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PROGRESS REPORT 2015 – 2017 Centre of Research Excellence: Type 1 Diabetes
PROGRESS REPORT 2015 – 2017
Centre of Research Excellence: Type 1 Diabetes
PROGRESS REPORT 2015 – 2017
Centre of Research Excellence: Type 1 Diabetes
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CONTENTS 3 ABOUT THE CENTRE
OUR PEOPLE
ABOUT OUR RESEARCH
HIGHLIGHTS — RESEARCH AND EVENTS
STUDENTS
CONSUMER AND COMMUNITY ENGAGEMENT
OUTPUTS
4
6
8
10
12
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ABOUT THE CENTRE
The Children’s Diabetes Centre was established in 2015 by a Centre for Research Excellence (CRE) grant from the Na�onal Health and Medical Research Council and Juvenile Diabetes Research Founda�on Australia. Direc�on of the Centre is led by Professor Timothy Jones and Professor Elizabeth Davis. The centre is a joint ini�a�ve between the Endocrinology and Diabetes Department at Princess Margaret Hospital, and the Telethon Kids Ins�tute. The Centre has an established interna�onal reputa�on as a leader in clinical diabetes research and a team that includes clinical fellows, post‐docs, research assistants, research nurses, die��ans, physiotherapist, program/project managers, clinical trial managers, sta�s�cian, students and administra�ve support, as well as numerous local, na�onal and interna�onal collaborators from leading research ins�tu�ons. The Children's Diabetes Centre's uniquely holis�c research program incorporates state‐of‐the‐art technologies, therapies and educa�on that are all aimed at improving the quality of life for young people with Type 1 Diabetes. The centre’s overarching objec�ve is to ensure that children diagnosed with Type 1 Diabetes (T1D) have the best evidence‐based care available and access to the latest therapies. This is achieved through research in the following areas: Reducing the glucose excursions related to exercise Reducing the glucose excursions related to diet New diabetes technologies Schools and the impact on educa�on Mental wellbeing Data sets and Epidemiology Clinical trials Our vision is to con�nue to generate important new knowledge, and inspire the next genera�on of Australia’s clinical researchers to generate ques�ons from their clinical experience, design studies to inves�gate these gaps in knowledge, and translate outcomes into be�er clinical prac�ce and long‐term outcomes for children and their families with Type 1 Diabetes.
Professor Tim Jones Professor Liz Davis
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OUR PEOPLE DIRECTORS
Professor Timothy Jones Professor Elizabeth Davis
Dr Charles Czank Nirubasini Paramalingam
MANAGEMENT
Heather Roby
RESEARCH FELLOWS / POST DOCTORATES
Dr Mar�n de Bock Dr Aveni Haynes Dr Vinutha She�y Dr Tarini Che�y
Dr Jacqueline Curran Dr Karen Rothacker Dr Kiranjit Joshi Dr Mary Abraham
Dr Marie‐Anne Burckhardt Dr Uma Gan� Dr Ashleigh Lin Dr Leanne Fried
Alison Roberts Julie Dart Ace Choo Alexandra Tully
Jennifer Nicholas Carol Cole Joanne O’Dea Sam Armstrong
Wayne Soon Barbara Kea�ng Natalie Cordon Rena Vithiatharan
RESEARCH NURSES, RESEARCH ASSISTANTS & DIETITIANS
COLLABORATING CENTRES
Yale University, USA Professor Margaret Grey Professor Bill Tamborlane Professor Stuart Weinzimer
Dr Carmel Smart Associate Professor Bruce King
Murdoch Children's Research Ins�tute; & The Royal Children's Hospital VIC Professor Fergus Cameron
The Children's Hospital & Westmead; and University of Sydney, NSW Professor Geoffrey Ambler
Sir Charles Gairdner Hospital, WA Dr Joey Kaye
Fiona Stanley Hospital; and University of Western Australia, WA Professor Bu Yeap
John Hunter Children's Hospital, NSW
University of Gothenburg, Sweden Peter Adolfsson
STUDENTS
Alison Roberts (MPh) Nirubasini Parmalingam (PhD) Dr Jacqueline Curran (PhD) Zac Leow (PhD) Mary Abraham (PhD
Dr Tarini Che�y (MD) Ma�hew Cooper (PhD) Dr Vinutha She�y (PhD) Wayne Soon (PhD) Jennifer Nicholas (PhD)
Tina Commisso Claire Willows
RESEARCH SUPPORT STAFF
Grant Smith Helen Clapin Jane Makin Leah Laurenson
DATA AND BIOSTATISTICS
Courtney Robertson (Med Student)
Jeremy Nixon (Med Student)
Dr Marie‐Anne Burckhardt (PhD)
Kinglsey Frearson (Med Student)
Beth Fisher (PhD) Melissa Simonds (Med Student)
ASSOCIATE INVESTIGATORS
Dr Carmel Smart Associate Professor Bruce King Professor Fergus Cameron Dr Jan Fairchild
Professor Bu Yeap Associate Professor Aris Siafarikas Professor Geoffrey Ambler Dr Joey Kaye
Dr Seng Khee Gan
Dr Gerry Fegan
CHIEF INVESTIGATORS
Professor Donna Cross Professor Paul Fournier Associate Professor Liz Geelhoed
Professor Margaret Grey Professor William Tamborlane Professor Stuart Weinzimer
Children’s Diabetes Centre Team
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ABOUT OUR RESEARCH
The Children’s Diabetes Centre Goals, Approaches and Outcomes
Most young people with Type 1 Diabetes (T1D) s�ll do not meet treatment targets. Hypoglycaemia remains common and the burden of care high. The Children’s Diabetes Centre addresses these challenges through a comprehensive approach that involves a broad range of exper�se, methodologies and collabora�ons. Our aim is to generate signicant new knowledge that will lead to an improvement in clinical care through the focused research and clinical transla�on in the following areas. Over the past 2 years we have made signicant progress. Diabetes Technology In recent years, technological approaches have offered the poten�al to improve diabetes outcomes. The last 2 years have seen the successful comple�on of the mul�centre RCT of the predic�ve suspend insulin pump. While this trial was ongoing, Centre inves�gators have tested the safety of the most recent closed loop algorithm in the at home se�ng, providing data that has facilitated the move to the use of a hybrid system in the community. The trial of con�nuous glucose monitoring in young children focusing on psychological measures will be completed in 2017. A cri�cally important 6 month RCT of a hybrid closed loop system kicks off in May 2017. This is the rst trial to compare the new systems with standard therapy and has mul�ple outcomes including glycaemic, behavioural and economic endpoints. Con�nued research is needed to rene engineering hardware and so�ware algorithms and investment in well‐designed clinical trials is cri�cal. Furthermore, before these systems can be translated into rou�ne care, informa�on is needed about the real impact of the use of these technologies on the lives of pa�ents with diabetes and the human factors involved when the systems are used in daily life. The inves�ga�ons to date have all contributed to this goal.
