

Hospital Guidelines ADS Guidelines for Routine Glucose Control in Hospital

To read or download your copy, please click here

ADS Peri-Operative Diabetes Management Guidelines

These guidelines are primarily intended to provide assistance for those practitioners whose primary focus is not diabetes or who do not have the support of local diabetes expertise in their management of patients with diabetes undergoing surgical procedures. To read or download your copy, please click here

Obesity Management

Australian Obesity Management Algorithm This statement has been developed by a working group with representatives from the Australian Diabetes Society, the Australian and New Zealand Obesity Society and the Obesity Surgery Society of Australian and New Zealand.

The aims of the document are to:

1) Assist general practitioners (GPs) in treatment decisions for non-pregnant adults with obesity

2) Provide a practical clinical tool to guide the implementation ofexisting guidelines for the treatment of obesity in the primary caresetting in Australia.

To read or download your copy, please click here (Posted: October, 2016)

Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations

The ADS has recently endorsed international guidelines that recommend metabolic surgery for patients with type 2 diabetes and class III (BMI ≥40 kg/m2) obesity and patients with type 2 diabetes with class II (BMI 35.0–39.9 kg/m2) obesity who have had inadequate glycaemic control with lifestyle and pharmacotherapy.

To read or download your copy, please click here (Posted: June, 2016)

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Type 1 Diabetes

Alcohol and type 1 diabetes To view or download your copy, please click here

Diabetes in Pregnancy booklet for women with type 1 – Having a Healthy Baby

To view or download your copy, please click here

Drug use and type 1 diabetes To view or download your copy, please click here

Guidelines for Sick Day Management for People with Diabetes

Provides readily accessible information recommending strategies for managing sick days in diabetes. To view the technical document for health professional, please click here

To view the sick day management of adults with type 1 diabetes consumer resources, please click here

NDSS Pregnancy and Diabetes Website Information for women with type 1 or type diabetes planning a pregnancy now or in the future

To view this website, please click here

National Evidence Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults

To view or download your copy, please click here

Travelling and type 1 diabetes

To view or download your copy, please click here

Understanding Hypoglycaemia The International Hypoglycaemia Study Group (IHSG) has launched a website providing information about hypoglycaemia in diabetes. It includes statements and guidelines, practice tools for health professionals and much more.

To view this website, please click here

Type 2 Diabetes ADS Position Statement on A New Blood Glucose Management Algorithm for Type 2 Diabetes

This position statement developed by the Australian Diabetes Society outlines the risks, benefits and costs of the available therapies and suggests a treatment algorithm incorporating the older and newer agents. Summary of this ADS Position Statement is as follows:

To read or download the full version of the ADS A New Blood Glucose Management Algorithm for Type 2 Diabetes Position Statement please click here (Updated: December, 2016)

T2D Treatment Website (A New Blood Glucose Management Algorithm for Type 2 Diabetes)

The blood glucose management algorithm for type 2 diabetes outlines the risks, benefits and costs of available therapies and provides an approach for how to incorporate older and newer agents. To view the algorithm and associated resources, including case studies please click here

Diabetes Management in General Practice 2016/18 General practitioners continue to provide most of the medical support to people with type 2 diabetes. This guide plays an important role in providing a readable summary of current guidelines and recommendations from various sources on the management of type 2 diabetes in the general practice setting. To read or download your copy, please click here

Australian Diabetes Society Position Statement:

The Prevention and Management of Type 2 Diabetes in the Context of Psychotic Disorders

To read or download your copy, please click here

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Guidelines for Sick Day Management for People with Diabetes

Provides readily accessible information recommending strategies for managing sick days in diabetes. To view the technical document for health professional, please click here

To view the sick day management of adults with type 2 diabetes consumer resources, please click here

Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organisations

The ADS has recently endorsed international guidelines that recommend metabolic surgery for patients with type 2 diabetes and class III (BMI ≥40 kg/m2) obesity and patients with type 2 diabetes with class II (BMI 35.0–39.9 kg/m2) obesity who have had inadequate glycaemic control with lifestyle and pharmacotherapy.

