IN THIS ISSUE: 1. Editorial 2. ASM speaker profiles—Drs Adler and Smart 3. Dr Lucy M Hinder 4. ACDN Accreditaon Programme 5. Diabetes in Young People SIG 6. Dr H Lunt arcle: Use of new blood collecon tubes for the measurement of plasma glucose From the Editor…….. Welcome to the 2017 autumn edion of NewSweet. In the Manawatu this year, summer almost passed us by, and throughout the country we have all experienced wild weather including power cuts, road closures and fires. As labile as some of our paents’ blood glucose readings I’m sure! Tradionally, Newsweet has featured in line with the NZ seasons; September (Spring), Summer (December), Au- tumn (March) and Winter (June). Therefore, arcles for the upcoming edion need to be sent to me by the last week of the previous month prior to publishing date. To keep NewSweet relevant, we need to feature items of interest from all speciality groups within NZSSD please. Many of you will be looking forward to aending the annual scienfic meeng in Dunedin in May. This edi- on includes profiles of the invited speakers; further in- formaon also appears on the NZSSD website. In the June edion of Newsweet we will feature informaon gleaned at conference, to share with colleagues who were unable to aend. Please take notes to form the basis for your arcles for Newsweet; I will look forward to receiving them! Alison.fellerhoff@midcentraldhb.govt.nz Recently, Dr Lucy Hinder, a recipient of the JDRF Ange- lika Bierhaus Post-Doctoral Fellowship in Diabec Com- plicaons (2013 – 2016) spoke to the Palmerston North Hospital Post Graduate Medical Society, and a summary of her informave talk is included in this edion for your interest. Alison Fellerhoff RN, MN This year's Annual Scientific Meeting will be held in Dun- edin 2-5 May 2017 Early bird registrations close: 17 March 2017 Final date for registrations: 14 April 2017 Speakers include: Dr Amanda Adler, Dr Carmel Smart, Dr Roger Chen, Prof . Fergus Cameron, Dr Bryan Betty, Dr Helen Paterson and Dr Brandon Orr-Walker.
Transcript
IN THIS ISSUE:
1. Editorial
2. ASM speaker profiles—Drs Adler and Smart
3. Dr Lucy M Hinder
4. ACDN Accreditation Programme
5. Diabetes in Young People SIG
6. Dr H Lunt article:
Use of new blood collection tubes for
the measurement of plasma glucose
From the Editor……..
Welcome to the 2017 autumn edition of NewSweet. In
the Manawatu this year, summer almost passed us by,
and throughout the country we have all experienced
wild weather including power cuts, road closures and
fires. As labile as some of our patients’ blood glucose
readings I’m sure!
Traditionally, Newsweet has featured in line with the NZ
seasons; September (Spring), Summer (December), Au-
tumn (March) and Winter (June). Therefore, articles for
the upcoming edition need to be sent to me by the last
week of the previous month prior to publishing date. To
keep NewSweet relevant, we need to feature items of
interest from all speciality groups within NZSSD please.
Many of you will be looking forward to attending the
annual scientific meeting in Dunedin in May. This edi-
tion includes profiles of the invited speakers; further in-
formation also appears on the NZSSD website. In the
June edition of Newsweet we will feature information
gleaned at conference, to share with colleagues who
were unable to attend. Please take notes to form the
basis for your articles for Newsweet; I will look forward
Annual Scientific Meeting: Drs Adler and Smart Page 2
Dr Amanda Adler - Dr Adler, who trained in economics, medi-cine and pharmacoepidemiology, is a Consultant Physician in the National Health Service (NHS) at Addenbrooke's Hospital, Cambridge, and Chair of Technology Appraisal Committee B at the National Institute for Health and Care Excellence (NICE).
Also with NICE, she chaired the Clinical Guidelines for Newer Agents for Type 2 Diabetes and the Quality Standard for Dia-betes. With NICE International, she participated in projects setting priorities under universal health coverage.
Dr Adler’s clinical work includes outpatient diabetes clinics (including cystic fibrosis related diabetes), in-patient general medicine, and clinics with GPs in the community.
Dr Adler previously worked on diabetes projects with native communities in Alaska. She was the Clinical Epidemiologist for the UK Prospective Diabetes Study (UKPDS) for the Diabetes Trials Unit in Oxford. Dr. Adler chaired the Expert Group on the Safety of Insulin for Britain’s Medicines and Health prod-ucts Regulatory Agency.
She serves on the UK Commission on Human Medicines Expert Advisory Group on Cardiovascular, Diabetes, Renal, Respirato-ry and Allergy.
Dr Carmel Smart—Carmel Smart, RD, PhD has worked as a Specialist Endocrinology Dietician at the John Hunter Chil-dren’s Hospital for over 20 years. In addition, Dr Smart is a Conjoint Senior Lecturer with the University of Newcas-tle. She completed her PhD in 2012. Her research focuses on the effect of macronutrients on glycaemia. She is recognised as a world expert on diet and Type 1 Diabetes and has been invited as lead author on national and international clinical practice guidelines in dietary management. Most recently, she was invited as a lead author on the American Diabetes Association Clinical Nutrition Guidelines and as a co-author on the International Society of Pediatric and Adolescent Dia-betes (ISPAD) Preschool Guidelines. Her research has trans-lated into changes and improvements in clinical care at a global level.