Reducing Glycaemic Excursions Associated With Exercise and Diet The ul�mate goal of this research is to provide data to inform guidelines for managing food and exercise as well as to inform closed loop development. Since con�nuous glucose monitoring is a cri�cal component of closed loop systems, strategies for minimising glycaemic excursions and rate of change in blood glucose levels are likely to enhance successful long‐term adop�on of these systems. To address these issues, our research plan involves ini�al in‐clinic studies that will provide data to inform guideline development. Transla�on of research studies into accessible guidelines for pa�ents and health care professionals will be a staged approach, engaging all stakeholders, and will include a clinical trial of the end‐products. Exercise Over the last 2 years a number of in‐clinic studies have been conducted. These have detailed the glucose requirements for different exercise intensi�es and different insulin levels, the impact of oral glucose and sprints on glucose requirements with exercise, and the impact of hyperglycaemia on performance. Focus groups with young people have been completed inves�ga�ng the challenges of exercise and T1D from a consumer perspec�ve. A 6 week clinical trial to evaluate the efficacy and safety of sprin�ng to prevent hypoglycaemia will be completed in 2017. Diet The glycaemic impact of dietary fat and protein has been underes�mated in the past. Our studies have been detailing precisely how much insulin is required for addi�onal fat and protein in a meal using a novel insulin clamp technique. The rela�onship between the amount of carbohydrate and insulin required is undened and current studies are inves�ga�ng whether or not this rela�onship is linear. Mental Wellbeing in Pa�ents with Type 1 Diabetes Stress and anxiety are signicant problems in children and adolescents with T1D because they impact quality of life, wellbeing and glycaemic control. We have recently completed research which shows that children diagnosed with T1D are twice as likely to develop mental health condi�ons during early adulthood as their non‐diabe�c peers. Iden�fying risk for anxiety and intervening early is essen�al, but our understanding of the link between stress, anxiety and blood glucose levels in youth with T1D is limited. Our research aims to signicantly improve mental health and wellbeing of people with T1D, ease overburdened mental health services, and translate into reduced economic costs of health care and lost produc�vity. Improving the School Experience for Pa�ents with Type 1 Diabetes The school environment can have a signicant impact on the psychosocial development of young people. Besides challenges associated with the teenage years, adolescents with T1D encounter addi�onal burden of living with a chronic condi�on. Research shows that young people with T1D are at higher risk for mental health problems than their healthy peers. Posi�ve school experiences that promote psychosocial wellbeing are therefore vital for adolescents with T1D. This research focuses on developing a deeper understanding of school experiences of adolescents with T1D and how these help or hinder their psychosocial wellbeing. Development of Capacity for Long Term Evalua�on of New Therapies in a Popula�on‐Based Sample in the Real Clinic Environment The objec�ve of this research program is to extend our current clinical data management system beyond the paediatric age group to allow con�nued monitoring throughout adulthood. Although randomised clinical trials may not reect real life use in non‐trial pa�ents, the poten�al to develop the capacity to complement trial outcomes with representa�ve real world data adds a powerful assessment tool to understand the effec�veness of new therapies. This will in turn aid the introduc�on of poten�ally benecial therapies, inform reimbursement decisions and also promote pa�ent and clinician uptake.