To read or download the full version of the 'Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations' Guidelines please click here (Posted: June, 2016)

National Evidence Based Guideline for Blood Glucose Control in Type 2 Diabetes

To read or download your copy, please click here

National Evidence Based Guideline for Diagnosis, Prevention and Management of Chronic Kidney Disease in Type 2 Diabetes

To read or download your copy, please click here

National Evidence Based Guidelines for the Management of Type 2 Diabetes

These guidelines comprise a suite of Type 2 Diabetes Guidelines developed in 2009 under a funding agreement between the Department of Health and Ageing and the Diabetes Australia Guideline Development Consortium. The five Guidelines in the series, when combined, present a comprehensive set of evidence-based guidelines for the prevention, diagnosis and management of Type 2 Diabetes. To read or download your copy, please click here

Understanding Hypoglycaemia The International Hypoglycaemia Study Group (IHSG) has launched a website providing information about hypoglycaemia in diabetes. It includes statements and guidelines, practice tools for health professionals and much more.

To view this website, please click here

Elderly / Aged Care / End of Life Glucose Lowering Medicines and Older People with Diabetes: Information for Personal Care Workers

This is the links to the Q-Med project resources which are available on the Australian Disease Management Association (ADMA) Online Clearinghouse site. To read or download the information please click here

Glucose Lowering Medicines and Older People with Diabetes: Information for Registered and Enrolled Nurses

This is the links to the Q-Med project resources which are available on the Australian Disease Management Association (ADMA) Online Clearinghouse site. To read or download the information please click here

Glucose Lowering Medicines: Information for Older People with Diabetes and their Family Members

This is the links to the Q-Med project resources which are available on the Australian Disease Management Association (ADMA) Online Clearinghouse site. To read or download the information please click here

Aged Care Diabetes Care Checklist This is a checklist to assist in the management of diabetes care for the aged. To read or download your copy please click here

Diabetes Management in Aged Care: A practical handbook

This is an updated version of the resource developed in 2012 and is aimed at care staff. To read or download your copy of the E-book, please click here To read or download your PDF copy, please click here

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Diabetes Management in Aged Care: Fact sheets for care workers

The diabetes management in aged care fast facts for care workers is a booklet of quick reference sheets that aim to give care staff basic information on how to manage diabetes in a residential care setting: To read or download your copy of the E-book, please click here

To read or download your PDF copy, please click here

Guidelines for the Management and Care of Diabetes in the Elderly

Focuses on the ‘healthy’ person over 65 years of age. Provides readily accessible information about diabetes prevention, diagnosis, treatment and long term management option for elderly people at risk of or living with diabetes. To view or download your full copy, please click here. To view a summary version, click here

Guidelines for Managing Diabetes at the End of Life These guidelines were developed in 2014 to assist with the management of Diabetes at the End of Life. To access these guidelines, search for these on the ADMA website. To access the ADMA website please click here

Older People – Healthy Eating Guide To read or download your copy, please click here

Older People – Managing Diabetes as You Age To read or download your copy, please click here

Older People – You and your Health Care Team To read or download your copy, please click here

The McKellar guidelines for Managing Older people with Diabetes in Residential and Other Care Settings

These Guidelines were developed in 2014 to assist with the management of Diabetes in Residential Care Facilities. To access these guidelines, search for these on the ADMA website. To access the ADMA website please click here

Consulting / Diabetes Education A new language for diabetes – Improving communications with and about people with diabetes

Diabetes Australia has released an updated version (May 2016) of their position statement on language around diabetes. To view or download your copy, please click here

The use of Language in Diabetes Care and Education

Article from The American Association of Diabetes Educators (AADE) and American Diabetes Association on the use of language in Diabetes Care and Education. To view or download your copy, please click here

Enhancing your consulting skills “Enhancing Your Consulting Skills” was developed by the ADS for the NDSS. It is now available in electronic format through the ADS website. Please click here to access this. It can be downloaded free of charge for individual use. Please note that you will be required to submit a request for download and obtain your password prior to receiving the download link. Hard copies of the resource are available from the ADS Secretariat.

