Background:

In 2007, after receiving ethics approval* The Mapping Glycaemic Control Across Australia (MGCAA) project was provided access to de-identified HbA1c data directly from pathology laboratories thereby removing the possibility of transcription errors. The MGCAA was established to review diabetes related biochemical markers across geographic locations at a national, state and territory, Division of Primary Care (PC) and postcode level throughout Australia. Glycaemic Control Cohort Substudy is an extension of this study.

*Bellberry Human Research Ethics Committee approval ref B121/07


Investigator:

Dr. Chrys Michaelides


Methodology:

Of the original 310,000 patient data collected in 2007 MGCAA project, 87552 individuals have been followed each year for 4 years to 31/12/2010. This represents approximately 7 % of the estimated diabetes population of Australia. Although change in national glycaemic control is marginal, there are clear regional differences in both mean HbA1c as well the proportion of patients achieving HbA1c targets at a postcode, division and state/territory level. Within each postcode, data is only provided if the data reports are available for more than 14 (28% of the benchmark sample threshold) individual records. At a Division of Primary Care level if data reports available exceed 280 (28% of the benchmark sample threshold) they are reported.


How to use the data:

The Glycaemic Cohort Substudy follows the 87,552 individuals with data for each of the 4 years. Following this cohort group, we have established a diabetes surveillance system. With this we can identify trends in glycaemic control and regional differences that may exist. Divisions of Primary Care and the associated postcodes and divisions with the greatest glycaemic improvement as well as those with the greatest need can be identified. Strategic interventions incorporating processes identified from areas with the greatest success can be implemented and effectiveness monitored through prospective surveillance.


Conclusion:

It is well documented that diabetes is a progressive disorder requiring frequent review Harris et al1 in 2003, showed that there was a progressive increase in the number of patients with an HbA1c >7% associated with increasing duration of diabetes. However, data from Glycaemic Control Cohort Substudy suggests that nationally this is not the case and that interrogation at a postcode level shows further variability.

Acknowledgements, Aim and Background

Acknowledgements:

This project has been made possible through the unrestricted funding support and partnership of Novo Nordisk.

Aim:

A review of the HbA1c values provides valuable information about whether diabetes specific HbA1c targets are being met and more importantly, in which geographic regions, more targeted interventions are required. The aim of this observational study is to raise awareness amongst the health care community, promote reflection with the aim of leading to change how we manage diabetes and in turn changing diabetes outcomes.

Background:

In 2007, after receiving ethics approval* The Mapping Glycaemic Control Across Australia (MGCAA) project was provided access to de-identified HbA1c data directly from pathology laboratories thereby removing the possibility of transcription errors. The following laboratories supported the project -Sullivan Nicolaides Pathology, Central Queensland Pathology Laboratory, Barratt & Smith Pathology, Douglas Hanly Moir Pathology, Southern.IML Pathology, Capital Pathology, Melbourne Pathology, Hobart Pathology, Launceston Pathology, North West Pathology, Clinipath Pathology, Clinpath Laboratories, QML, Western Diagnostic Pathology. The MGCAA was established to review diabetes related biochemical markers across geographic locations at a national, state and territory, Division of Primary Care (PC) and postcode level throughout Australia.

*Bellberry Human Research Ethics Committee approval ref B121/07

Materials and Methods


De-identified data including lipids, HbA1c, age and gender were collected from private pathology laboratories in CSV format. The data were cleaned (duplicates and screening HbA1c values removed) and stratified geographically, resulting in a community population sample in 2007 of approximately 310,546 people with diabetes. The population sample size for 2008, 2009 and 2010 was 585,151, 381,205 and 394,355 respectively. Data from the first year of collection were regarded as benchmark data. Summary data of a Division of Primary Care accessed via the Changing Diabetes Map is reported only when the data sample exceeds 1000, equating to more than 10% of the expected prevalence of 7 % of the population for that division (1). Within each postcode, data is only provided if the data reports are available for more than 50 individual records. Each year we reviewed the data provided and updated the individual maps. A cohort of approximately 87,600 people with diabetes is also reported in the Glycaemic Control Cohort Substudy. To further enhance and support the health care team managing those with diabetes we provide the Changing Diabetes Benchmark Interrogation tool allowing the reporting of information about glycaemic control from the data set by gender and age group and then compared to the same selected parameters for the division, state/territory and nation.