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STUDENTS
Alison Roberts – MPh Alison started a Masters of Philosophy in 2015 as a part �me student to explore parents’ perspec�ve of their experiences when their child is diagnosed with T1D, and to determine if a diagnosis of T1D in a parent has any inuence on their coping, adap�on, and management of their own child, when newly diagnosed with T1D . Beth Fisher – PhD Beth commenced her PhD in 2016 a�er comple�ng her Honours with the team, to explore the rela�onship between insulin and the produc�on of reac�ve oxygen species believed to be involved in the development of diabetes complica�ons. Courtney Robertson — Medical Student Notre Dame Courtney is working under the supervision of Dr Mar�n de Bock on the aspects of T1D technology that impact on in�macy, including a broader look at sexual health among pa�ents with type 1 diabetes. Her preliminary results have been accepted for a poster presenta�on at the American Diabetes Associa�on annual scien�c conference in San Diego 2017. Dr Jacqueline Curran – PhD Dr Curran is a Paediatric Endocrinologist and research fellow at Princess Margaret Hospital and a Senior lecturer in Paediatrics, Notre Dame University. Dr Curran is studying the effect of a novel treatment for weight loss in obese adolescents for her PhD. Jeremy Nixon — Medical Student UWA Jeremy is a Medical Student from the University of Western Australia. Jeremy’s project aims to assess pa�ent knowledge of and adherence to T1D exercise management guidelines in order to determine the facilitators and barriers of adherence with guidelines. Results from this study will help to inform how exercise guidelines will be provided to the community. Jennifer Nicholas — PhD Jennifer has worked with the team as a clinical research nurse since 2010. A�er comple�ng a Master of Science (Nursing) followed by a Master of Nursing (Nurse Prac��oner), Jennifer has decided to complete her PhD. Jennifer’s project will examine health literacy, in conjunc�on with measures of psychosocial risk and wellbeing and diabetes health outcomes, in a Western Australian popula�on of adolescents and young adults with type 1 diabetes. Where emerging trends are iden�ed, this will inform a process of iden�ca�on, monitoring and targeted healthcare plan‐ning. Dr Marie‐Anne Burckhardt — PhD Dr Burckhardt is a Swiss Board qualied paediatric endocrinologist and began her fellowship with the centre in October 2015. She enrolled in a PhD in 2016 with the aim to improve pa�ent care in young people with T1D using advances in technology to reduce morbidity around hypoglycaemia. Dr Burckhardt has been inves�ga�ng the impact of real �me con�nuous glucose monitoring on psychosocial factors such as fear of hypoglycaemia and quality of life in young children with T1D and their parents and will soon commence a study looking at the use of a hybrid closed loop system in pa�ents with impaired hypoglycaemia awareness. Dr Mary Abraham – PhD Dr Abraham is a clinician with strong research interest in the eld of hypoglycaemia and T1D. She has been involved with technology trials in Type 1 Diabetes and conducted the in‐clinic and home studies tes�ng the efficacy of the Predic�ve Low Glucose Management System in the preven�on of hypoglycaemia.
Kingsley Frearson — Medical Student UWA Kingsley joined the diabetes research team as part of his medical training programme. He is currently involved in a project which endeavours to iden�fy barriers to diabetes management in non‐caucasian families. The project was awarded the CRE seeding grant and has received ethics approval. The project will aim to improve the resources made available to families from minority communi�es. Ma�hew Cooper – PhD Ma�hew began his PhD in 2012. His studies focus on the contemporary epidemiology of the complica�ons of T1D. Using data linkage and the unique data registries available in Western Australia, he has sourced an enriched dataset to examine the incidence of and risk factors for severe hypoglycaemia, schooling outcomes, vascular complica�ons, psychiatric disorders and mortality. Ma�hew’s thesis will be submi�ed during 2017; his thesis includes ve manuscripts which have been peer reviewed and published during his candidature. Melissa Simonds – Medical Student UWAMelissa is a medical student from UWA doing an MD project inves�ga�ng BMI trajectories in children and adolescents diagnosed with T1D. Melissa will be u�lising the unique database available in Western Australia to look at BMI at diagnosis and in the year following diagnosis. Nirubasini Paramalingam — PhD Niru’s PhD is on standardising the euglycaemic clamp protocols for maintaining euglycaemia in the face of glycaemic modula�on. The focus is the insulin‐only clamp protocol and an adapta�on of the hyperinsulinaemic‐euglycaemic clamp protocol for exercise. The aim is to facilitate reproducibility in terms of glycaemic variability during clamp studies run by different researchers or for paired studies, irrespec�ve of experience in implemen�ng clamp protocols. Dr Tarini Che�y – MD Dr Che�y began her Medical Doctorate in 2015 with the aim to reduce the risk of low blood glucose levels during exercise for young people with Type 1 diabetes. She has just completed a study inves�ga�ng the use of short sprints during exercise to prevent hypoglycaemia. Her future studies include looking at how con�nuous glucose monitoring can be used during exercise to guide carbohydrate intake, and trying to nd out if protein a�er exercise can help prevent low blood glucose levels on nights a�er exercise. Dr Vinutha She�y – PhD Dr She�y is a Paediatric endocrinologist at Princess Margaret Hospital and commenced her PhD in 2011, with her research focus on exercise in Type 1 Diabetes. Her research project comprises of studies exploring the different factors that affect glucose response to exercise such as exercise intensity and insulin levels and in turn to es�mate glucose requirement to maintain stable blood glucose levels during exercise. Results of these studies will be compiled to help rene the current exercise guidelines. Wayne Soon – PhD Wayne began his PhD in 2015, with the aim to improve our knowledge on managing blood glucose levels during exercise. He has just completed his rst study inves�ga�ng the changes in blood glucose levels during and a�er con�nuous moderate intensity exercise, compared to interval exercise, and how this affects the amount of carbohydrates that should be consumed to prevent hypoglycaemia. His next study will be looking at the reproducibility of responses to exercise. Zac Leow — PhD Zac commenced his PhD at the University of Western Australia in 2016, and is exploring the benets and risks of managing blood glucose levels with ketogenic low carbohydrate diets in adults with Type 1 Diabetes.
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HIGHLIGHTS — RESEARCH AND EVENTS
PREDICTIVE LOW GLUCOSE MANAGEMENT TRIAL
The trial commenced in August 2014, and the last visit was in October 2016. It is the largest mul�center study of the Medtronic 640G Insulin delivery system which aims to predict and prevent hypoglycaemia. We recruited 154 par�cipants aged 8 to 20 years with Type 1 Diabetes across ve paediatric hospitals in Australia.
SPRINT TRIAL
This study is the rst of its kind tes�ng the use of sprints to prevent hypos during exercise in the real world. The last par�cipant was enrolled in March 2017, and the last study visit will happen this month (May).
HYBRID CLOSED LOOP SYSTEMS
Recruited the rst paediatric pa�ent in Australia to the Hybrid Closed Loop study.
EXERCISE FOCUS GROUPS
In 2016 we ran our rst ever focus groups to ask young people with T1DM, and their families about the challenges of exercising with Type 1 Diabetes.