National Evidenced Based Guideline for Patient Education in Type 2 Diabetes

This document provides minimum standards for development and facilitation of diabetes education programs. To view or download your copy, please click here

Outcomes and Indicators for Diabetes Education: National Consensus Position Information and Education for People with Diabetes: a ‘Best Practice’ Strategy

This report details a systematically derived framework of nationally agreed goals, outcomes and indicators for diabetes education. It provides a benchmark and policy platform for refining and evaluating the consistency, quality and effectiveness of diabetes education services which can be applied nationally and/or at a regional or local service level. To view or download your copy, please click here

Person Centred Care & Health Literacy ADEA project In 2013-2014 ADEA completed a revision of the information sheet ‘Person Centred Care for people with diabetes’ and developed an information sheet on Health literacy for people with diabetes. To view or download your copy, please click here

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Management of Diabetes in the General Care Setting Update

ASM 2014 Presentation by Giuliana Murfet can be viewed at nadc.net.au/video/2/

Renal Information National Evidence Based Guideline for Diagnosis, Prevention and Management of Chronic Kidney Disease in Type 2 Diabetes

To view or download your copy, please click here

Foot Care • Australasian Podiatry Council • Limbs 4 Life • Diabetic Foot Australia

National Evidence Based Guidelines on Prevention, Identification and Management of Foot Complications in Diabetes

Approved by the NHMRC, the full guideline, clinical guide, consumer guides and technical report can be downloaded here

Standards for High Risk Foot Services (HRFS) in NSW To view or download your copy, please click here

Promoting Optimal Diabetes Foot Care

“Promoting Optimal Diabetes Foot Care” is a set of audio-visual resources based on national and international guidelines. The resources have been designed to help health professionals develop the clinical skills required to deliver high quality foot care to people with diabetes. The set is comprised of three learning modules:

1. The Foot Examination

2. Preventative Foot Care

3. Managing basic diabetes foot complications

Wound Institute of Australia The Wound Healing Institute of Australia has developed a comprehensive set of modules on wound care, including specific modules on foot ulcers and leg ulcers.

Find out more about these modules at: https://www.whia.com.au/product-category/online-learning/

NADC Foot Network 2017 ASM Presentation by Stephen Twigg and Leanne Mullan – Slides can be viewed, HERE (part 1), HERE (part 2)

Eye Care

• Optometrists Association of Australia

Eye care for diabetes: an Indigenous Perspective

ASM 2014 Presentation by Hugh Taylor can be viewed at nadc.net.au/video/2/

Diabetes Educators National Core Competencies for Credentialled Diabetes Educators

Provides a reference and a framework for guiding policy on the training and credentialling of diabetes educators. To view or download your copy, please click here

National Standards of Practice for Diabetes Educators

One of the strategies developed by ADEA to promote a quality professional diabetes education practice. To view or download your copy, please click here

The Credentialled Diabetes Educator in Australia – Role and Scope of Practice

Reflects the position of their unique and integral role in enabling people with diabetes manage their condition and as part of the multidisciplinary diabetes care team. To view or download your copy, please click here

200

The Role of Credentialled Diabetes Educators and Accredited Practising Dietitians in the Delivery of Diabetes Self-Management and Nutrition Services for People with Diabetes

To view or download your copy, please click here

Fact Sheets / Patient Resources Baker IDI Fact Sheets These materials have been developed by Baker IDI experts for use by

clients and health professionals for patient education. The Institute is committed to providing credible, evidence-based health information regarding optimum approaches to the prevention and management of disease. To view or download these resources, please click here

Diabetes Australia patient information and resources

To view or download these resources, please click here

National Diabetes Services Scheme (NDSS) resources including fact sheets

35 facts sheets including those in other languages are available through the NDSS website. To view or download these resources, please click here