(1) Dunstan DW, et al. The Rising Prevalence of Diabetes and Impaired Glucose Tolerance. The Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 2002;25:829–834

Results and Conclusion

Results:

Click here to see the 2007 Map

Click here to see the 2008 Map

Click here to see the 2009 Map

Click here to see the 2010 Map

Click here to see the 2012 Map

Conclusion:

Though awareness of targets for diabetes control are well known and documented, this benchmark observational study highlights that glycaemic control in Australia is not optimal. The reporting and dissemination of the data allows us to identify areas in need of targeted strategies. Used appropriately, this benchmarking exercise and the associated cohort follow-up and surveillance system can facilitate the implementation of strategies calling General Practitioners (GPs) and other Health Care Profressionals (HCPs) to action to support patients and help them achieve their diabetes targets.

Investigators



Dr. Chrys Michaelides is a Uni of QLD graduate General Practice (GP) working in Brisbane.

He has a special interest in the management of diabetes in a primary care setting and has been running diabetes specific mini clinics in general practice since 1988. He has been involved in the development of GP division diabetes programmes at a community level since the inception of GP divisions. His interest in diabetes spread to the monitoring of glycaemic control in 2007, when with unrestricted financial support and partnership with Novo Nordisk he made available to health care professionals the data from The Mapping Glycaemic Control Across Australia (MGCAA) Project.

He has presented this research locally to GP divisions, nationally at the Australian Diabetes Society (ADS) and the Australian Diabetes Educators Association (ADEA) Scientific Meetings and internationally at the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) conferences. His hope was that knowing what needed changing we could change outcomes, and being able to measure changes we could manage diabetes better in Australia. He is on numerous advisory boards dealing with GP education and continues to contribute to the development of educational programmes aiming to help optimise outcomes for GPs and their patients.

How to use the data


The Changing Diabetes Map provides an overview of HbA1c values across a sample of the Australian population with diabetes. It is an observation of glycaemic control, by postcode then pooled to Division of Primary Care, state/territory and national level. It allows for the observation of trends and and no statistical conclusion can be drawn. It has been developed to stimulate reflection and promote action for change.

 

1. Acknowledgements:

This project has been made possible through the unrestricted funding support and partnership of Novo Nordisk


2. Aim:

A review of the HbA1c values provides valuable information about whether diabetes specific HbA1c targets are being met and more importantly, in which geographic regions, more targeted interventions are required. The aim of this observational study is to raise awareness amongst the health care community, promote reflection with the aim of leading to change how we manage diabetes and in turn changing diabetes outcomes.


3. Background:

In 2007, after receiving ethics approval* The Mapping Glycaemic Control Across Australia (MGCAA) project was provided access to de-identified HbA1c data directly from pathology laboratories thereby removing the possibility of transcription errors. The following laboratories supported the project -Sullivan Nicolaides Pathology, Central Queensland Pathology Laboratory, Barratt & Smith Pathology, Douglas Hanly Moir Pathology, Southern.IML Pathology, Capital Pathology, Melbourne Pathology, Hobart Pathology, Launceston Pathology, North West Pathology, Clinipath Pathology, Clinpath Laboratories, QML, Western Diagnostic Pathology. The MGCAA was established to review diabetes related biochemical markers across geographic locations at a national, state, Division of Primary Care (PC) and postcode level throughout Australia.

*Bellberry Human Research Ethics Committee approval ref B121/07

4. Materials and Methods:

De-identified data including lipids, HbA1c, age and gender were collected from private pathology laboratories in CSV format. The data were cleaned (duplicates and screening HbA1c values removed) and stratified geographically, resulting in a community population sample of approximately 250,000 diabetes patients (and upwards of 300, 000 in the following years). Data from the first year of collection were regarded as benchmark data. Each year we review the data provided and update individual maps, A cohort of approximately XXXXX is also reported upon – the Glycaemic Control Cohort Substudy.

5. Results:

Click here to see the

2007 Map

2008 Map

2009 Map

2010 Map

.

Conclusion:

Though awareness of targets for diabetes control are well known and documented, this benchmark observational study highlights that glycaemic control in Australia is not optimal. The reporting and dissemination of the data allows us to identify areas in need of targeted strategies. Used appropriately, this benchmarking exercise and the associated cohort follow-up and surveillance system can facilitate the implementation of strategies calling GP's and other HCP to action to support patients and help them achieve targets.

Investigators:

Chrys Michaelides with bio
Mirella Daja with bio

How to use the data

The Changing Diabetes Map provides an overview of HbA1c values across a sample of the Australian population. It is an observation of glycaemic control, by postcode then pooled to Division of Primary Care, State and national level. It allows for the observation of trends and and no statistical conclusion can be drawn. It has been developed to stimulate reflection and promote action for change.



Also of mention

On this page will be links to
1. Cohort substudy
2. Interrogation tool
3. Years of map


*A pre-defined minimum number of 50 pathology records are required for a postcode to be included in the Changing Diabetes Map. This represents a minimum of 3% of the estimated diabetes prevalence (1) in a postcode.
Ref 1- We could then insert the AusDiab publication for prevalence rate etc