MENTAL WELLBEING
We compared the health records of the 1300 West Australian children diagnosed with diabetes over the past 20 years with the records of 6000, non‐diabe�cs of the same age and gender. Mental health disorders oc‐curred at a higher rate among pa�ents with poorer glycaemic control.
JDRF Exercise Day July 2016
Our exercise team visited the Telethon Family centre to update families on our exercise research.
ENDIA
The Perth ENDIA team recruited its 100th par�cipant to the study in
March 2017.
AdDIT
870 AdDIT visits were completed for the WA AdDIT par�cipants.
Gavin Griffiths founder of DiAthlete
In March 2017, Mr Gavin Griffiths founder of DiAthlete, an organisa�on set up to educate, encourage and empower young people with T1DM visited Perth and held sports clinics developed to provide a fun learning environment for young people with diabetes. Gavin was also invited to speak about his experiences as an athlete with T1DM at the Diabetes WA family informa�on evening.
Parent Informa�on Evening March 2016
An Adolescent and Parent Informa�on evening was held in March 2016. Presenters from PMH and our collaborators from Newcastle updated families on ndings from our food research and latest clinical prac�ces.
Exercise Research Workshop, Darlington Estate, Perth, 21st of November 2016
Special guest Professor Peter Adolfsson of the University of Gothenburg, Sweden a�ended a workshop with our research team to review and develop our exercise studies.
JDRF Laboratory Tour of Research Facili�es, 19th October 2016
Staff from JDRF Australia and local donors visited the Telethon Kids In‐s�tute and Princess Margaret Hos‐pital to see our research in ac�on.
Food Research Workshop, Ro�nest Lodge, Ro�nest Island, Wednesday 23 March 2016
Our collaborators from John Hunter Children’s Hospital in Newcastle, a�ended a workshop with our re‐search team to design and develop our food studies.
ADA VIDEO, JUNE 2016
Our team were invited to create a video featuring both our clinical and research work presented at the American Diabetes Associa�on conference. This video presenta�on is now available on the CRE website.
JDRF One Walk
Did you see the Children’s Diabetes Centre booth at the
JDRF one walk in 2016?
Workshop, University Club ‐ University of Western Australia,
14th October 2015
Workshop with interna�onal and na�onal guests to design and develop the closed loop trial and exercise guidelines and discuss how to measure health economics and quality of life in trials.
CHILDREN’S DIABETES CENTRE WEBSITE
Have you seen our new look website? www.childrensdiabetescentre.org.au
Launch of the Children’s Diabetes Centre, 12th November 2015
The Centre was launched by Hon. Judi Moylan with more than $7million of funding over ve years from the Na�onal Health and Medical Research Council, Juvenile Diabetes Research Founda�on (JDRF) Australia, Australian Research Council and UWA.
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CONSUMER AND COMMUNITY ENGAGEMENT
Clinical excellence in diabetes care
In November 2016, our Centre's co‐Director Liz Davis, a�ended the Na�onal Associa�on of Diabetes Centre's (NADC) Symposium in Sydney.
The event brought together diabetes specialists from a number of research and clinical facili�es across Australia, who were all acknowledged for their 'best prac�ce' in diabetes care. The Hon. Sussan Ley MP also a�ended and shared insights into the Australian Na�onal Diabetes Strategy. As the only paediatric centre accredited as a centre of clinical excellence in Australia, we were honoured to be invited to present recent ini�a�ves in the PMH diabetes clinic. This recogni�on as a clinical centre of excellence would not have been possible without our team's hard work and dedica�on in working towards improving the lives of children living with type 1 diabetes, and the valuable feedback and input from the families in our service.
The Children’s Diabetes Centre values the importance of community members giving feedback and guidance about the issues that are important to them concerning Princess Margaret Hospital’s clinical services and our research.
In 2015 and 2016, parents and young adults from the Type 1 Diabetes community were invited to share their ideas about research and clinic. The diabetes consumer group has mul�ple purposes affec�ng the clinical and research departments. These include:
improving our services contribu�ng to the direc�on of research providing feedback on pa�ent resources providing ideas for our newsle�er iden�fying new ideas for projects sharing research results reviewing research proposals
The Consumer Group consists of:
Community members with an interest in Type 1 Diabetes Staff from the Children’s Diabetes Centre and PMH Endocrinology and Diabetes Department Consumer and community par�cipa�on program staff members from Telethon Kids Ins�tute
Achievements so far:
Provided feedback on school management plans Exams and stress are of concern to a lot of teenagers and their families so we featured an ar�cle on
how to apply for special circumstances. The group has reviewed and assisted with the upda�ng of the Department’s newly diagnosed folder.
Based on feedback, the resources in this folder will be uploaded to the centre’s website. Following consulta�on with the consumer group, the centre has created video resources to go on our
website and be shared in the community. Jasper: h�ps://youtu.be/x2sgevQgFFE Cleo: h�ps://youtu.be/IzcCPzguCEA
We are now including research summaries on our website when studies are completed and published. The consumers formed part of a panel to review research seeding grants submi�ed to the centre for
funding.
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OUTPUTS
PUBLICATIONS This is a list of publica�ons from the centre staff and students in 2015, 2016 and 2017. For further publica�ons please see the Children’s Diabetes Centre website at www.childrensdiabetescentre.org.au .
Haynes, A Bulsara, MK, Bower, C, Jones, TW, Davis, EA. Regular peaks and troughs in the Australian incidence of childhood type 1 diabetes mellitus (2000–2011). Diabetologia. April 2015
Cho, YH, Craig, ME, Davis, EA, Co�erill, AM, Couper, JJ, Cameron, FJ, Benitez‐Aguirre, PZ, Dalton, RN, Dunger, DB, Jones, TW, Donaghue, KC & on behalf of Adolescent Type 1 Diabetes Cardio‐Renal Interven�on, T 2015, 'Cardiac Autonomic Dysfunc�on Is Associated with High‐Risk Albumin‐to‐Crea�nine Ra�o in Young Adolescents with Type 1 Diabetes in Addit (Adolescent Type 1 Diabetes Cardio‐Renal Interven�onal Trial)', Diabetes Care.