Diabetes and Emotional Health Handbook and Toolkit

‘Diabetes and Emotional Health’ is a handbook and toolkit developed as part of the National Diabetes Services Scheme Mental Health and Diabetes National Development Programme. The handbook has been designed as an evidence-based, practical resource to enable health professionals to identify, address, and communicate about emotional problems during consultations with adults with diabetes. A related toolkit contains resources to complement the handbook, including summary cards of several chapters, questionnaires for routine clinical use, and related ‘factsheets’ for people with diabetes. The latter provide information about the psychological topics covered in the chapters of the handbook, tips about what people with diabetes can do when they experience this problem and where they can get further support. Both the handbook and the toolkit can be accessed electronically via the Health Professionals tab of the NDSS website (ndss.com.au). The direct link is www.ndss.com.au/online-resources-for-health-professionals (you will need to ‘sign up’ to view it). The ‘factsheets’ are also available directly to people with diabetes electronically via the NDSS website. The direct link is https://www.ndss.com.au/diabetes-and-emotional-health.

Nutrition / Diet • Dietitians Association of Australia (DAA) • Food Standards Australia New Zealand (FSANZ) • Glycemic Index Ltd • Nutrition Australia • Coeliac Australia • Diabetes Australia recipes

Healthy Eating Guide for Older Australians with Diabetes

To view or download your copy, please click here

Diabetes and Ramadan To assist health professionals, religious leaders and people with diabetes who fast during Ramadan, the Australian Diabetes Society, in conjunction with the International Diabetes Federation and Diabetes and Ramadan International Alliance, has endorsed the following brochures:

• Diabetes during Ramadan: Patient Guide • Ramadan and Diabetes: Guidance Sheet for Imam • Management of Diabetes During Ramadan: Quick Reference

Guide for Health Professionals

201

In February 2017 the NADC joined representatives from the ADS and the Diabetes and Ramadan (DaR) International Alliance at the first-ever Diabetes and Ramadan Symposium at Concord Repatriation General Hospital. The event promoted the new IDF-DaR Diabetes and Ramadan Practical Guidelines, which aim to support healthcare professionals to better support patients during this important religious period.

A copy of the guidelines can be downloaded from the IDF website at http://www.idf.org/guidelines/diabetes-in-ramadan and presentations from the event can be viewed here: http://nadc.net.au/video/

or via the NADC YouTube channel - NADC Australia.

Diabetes and Ramadan Overview

Diabetes and Ramadan Symposium Introduction - Dr Sof Andrikopoulos

Diabetes and Ramadan Dr Marwan Obaid

Diabetes and Ramadan 2 Case Studies Dr Elif Ekinci

Ramadan, Diabetes and Pregnancy Dr Sarah Abdo

IDF DAR Practical Guidelines Dr Mohamed Hassanein

Pregnancy

• The Australasian Diabetes in Pregnancy Society (ADIPS)

• Pregnancy and Diabetes

Diabetes in Pregnancy booklet for women with type 1 – Having a Healthy Baby

To view or download your copy, please click here for the e-book Click here for the PDF

Diabetes in Pregnancy booklet for women with type 2 – Having a Healthy Baby

To view or download your copy, please click here Click here for the PDF

Gestational Diabetes - Caring for Yourself and Your Baby

To view or download your copy, please click here

Life after Gestational Diabetes To view or download your copy, please click here

NDSS Understanding Gestational Diabetes Factsheet

To view or download your copy, please click here

Also available in 10 different languages, to view or download translated factsheets, please click here

NDSS Pregnancy and Diabetes Website

Information for women with type 1 or type diabetes planning a pregnancy now or in the future

To view this website, please click here

NDSS Pregnancy Planning Checklist

To view or download your copy, please click here

NDSS Pregnancy and Diabetes Factsheet To view or download your copy, please click here

Also available in 10 different languages, to view or download translated factsheets, please click here

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Aboriginal and Torres Strait Islander

• HealthInfoNet

Aboriginal and Torres Strait Islander Resources – NDSS

To view or download resources, please click here

Aboriginal and Torres Strait Islander Resources – Diabetes Australia State Branches