She has won several awards including APEG Young Investiga-tor (the first time this has been awarded to a non-medical graduate), Dietitians Association of Australia Contribution to Diabetes award and the HCRF Research Excellence award. Dr Smart was invited convenor of the ISPAD Health Professional Science School and the non-medical representative on the ISPAD advisory committee. In 2015, she was invited as a member of the JDRF International Expert Advisory Group for exercise management in Type 1 diabetes.
Page 3 Lucy M. Hinder, Ph.D.
Lucy M. Hinder, Ph.D. http://www.pnrdfeldman.org/
Dr. Hinder received her Ph.D. from the University of Aberdeen, Scotland in 2007. Her graduate research evaluated the efficacy of antioxidant, vasodi-lator and growth factor therapeutic strategies on functional and quantita-tive indices of diabetic neuropathy. She joined Dr. Eva Feldman’s laborato-ry, the Program for Neurology Research and Discovery, at The University of Michigan to pursue postdoctoral work on the contribution of obesity and dyslipidemia to the development of peripheral neuropathy. Dr. Hinder was the recipient of the JDRF Angelika Bierhaus Postdoctoral Fellowship in Dia-betic Complications (2013-2016), and the Wolfe Neuropathy Research Prize from the American Neurological Association (2015). On February 7th Dr. Hinder spoke to Palmerston North Postgraduate Med-ical Society at Palmerston North Hospital on The Neurological Complica-tions of Obesity: A Modern Epidemic. The following is a summary of the talk. Obesity definition: Obesity is the excessive accumulation and storage of body fat, associated with increased disease risk. Globally 670 million adults are obese, with a projected 1 billion by 2025. Body Mass Index (BMI)
(weight (kg) divided by height squared (m2)) is routinely used in the clinic and large population studies to define obesity. Although it is inexpensive and easy to perform, BMI does not factor in where the excess fat is stored. This is important because when excess fat is stored in the gluteal or femoral adipose depots, an individual can be obese, but still be metabolically healthy. In contrast, an individual who stores their excess body fat in the central, visceral area is more likely to be metabolically unhealthy and at higher disease risk, even before frank obesity. In simple terms, a pear-shape body (fat stored below the waist) confers lower disease risk, while an apple-shape body (fat stored above the waist) confers greater disease risk. When we think of it in these terms, Waist-Hip Ratio (WHR) may be the better predictor of disease risk than BMI. As fat distribution varies depending on age, sex, and ethnicity, there are different BMI and WHR criteria for children, women and ethnic groups.
Prevalence: According to the 2015-2016 New Zealand Health Survey, obesity in New Zealand is on par with the USA with almost 1 in 3 adults obese (1.18 million) and a further 35% (1.32 million) overweight but not obese. Stratified by ethnicity, 47% of Māori adults are obese, and 67% of Pacific adults are obese. These patterns hold for children aged 2-14 years, with 85,000 children currently obese in New Zealand.
Drivers of obesity: The increasingly obesogenic environment is largely considered the driving force behind the obe-sity epidemic. Processed, affordable, highly palatable energy-dense foods are heavily marketed and over-consumed. Combined with increased sedentary lifestyles this has been a recipe for disaster. Obesity has the obvi-ous direct costs in terms of healthcare, but also wider indirect economic costs resulting from reduced productivity, and increased time off work.
Mouse models to understand neurological consequences of obesity: Central Nervous System: Because of its role in monitoring the nutritional status of the blood, the hypothalamus is one of the first areas affected by chronic over-consumption. Chronic elevations in diet-derived saturated long-chain fatty acids directly cause hypothalamic in-flammation. This results in altered leptin signaling, impaired satiety control, and increases the risk of obesity. De-spite clear clinical associations between obesity and cognitive impairment, direct causality is difficult to establish in humans. Mouse models can bridge this gap. Mouse models in which leptin signaling is genetically removed model type 2 diabetes, while feeding mice a high fat diet models obesity, metabolic syndrome, and prediabetes. These mice develop cognitive impairment, determined by behavioral assessment of working memory and spatial learn-ing. Using hippocampal tissue from these mice and in vitro cultured neurons we now know that these functional impairments are related to structural changes including the development of neurofibrillary tangles. Importantly, some of these changes are reversed with diet, exercise and weight loss. Peripheral Nervous System: Neuropathy is the distal to proximal loss of sensory, unmyelinated C-fibers with pain and eventual loss of sensation in the fingers and toes. The sensory neurons of C-fibers, dorsal root ganglion neu-rons, lie outside the blood-nerve barrier, and are therefore exposed to systemic metabolic stressors, and more vulnerable to injury. (Continued over…)
Page 5
ACDN Accreditation Programme Page 4
Why accreditation?
The May round for accreditation applications closed on 9 February and assessment of the portfolios will be under way. By why would you want to submit an accreditation application?