Jus�ce, TD, Hammer, GL, Davey, RJ, Paramalingam, N, Guel, KJ, Lewis, L, Davis, EA, Jones, TW, Fournier, PA. (2015) Effect of antecedent moderate‐intensity exercise on the glycemia‐increasing effect of a 30‐sec maximal sprint: a sex comparison. Physiological Reports 28 May 2015 Vol. 3
Anderson D, Cordell HJ, Fakiola M, Francis RW, Syn G, Scaman ES, Davis E, Miles SJ, McLeay T, Jamieson SE, Black‐well JM. First genome‐wide associa�on study in an Australian aboriginal popula�on provides insights into gene�c risk factors for body mass index and type 2 diabetes PLoS One. 2015 Mar
Abraham, MB, She�y, VB, Price, G, Smith, N, de Bock, M, Siafarikas, A, Resnick, S, Whan, E, Ellard, S, Flanagan, SE, Davis, EA, Jones, TW, Hussain, K, Choong, CS. Efficacy and safety of sirolimus in a neonate with persistent hypogly‐caemia following neartotal pancreatectomy for hyperinsulinaemic hypoglycaemia. J Pediatr Endocrinol Metab 2015
Interna�onal Hypoglycaemia Study Group. Minimizing Hypoglycemia in Diabetes. Diabetes Care Volume 38, Au‐gust 2015
Simon Heller, Stephanie A. Amiel, and Kamlesh Khun� on behalf of the Interna�onal. Hypoglycaemia Study GroupHypoglycaemia, a global cause for concern. Diabetes Voice Online ‐ September 2015
de Bock, M, Roy, A, Cooper, MN, Dart, JA, Berthold, CL, Re�erath, AJ, Freeman, KE, Grosman, B, Kurtz, N, Kauf‐man, F, Jones, TW, Davis, EA. Feasibility of Outpa�ent 24‐Hour Closed‐Loop Insulin Delivery. Diabetes Care Sept 2015
Abraham, M. B., R. Davey, M. J. O'Grady, T. T. Ly, N. Paramalingam, P. A. Fournier, A. Roy, B. Grosman, N. Kurtz, J. M. Fairchild, B. R. King, G. R. Ambler, F. Cameron, T. W. Jones and E. A. Davis. "Effec�veness of a Predic�ve Algo‐rithm in the Preven�on of Exercise‐Induced Hypoglycemia in Type 1 Diabetes." Diabetes Technol Ther, (2016).
Abraham, M. B., M. de Bock, N. Paramalingam, M. J. O'Grady, T. T. Ly, C. George, A. Roy, G. Spital, S. Karula, K. Heels, R. Gebert, J. M. Fairchild, B. R. King, G. R. Ambler, F. Cameron, E. A. Davis and T. W. Jones. "Preven�on of Insulin‐Induced Hypoglycemia in Type 1 Diabetes with Predic�ve Low Glucose Management System." Diabetes Technol Ther, (2016).
Abraham, M. B., P. H. Gallego, W. M. Brownlee, G. J. Smith, E. A. Davis and T. W. Jones. "Reduced Prevalence of Impaired Awareness of Hypoglycemia in a Popula�on‐Based Clinic Sample of Youth with Type 1 Diabetes." Pediatr Diabetes, (2016).
Abraham, M. B., J. A. Nicholas, T. T. Ly, H. C. Roby, N. Paramalingam, J. Fairchild, B. R. King, G. R. Ambler, F. Cam‐eron, E. A. Davis and T. W. Jones. "Safety and Efficacy of the Predic�ve Low Glucose Management System in the Preven�on of Hypoglycaemia: Protocol for Randomised Controlled Home Trial to Evaluate the Suspend before Low Func�on." BMJ Open 6, no. 4 (2016): e011589.
Clapin, H., L. Hop, E. Ritchie, R. Jayabalan, M. Evans, K. Browne‐Cooper, S. Peter, J. Vine, T. W. Jones and E. A. Davis. "Home‐Based Vs Inpa�ent Educa�on for Children Newly Diagnosed with Type 1 Diabetes." Pediatr Diabetes, (2016).
Clapin, H., H. Phelan, L. Bruns, Jr., R. Sinno�, P. Colman, M. Craig and T. Jones. "Australasian Diabetes Data Net‐work: Building a Collabora�ve Resource." J Diabetes Sci Technol 10, no. 5 (2016): 1015‐26.
Cooper, M. N., A. Lin, G. A. Alvares, N. H. de Klerk, T. W. Jones and E. A. Davis. "Psychiatric Disorders During Early Adulthood in Those with Childhood Onset Type 1 Diabetes: Rates and Clinical Risk Factors from Popula�on‐Based Follow‐Up." Pediatric Diabetes, (2016).
Cooper, M. N., A. Lin, G. A. Alvares, N. H. de Klerk, T. W. Jones and E. A. Davis. "Psychiatric Disorders During Early Adulthood in Those with Childhood Onset Type 1 Diabetes: Rates and Clinical Risk Factors from Popula�on‐Based Follow‐Up." Pediatric Diabetes, (2016).