Diabetes Victoria - https://www.diabetesvic.org.au/ATSI-resources Diabetes Queensland - https://www.diabetesqld.org.au/managing-diabetes/aboriginal-and-torres-strait-islander.aspx https://www.diabetesqld.org.au/managing-diabetes/aboriginal-and-torres-strait-islander/diabetes-and-me.aspx Diabetes Western Australia - https://diabeteswa.com.au/manage-your-diabetes/resources/aboriginal-health-resources/ Diabetes Tasmania - https://www.diabetestas.org.au/News-and-Resources/Resources/Aboriginal-and-Torres-Strait-Islander-NDSS-Resources Diabetes NSW and ACT - https://diabetesnsw.com.au/useful-tools/information-sheets/indigenous-information-sheets/ Feltman Training - http://www.aboriginalhealthdiabeteswa.com.au/health-professionals/feltman-training/ http://www.diabetessa.com.au/resources/feltman-diabetes-education-resource.html

Online Diabetes Education Training Manual for Aboriginal Health Workers

An online training manual has been developed to increase diabetes knowledge among Aboriginal Health Workers to better support Aboriginal and Torres Strait Islander peoples with diabetes and assist them in self-managing their diabetes.

This training is targeted to Aboriginal and Torres Strait Islander Health Practitioners and Aboriginal and Torres Strait Islander Health Workers who have completed a minimum of Certificate IV in Aboriginal and/or Torres Strait Islander Primary Health Care (Community Care) or (Practice).

This course is available through the ADEA Learning Management System at: learning.adea.com.au

Your guide to Medicare for Indigenous health services

The department of Human Services have updated the newly launched education resource, “Your guide to Medicare for Indigenous health services” to incorporate the important 1 July 2018 Medicare changes. To access the guide please click HERE. To find more Indigenous health education resources please visit Human Services.

Eye care for diabetes: An Indigenous Perspective ASM 2014 Presentation by Hugh Taylor can be viewed at nadc.net.au/video/2/

CALD / Multilingual • NDSS translated resources

• Health Translations by the Victorian Government includes translated health information

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• Multicultural Health by the Queensland Government

• Multicultural Health Communication by NSW Health

Translated resources for CALD groups All of the NDSS's translated resources are now also available on our Multicultural Diabetes Portal. The portal provides access to a broad range of diabetes resources for people from culturally and linguistically diverse (CALD) backgrounds.

Resources contained on the site have been sourced from Diabetes Australia and its agents and from other reputable sources. All content has undergone a quality assessment process and guidelines are in place to ensure periodic review. To view or download this content, please click here

Web portal for information about diabetes for people from culturally and linguistically diverse backgrounds

To view or download your copy, please click here

Diabetes and Ramadan To assist health professionals, religious leaders and people with diabetes who fast during Ramadan, the Australian Diabetes Society, in conjunction with the International Diabetes Federation and Diabetes and Ramadan International Alliance, has endorsed the following brochures:

• Diabetes during Ramadan: Patient Guide • Ramadan and Diabetes: Guidance Sheet for Imam • Management of Diabetes During Ramadan: Quick Reference

Guide for Health Professionals

In February 2017 the NADC joined representatives from the ADS and the Diabetes and Ramadan (DaR) International Alliance at the first-ever Diabetes and Ramadan Symposium at Concord Repatriation General Hospital. The event promoted the new IDF-DaR Diabetes and Ramadan Practical Guidelines, which aim to support healthcare professionals to better support patients during this important religious period.

A copy of the guidelines can be downloaded from the IDF website at http://www.idf.org/guidelines/diabetes-in-ramadan and presentations from the event can be viewed here: http://nadc.net.au/video/

or via the NADC YouTube channel - NADC Australia.

Diabetes and Ramadan Overview

Diabetes and Ramadan Symposium Introduction - Dr Sof Andrikopoulos

Diabetes and Ramadan Dr Marwan Obaid

Diabetes and Ramadan 2 Case Studies Dr Elif Ekinci

Ramadan, Diabetes and Pregnancy Dr Sarah Abdo

IDF DAR Practical Guidelines Dr Mohamed Hassanein

Data / Research / Quality Improvement

• Diabetes Australia Research Program

• Juvenile Diabetes Research Foundation (JDRF)

• The Australian Centre for Behavioural Research in Diabetes

• The Diabetes Research Centre

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• The Diabetes Research Foundation Western Australia