The Aotearoa College of Diabetes Nurses (ACDN) (NZNO) fosters professional accountability for nurses working in the specialty of diabetes. An important component of accountability is the ongoing mainte-nance and development of professional knowledge and skills within the focus of practice. Nurses in New Zealand work in a multitude of practise settings across the health continuum and within a uniquely New Zealand context. We are required to demonstrate our competence to practice. Knowledge and skills in-form competence and there are a number of frameworks that exist by which competence can be evi-denced, such as PDRP, performance review and/or accreditation or credentialing. Accreditation is one way by which registered nurses may receive professional recognition of their advancing knowledge and skills within this specialty area of nursing practice.
So, what are we doing to try and make accreditation more accessible?
ACDN is unique in that it is the only College with an accreditation process for its members.
As the current coordinator for the accreditation programme, and having been involved with the process for the last 5 years, I am working towards making accreditation a more straight forward process. The docu-mentation required for accreditation is to be reviewed and will seek to align more strongly with the Nation-al Diabetes Nurses Knowledge and Skills Framework, which is also currently being reviewed. My aim would be to simply things and enable applicants to utilise evidence from PDRP in an accreditation appli-cation, and that an accreditation portfolio could be used for PDRP. PDRP is about competence but knowledge and skills informs the competence at the relevant level, and so there needs to be greater cross-pollination between the two processes.
The Mentorship programme for those seeking initial accreditation at either Specialty (Level 3/Proficient) or Specialist (level 4/Senior Nurse/Expert) is strongly recommended. The feedback about the programme has been that the process is supportive, positive, and useful, for both the applicant and the mentor.
Feedback is sought from applicants at the end of each round. Recent comments about the process in-clude, “the accreditation package was found easily on the website”, and that it was “clear and helpful”. The information in the handbook was “clear and straightforward”, “a good guideline”, but “perhaps needs to emphasise the need for a case study to support evidence”. The feedback form the assessor was “generally helpful”, “positive and encouraging”, and “helped clarify areas for future development”.
I am aware though that with the move to a single assessor for each portfolio there is a need for con-sistent, quality feedback to the applicant, and the need to reduce duplication. The assessor team will be meeting in early March for a 1-day education and training day. We will, among other things, be looking at issues around feedback, workforce development and evidence requirements for Specialty and Specialist portfolios. This day has received a professional development funding grant from NZSSD to help cover the expenses and we are grateful to them for their support. A report from this day will be published in a future edition of On-Target.
(Cont. from previous page) Indeed, obesity and metabolic syndrome significantly increase the risk of neuropathy, and progression to neuropathy over time. Importantly, diet and exercise can improve cutaneous innervation in obese, metabolic syndrome patients with neuropathy, and in our mouse models. Our mechanistic mouse work has revealed that the distinct systemic metabolic alterations occurring in obesity, metabolic syndrome, and type 2 dia-betes induce tissue-specific metabolic reprogramming within the peripheral nerve, altering fuel utilization and ulti-mately leading to tissue dysfunction. Concluding statement: As the obesity epidemic continues, the central goal of our work is to identify targeted treat-ment strategies that improve the neurological complications of obesity. However, as diet and exercise positively impact metabolic and neurologic phenotypes, perhaps education and prevention should be our collective goal. Dr Lucy M Hinder
Page 5 Diabetes in young people SIG
PROFESSIONAL DEVELOPMENT AWARDS: Next round of awards closes 1 May 2017
For further information please refer — www.nzssd.org.nz/awards.html or contact [email protected]
A Special Interest Group (SIG) was formed in 2016 for health professionals in New Zealand working with Youth and Young Adults with diabetes between 15 to 25 years of age. To date, the SIG has approxi-mately 50 members with representation from most regions of New Zealand, from both Primary and Secondary/Tertiary Care, and from a broad range of health disciplines.
Early last year, a survey of SIG members was conducted to determine the main barriers to effective management of diabetes in Youth and Young Adults in New Zealand. Drug and alcohol use, poor at-tendance at clinic appointments, the strive for independence, suboptimal transition from Paediatric to Adult Diabetes Services, parental conflict, mental health issues, and lack of time and resources for health professionals were the most common barriers identified. SIG members also reported that sharing resources and information to develop national consistency in the delivery of care was important in im-proving the management of Youth and Young Adults with diabetes. Consequently, a ‘Google Group’ was created to enable SIG members to network with each other. Using this forum, a ‘useful website/resources’ list has been created and projects advertised, which has allowed the sharing of resources and collaboration on research, respectively. This Google communication channel will be further developed this year to enable greater networking between SIG members.
To further our goals of increased networking and collaboration, we would like all interested health professionals who work with Youth and Young Adults with diabe-tes in New Zealand to join our SIG. If you would like to join our SIG or know of other health professionals who may want to join, then please email me at [email protected].
Vickie Corbett, Diabetes Nurse Practitioner and Co-ordinator of Diabetes in Young People Special In-terest Group
Diabetes in Young People Special Interest Group
national diabetes foot care audit report 2014-2016 England and