Cooper, Ma�hew N., Kaitrin A. R. McNamara, Nicholas H. de Klerk, Elizabeth A. Davis and Timothy W. Jones. "School Performance in Children with Type 1 Diabetes: A Contemporary Popula�on‐Based Study." Pediatric Diabe‐tes, (2016): n/a‐n/a.
de Bock, Mar�n, Ma�hew Cooper, Adam Re�erath, Jennifer Nicholas, Trang Ly, Timothy Jones and Elizabeth Davis. "Con�nuous Glucose Monitoring Adherence Lessons from a Clinical Trial to Predict Outpa�ent Behavior." Journal of diabetes science and technology, (2016): 1932296816633484.
de Bock, M. Dart, J, Roy, A, Davey, R, Soon, R, Berthold, C , Re�erath, A, Grosman, B, Kurtz, N, Davis, E, Jones, T. . " Explora�on of the Performance of a Hybrid Closed Loop Insulin Delivery Algorithm That Includes Insulin Delivery Limits Designed to Protect against Hypoglycemia. ." Journal of Diabetes Science and Technology., (2016).
Haynes, Aveni, Julia M. Hermann, Kellee M. Miller, Sabine E. Hofer, Timothy W. Jones, Roy W. Beck, David M. Maahs, Elizabeth A. Davis and Reinhard W. Holl. "Severe Hypoglycemia Rates Are Not Associated with Hba1c: A Cross‐Sec�onal Analysis of 3 Contemporary Pediatric Diabetes Registry Databases." Pediatric Diabetes, (2016).
Haynes, A., R. Kalic, M. Cooper, J. K. Hewi� and E. A. Davis. "Increasing Incidence of Type 2 Diabetes in Indigenous and Non‐Indigenous Children in Western Australia, 1990‐2012." Med J Aust 204, no. 8 (2016): 303.
M B Abraham, J A Nicholas, T T Ly, H C Roby , N Paramalingam, J Fairchild, B R King, G R Ambler ,F Cameron, E A Davis, T W Jones. "Safety and Efficacy of the Predic�ve Low Glucose Management System in the Preven�on of Hy‐poglycaemia: Protocol for Randomised Controlled Home Trial to Evaluate the Suspend before Low Func�on." BMJ Open Access, (2016).
Maahs, D. M., B. A. Buckingham, J. R. Castle, A. Cinar, E. R. Damiano, E. Dassau, J. H. DeVries, F. J. Doyle, 3rd, S. C. Griffen, A. Haidar, L. Heinemann, R. Hovorka, T. W. Jones, C. Kollman, B. Kovatchev, B. L. Levy, R. Nimri, D. N. O'Neal, M. Philip, E. Renard, S. J. Russell, S. A. Weinzimer, H. Zisser and J. W. Lum. "Outcome Measures for Ar�cial Pancreas Clinical Trials: A Consensus Report." Diabetes Care 39, no. 7 (2016): 1175‐9.
Miller, KM, Hart, PH, de Klerk, N, Davis, EA, Lucas, RM. "Are Low Sun Exposure and/or Vitamin D Risk Factors for Type 1 Diabetes?" Photochemical and Photobiological Sciences, (2016).
Naylor, L. H., E. A. Davis, R. J. Kalic, N. Paramalingam, M. B. Abraham, T. W. Jones and D. J. Green. "Exercise Train‐ing Improves Vascular Func�on in Adolescents with Type 2 Diabetes." Physiol Rep 4, no. 4 (2016).
Phelan, H, Clapin, H, Bruns Jr. L, Cameron, FJ, Co�erill, AM, Couper, JJ, Davis, EA, Donaghue, KC, Jefferies, C, King, B, Sinno�, RO, Tham, E, Wales, JK, Jones, TW, Craig, ME. On Behalf of the ADDN Study group. . "The Australasian Diabetes Data Network (Addn): First Na�onal Audit Data on Youth with Type 1 Diabetes." Medical Journal of Aus‐tralia, (2016).
Shari, A., M. I. De Bock, D. Jayawardene, M. M. Loh, J. C. Horsburgh, C. L. Berthold, N. Paramalingam, L. A. Bach, P. G. Colman, E. A. Davis, B. Grosman, C. Hendrieckx, A. J. Jenkins, K. Kumareswaran, N. Kurtz, A. Kyoong, R. J. MacIsaac, J. Speight, S. Trawley, G. M. Ward, A. Roy, T. W. Jones and D. N. O'Neal. "Glycemia, Treatment Sa�sfac‐�on, Cogni�on, and Sleep Quality in Adults and Adolescents with Type 1 Diabetes When Using a Closed‐Loop Sys‐tem Overnight Versus Sensor‐Augmented Pump with Low‐Glucose Suspend Func�on: A Randomized Crossover Study." Diabetes Technol Ther, (2016).
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She�y, V. B., P. A. Fournier, R. J. Davey, A. J. Re�erath, N. Paramalingam, H. C. Roby, M. N. Cooper, E. A. Davis and T. W. Jones. "Effect of Exercise Intensity on Glucose Requirements to Maintain Euglycaemia During Exercise in Type 1 Diabetes." J Clin Endocrinol Metab, (2016): jc20154026.
Cooper, MN, de Bock, M, Carter, KW, de Klerk, NH, Jones, TW, Davis, EA. Incidence of and risk factors for hospi‐talisa�ons due to vascular complica�ons; a popula�on‐based Type 1 diabetes cohort (n=1,316) followed into ear‐ly adulthood. Journal of Diabetes and Its Complica�ons March 2017
Interna�onal Hypoglycaemia Study Group.. Glucose Concentra�ons of Less Than 3.0 mmol/L (54 mg/dL) Should Be Reported in Clinical Trials: A Joint Posi�on Statement of the American Diabetes Associa�on and the European Associa�on for the Study of Diabetes. Diabetes care. 2017;40(1):155‐7.