• The John Curtin School of Medical Research

• The NHMRC Centre of Clinical Research Excellence on Clinical Science in Diabetes (Diabetes CCRE)

• Baker IDI

• The Walter and Eliza Hall Institute of Medical Research

Australian National Diabetes Audit (ANDA) reports The primary aim of ANDA is to:

·conduct a survey that will assess a standardised set of predefinedclinical (AQCA) and self-management diabetes (AQSMA) indicatorsincluding demographic and biological variables, and clinical outcomes;

·enable diabetes services to benchmark their practice processes andclinical outcome data against that of other centres;

·enable diabetes services to compare their practice processes andclinical outcome data over time (where participation in previouscollections has occurred); and

·provide pooled national data and data grouped by state andmetropolitan/regional/remote location on the clinical status of peoplewith diabetes attending diabetes services.

This important quality assurance activity promotes continuous improvement in the standard of service provided by diabetes centres and is the primary quality assurance activity of the NADC. To view this data please click here

ANDA: Lessons from the 2016 Quality Self-Management Audit

ASM 2017 Presentation Slides by Anthony Pease can be accessed here

Data Snapshots NDSS national diabetes data snapshots are updated every three months, and provide key statistics for all types of diabetes, type 1 diabetes, type 2 diabetes, gestational diabetes, and insulin therapy. To view or download these snapshots, please click here

Diabetes Map Australia The Australian Diabetes Map is the only national map monitoring the prevalence of diabetes in Australia.

The data contained in the Australian Diabetes Map is derived from the National Diabetes Services Scheme (NDSS) Registrant database* and the Australian Bureau of Statistics (ABS) and shows people diagnosed with diabetes that are registered on the Scheme.

It shows the numbers of people diagnosed with diabetes in all parts of Australia with information on age, gender, type of diabetes, ATSI status and socio-economic disadvantage. To view the Australian Diabetes Map, please click here

2015 Miles Youth Report To view or download your copy, please click here

National Association of Diabetes Centres Accreditation

ASM 2014 Presentation by Elaine Pretorious can be viewed at nadc.net.au/video/2/

Implementing and utilising the Biogrid database in Diabetes Centres

ASM 2014 Presentation by Peter Coleman can be viewed at nadc.net.au/video/2/

HbA1c

ADEA Position Statement on HbA1c Reporting The ADEA supports the change in routine laboratory HbA1c reporting from the NGSP % units to International Federation of Clinical Chemists (IFCC) units (mmol/mol). To view ADEA’s position statement,

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please click here

Individualisation of HbA1c targets for Adults with Diabetes Mellitus.

To view or download the full version of this guideline, please click here

To view or download the short version, please click here

Subcutaneous Devices / Techniques ADEA Clinical Guiding Principles for Subcutaneous Injection Technique

The ADEA Clinical Guiding Principles for Subcutaneous Injection Technique identifies a number of broad clinical issues including optimal needle length and angle of needle insertion for children/adolescents and adults of varying anatomical size. These clinical recommendations reinforce the importance of documenting the process of teaching and reviewing injection technique. To view or download your copy, please click here

Use of subcutaneous insulin delivery devices This position statement outlines ADEA recommendations for use of subcutaneous insulin delivery devices. To view or download your copy, please click here

Australian New Zealand (ANZ) Forum for Injection Technique & Therapy Expert Recommendations (FITTER)

ANZ FITTER Speaker Presentation Slides: Introduction to FITTER Presentation – Prof Glen Maberly

IT in Adults & AU ITQ Findings – Michelle Robins

IT In Children – Prof Paul Hofman

NZ Perspective & IT Trends – Dr Helen Snell & Dr Brandon Orr-Walker

The Role of General Prac in IT Education for Patients – Dr Kean-Seng Lim…

The Role of Pharmacy in IT Education for Patients – Teresa Di Franco

Driving ADEA Fitness to Drive

The goal of the roll out of the Support for Health Professionals in the assessment of a person with diabetes and their fitness to drive program is to ensure a large percentage of health professionals are exposed to the online program and are aware of their obligations under AustRoad’s Assessing Fitness to Drive for commercial and private drivers; Medical Standards for Licensing and Clinical Management Guidelines.