Interna�onal Hypoglycaemia Study Group.. Glucose Concentra�ons of Less Than 3.0 mmol/L (54 mg/dL) Should Be Reported in Clinical Trials: A Joint Posi�on Statement of the American Diabetes Associa�on and the European Associa�on for the Study of Diabetes. Diabetologia (2017) 60:3–6
Michael C Riddell, Ian W Gallen, Carmel E Smart, Craig E Taplin, Peter Adolfsson, Alistair N Lumb, Aaron Kowalski, Remi Rabasa‐Lhoret, Rory J McCrimmon, Carin Hume, Francesca Annan, Paul A Fournier, Claudia Graham, Bruce Bode, Pietro Galasse�, Timothy W Jones, Iñigo San Millán, Tim Heise, Anne L Peters, Andreas Petz, Lori M Laff el. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol January 2017
Graf, A, Ward, GM, Vogrin, S, Sundararajan, V, Shari, A, De Bock, M, Jayawardene, D, Loh, MM, Horsburgh, JC, Berthold, CL, Paramalingam, N, Bach, LA, Colman, PG, Davis, EA, Grosman, B, Jenkins, AJ, Kumareswaran, KV, Kurtz, N, Kyoong, A, MacIsaac, AJ, Roy, A, Jones, TW, and O’Neal, DN. Overnight Counter‐regulatory Hor‐mone Proles in Type 1 Diabetes Adults during Closed Loop Insulin Delivery versus Sensor Augmented Pump with Low Glucose Suspend. Diabetes Technology and Therapeu�cs. 2017
de Bock, M, Lobley K, Anderson D, Davis, E, , Donaghue K, Pappas M, Siafarikas, A, Cho YH, Jones T, Smart C. En‐docrine and metabolic consequences due to restric�ve carbohydrate diets in children with type 1 diabetes: an illustra�ve case series. Pediatric Diabetes 2017
ME Craig NP, C Boyle, FM Campbell, T Jones, SE Hofer, JH Simmons, N Holman, ETham, E Fröhlich‐Reiterer, S DuBose, H Thornton, B King, DM. Maahs, RW Holl and JT Warner on behalf of the Australasian Diabetes Data Net‐work (ADDN), the T1D Exchange, the Na�onal Paediatric Diabetes Audit (NPDA) and the Royal College of Paediat‐rics and Child Health, and the Prospec�ve Diabetes Follow‐up Registry (DPV) ini�a�ve. Prevalence of Celiac Dis‐ease in 52,721 Youth with Type 1 Diabetes: interna�onal comparison across three con�nents. Diabetes Care (in press). 2017.
Gibson,L, Allen, K, Davis, L, Blair, E, Zubrick, S, Byrne, S. The psychosocial burden of childhood overweight and obesity: Evidence for persis�ng difficul�es in boys and girls European Journal of Pediatrics. European Journal of Pediatrics (accepted) 2017
N. Paramalingam, P.A. Fournier, R.J. Davey, H.C. Roby, G.J. Smith, V.B. She�y, K. J. Guel, E.A. Davis, T.W. Jones. A ten second sprint does not blunt hormonal counterregula�on to subsequent hypoglycaemia. Diabe�c Medicine (accepted) 2017
J A. Nicholas, F J. Gill, L. Ellio�, M B. Abraham, D. Cross, T W. Jones, E A. Davis. Sensor‐augmented pump ther‐apy in the management of type 1 diabetes: lived experiences of children, adolescents and parents . Australian Diabetes Educator (In Press) 2017
MB Abraham, RJ Davey, MN Cooper, N Paramalingam, MJ O’Grady, TT Ly, TW Jones, PA Fournier ,EA Davis. Re‐producibility of the plasma glucose response to moderate‐intensity exercise in adolescents with type 1 diabetes. Diabe�c Medicine (accepted) 2017
GRANTS AWARDED TO CRE MEMBERS
This list includes grants awarded to members of the Children’s Diabetes Centre since 2015. 2015 Professor Timothy Jones, Professor Elizabeth Davis, Dr Stuart Weinzimer, Dr Mar�n De Bock, Dr Donna
Cross, Dr Margaret Grey, Professor William Tamborlane, Dr. Elizabeth Geelhoed et al. JDRF Australian Type 1 Diabetes Clinical Research Network research grant. The assessment and transla�on of new diabetes technologies including closed loop insulin therapy. $2,300,000.00
Professor Elizabeth Davis, Dr Raymond Davey, Dr Stuart Weinzimer, Dr Vinutha She�y, Dr Donna Cross, Dr Margaret Grey, Professor William Tamborlane, Dr. Carmel Smart, Dr. Elizabeth Geelhoed, Professor Paul Fournier, Professor Timothy Jones et al. JDRF Australian Type 1 Diabetes Clinical Research Network research grant. Reducing hypoglycaemia and glycaemic excursions caused by food and exercise in young people with T1D. $1,889,000.00
Dr Mary Abraham. JDRF Mentored Clinician Researcher Fellowship. 2016‐2017. $60,000.00 Professor Timothy Jones et al. Bri�sh Heart Founda�on. JDRF and Diabetes UK. AdDIT follow up study
$182,632.00 Dr Aveni Haynes, JDRF Travel Grant. $1,344.00 Professor Timothy Jones, Professor Elizabeth Davis, Associate Professor David O’Neal, Dr Mar�n de
Bock et al. NHMRC Project Grant (1099379). Free‐Living Hybrid Closed‐Loop Insulin Delivery for Pa�ents with Type 1 Diabetes: A long‐term mul�‐centre randomized controlled trial. $1,041,985.90
Dr Mar�n de Bock. Department of Health/Raine Clinician Research Fellowship. Closed loop insulin delivery for pa�ents with type 1 diabetes in free living condi�ons. $164,265.00
Dr Kiranjit Joshi. Princess Margaret hospital Founda�on Seeding Grant. Developing a protocol and assay to measure 25‐hydroxyvitamin D concentra�on in saliva. $20,000.00
Professor Timothy Jones and Professor Hung Nguyen. NHMRC Project Grant (1102286). Non‐invasive detec�on of hypoglycaemia in people with diabetes using brain wave ac�vity. $125,000.00
Professor Elizabeth Davis and Impact of Chronic Diseases working group. Telethon Kids Ins�tute Research Focus Area Working Group Project Funding. Impact of Chronic Diseases on Mental Health and School Success. $9,670.00
| PROGRESS REPORT18 PROGRESS REPORT | 19
2016 Dr Karen Rothacker. Diabetes Research Western Australia grant. The effect of hyperglycaemia in standard
and low insulin states on exercise performance compared to exercise performance in euglycaemia. $80,000.00
Dr Tarini Che�y. Australian Paediatric Endocrine Care(APEC) Research Grant. Can dietary intake a�er exercise decrease the risk of late onset post‐exercise hypoglycaemia in young people with Type 1 Diabetes. $47,978.00
Helen Clapin. Princess Margaret Hospital Founda�on Seeding Grant. HLA risk proles in early onset Type 1 Diabetes. $19,597.00
Dr Ashleigh Lin. Telethon Kids Ins�tute Compe��ve Working Group Project Grant. Characterising moment‐to‐moment uctua�ons in stress, anxiety and blood glucose levels in adolescents with Type 1 Diabetes. $14,700.00
Professor Timothy Jones., Professor Elizabeth Davis and Helen Clapin. Telethon‐Perth Children’s Hospital Research Fund. Building a shared research database for all of life monitoring of long‐term outcomes in pa�ents with Type 1 Diabetes. $468,832.00
SEEDING GRANTS PROVIDED BY CRE 2015 Dr Ashleigh Lin. Characterising moment‐to‐moment uctua�on in stress, anxiety and blood glucose levels in adolescents with Type 1 Diabetes. $19,250.00
Natrisha Barne�. Comprehensive economic evalua�on of sensor‐augmented insulin pump therapy among a paediatric popula�on in Western Australia: a mixed‐method analysis of costs and benets from an individual, societal and health system perspec�ve. $20,000.00
Dr Vinutha She�y. The effect of acute exercise on DNA methyla�on of genes in the leukocytes of children with Type 1 Diabetes mellitus. $20,000.00
2016 Helen Clapin. HLA risk proles in early onset Type 1 Diabetes: associated clinical phenotype and temporal
changes in the Western Australian cohort since 2000. $19,596 Dr Mar�n de Bock. Sexual health and in�macy in Type 1 Diabetes, and the impact this has on therapeu�c
choice. $19,927.00 Beth Fisher. Does bolus insulin administra�on during episodes of hyperglycaemia contribute to the
ae�ology of diabetes complica�ons in Type 1 Diabetes? $17,600.00 Dr Leanne Fried. Understanding and enhancing the school experiences of adolescents with Type 1 Diabetes.
$19,928.00 Dr Mary Abraham. Iden�ca�on of factors which impact glycaemic control in non‐Caucasian pa�ents with
Type 1 diabetes. $19,409.00
2017 Dr Tarini Che�y. Prac�cal use of con�nuous glucose monitoring during exercise to improve �me spent in target glucose range. $18,426.00
Dr Aveni Haynes. How is birth by Caesarean sec�on delivery associated with the risk of childhood T1D. $14,793.31
Zac Leow. Effect of ketogenic low carbohydrate diets on hypoglycaemia threshold and symptoms in adults with Type 1 Diabetes mellitus $18,901.00
Jennifer Nicholas. Health Literacy: Implica�ons and Interven�ons for Adolescents and Young Adults with Type 1 Diabetes. $20,000.00
TRAVEL AWARDS PROVIDED BY CRE Jaimee Rossborough Australasian Paediatric Endocrine Group mee�ng 2016 ‐ Alice Springs $2,100.00 Julie Dart Australian Diabetes Society mee�ng 2016 ‐ Gold Coast $1,960.00 Helen Clapin Diabetes database development collabora�on ‐ Europe $3,000.00 Wayne Soon Australian Diabetes Society mee�ng 2017 ‐ Perth $620.00 Dr Aveni Haynes Interna�onal Diabetes Epidemiology Group conference 2017 ‐ Abu Dhabi $3000.00 Dr Leanne Fried Interna�onal Society for Paediatric and Adolescent Diabetes (ISPAD) conference 2017 – Innsbruck $2811.00
FUNDING ORGANISATIONS
2017 Dr Tarini Che�y. Prac�cal use of con�nuous glucose monitoring during exercise to improve �me spent in target glucose range. $18,426.00
Dr Aveni Haynes. How is birth by Caesarean sec�on delivery associated with the risk of childhood T1D. $14,793.31
Zac Leow. Effect of ketogenic low carbohydrate diets on hypoglycaemia threshold and symptoms in adults with Type 1 Diabetes mellitus $18,901.00
Jennifer Nicholas. Health Literacy: Implica�ons and Interven�ons for Adolescents and Young Adults with Type 1 Diabetes. $20,000.00
TRAVEL AWARDS PROVIDED BY CRE Jaimee Rossborough Australasian Paediatric Endocrine Group mee�ng 2016 ‐ Alice Springs $2,100.00 Julie Dart Australian Diabetes Society mee�ng 2016 ‐ Gold Coast $1,960.00 Helen Clapin Diabetes database development collabora�on ‐ Europe $3,000.00 Wayne Soon Australian Diabetes Society mee�ng 2017 ‐ Perth $620.00 Dr Aveni Haynes Interna�onal Diabetes Epidemiology Group conference 2017 ‐ Abu Dhabi $3000.00 Dr Leanne Fried Interna�onal Society for Paediatric and Adolescent Diabetes (ISPAD) conference 2017 – Innsbruck $2811.00
FUNDING ORGANISATIONS
100 Roberts Road, Subiaco Western Australia 6008
PO Box 855, West Perth Western Australia 6872
T ǀ 08 9489 7777
W ǀ www.childrensdiabetescentre.org.au