Templates have been developed to assist general practice in implementing discussions around diabetes and driving during consultations:

Rich text format template GPMP721_Diabetes_MD3

Rich text format template GPMP721_Diabetes_BP Annual Cycle of Care

Assessing Fitness to Drive The National Transport Commission and Austroads have released Assessing Fitness to Drive 2016, a new edition of national medical standards for driver licensing. To view or download a copy, please click here

Driving and Diabetes in Australia Booklet To view or download a copy please click here

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Driving and Recent Severe Hypoglycaemia Flyer To view or download a copy, please click here

ADS Position Statement on Insulin-requiring diabetes and recreation diving

To view or download your copy, please click here

Workplace

An Employee’s Guide to Diabetes in the Workplace This booklet was developed in response to questions, concerns and suggestions Diabetes Australia received from members of the diabetes community about diabetes in the workplace. To view or download your copy, please click here

Diabetes Victoria Diabetes in the Workplace Diabetes Victoria have developed booklets about diabetes in the workplace for people with diabetes, their employees and co-workers.

To access these booklets and additional information from Diabetes Victoria click here or click below to view or download your PDF copy of a specific booklet.

• An employer's guide to diabetes in the workplace (PDF) • An employee's guide to diabetes in the workplace (PDF) • Diabetes in the workplace: explanatory notes for health

professionals (PDF) • Diabetes in the workplace checklist (PDF)

NDSS Blood Glucose Test Strip Six Month Approval – NDSS

To download your copy, please click here

Medication Change Form – NDSS

To download your copy, please click here

Registration Form - NDSS To download your copy, please click here

Personal Details Update Form - NDSS

To download your copy, please click here

Insulin Pump Consumables Assessment Form - NDSS To download your copy, please click here

Continuous Glucose Monitoring Eligibility Assessment Form – NDSS

To download your copy, please click here

Continuous Glucose Monitoring Update or Termination Form – NDSS

To download your copy, please click here

Diabetes Related Organisations In Australia

• Australian Diabetes Society

• Australian Diabetes Educators Association

• Diabetes Australia

• National Diabetes Services Scheme

• National Association of Diabetes Centres

Diabetes Australia Position Statements To view or download all current Diabetes Australia position statements, please click here

Australian Government Departments

• Australian Department of Health

• BPDC 2016 Minister for Health Presentation – Priorities for the Government in Health can be viewed at

https://www.youtube.com/watch?v=w-0QRgDlSS8

• Australian Institute of Health and Welfare

• Federation of Ethnic Communities Council Australia

• Healthdirect Australia

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• Food Standards Australia and New Zealand

• Medicare Australia

• National Health and Medical Research Council (NH&MRC)

• Pharmaceutical Benefits Scheme

• Therapeutic Goods Administration

Professional Associations & Organisations

• Australian Diabetes Society (ADS)

• Australian Diabetes Educators Association (ADEA)

• Australian Medicare Local Alliance (AMLA) - formerly AGPN

• Australian Practice Nurses Association (APNA)

• Australasian Diabetes In Pregnancy Society (ADIPS)

• Australasian Paediatric Endocrine Group (APEG)

• Australasian Podiatry Council

• Cancer Council Australia

• Dietitians Association of Australia

• National Heart Foundation

• Kidney Health Australia

• National Aboriginal Community Controlled Health Organisation

• National Stroke Foundation

• Optometrists Association of Australia

• Palliative Care Australia

• Pharmaceutical Society of Australia

• The Royal Australian College of General Practitioners

• Pharmacy Guild of Australia

International Diabetes Associations

• International Diabetes Federation

• American Diabetes Association

• Canadian Diabetes Association

• Diabetes New Zealand

• Diabetes United Kingdom

• Glycosmedia

Support

• Children with Diabetes (part of the Johnson & Johnson Diabetes Franchise)

• Diabetes Counselling Online

• Munted Pancreas

• Reality Check Inc.

• Diabetes and Emotional Health Handbook and Toolkitupdated 30.08.2018

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