Acid attack on diabetes

Professor Barbora de Courten has featured in the Herald Sun for her research into the use of Carnosine as a way to manage type 2 diabetes and the factors that lead to it. Read the full story here

$100 gift for participants in diabetes clinical trial

We are looking for individuals with pre-diabetes or type 2 diabetes (diet-controlled or on Metformin) aged 18 to 70 years to participate in a clinical trial at Monash Medical Centre, Clayton. The study will involve around 5 visits over a period of 14 weeks. You get a free assessment of your diabetes and cardiovascular risk and $100 visa card or gift card of your choice as a token of appreciation. If you are interested, please don’t hesitate to contact Josphin Johnson at 03-85722629 or email: med-carnosineir@monash.edu for further information. 

Are you:

• A pre-diabetic OR have type 2 diabetes (diet-controlled or taking Metformin only)
• Aged between 18 and 70 years
• Someone with no significant weight change in the last 6 months or have no intention to lose weight in the next 3 months
• Not taking other regular medications
• Someone with no significant diseases that require treatment
• A non-smoker, non-drug user, non-high alcohol intake
• Not lactating, pregnant or planning to be in next 4-6 months
• Living in Melbourne

What is in it for you?

• $100 visa card or gift card of your choice as a token of appreciation
• Free Diabetes and Cardiovascular risk assessment
• Free body fat and muscle assessment (around $200 value)
• Free Fibroscan to assess condition of your liver
• Free routine blood tests
• Free cognitive tests

This study involves around 4-6 visits over a period of approximately 14 weeks and takes place at Monash Medical Centre in Clayton. Medical certificates can be provided when needed.
For further information, or to take part, please contact Josphin Johnson @ 0385722629 or Email: med-carnosineir@monash.edu
(This study has approval from the Monash Health Human Research Ethics Committee–Project Number 16061A).

Dandenong Hospital team improving outcomes for patients with diabetic foot complications

Associate Professor Parm Naidoo and Professor Tim Buckenham

A unique multidisciplinary team of specialists at Dandenong Hospital is successfully managing a common but not often discussed complication associated with diabetes.

People with diabetes are at a much higher risk of developing atherosclerosis (narrowing and blockages in the arteries of the legs and feet)—and poor blood flow results in delayed healing of minor injuries and ulcers.   

According to Monash University’s Associate Professor Parm Naidoo, being diabetic also means these patients are relatively immunocompromised and thus susceptible to infection. 

“Even minor injuries can result in ulcerations in their feet, leading to deep soft tissue infection, bone infection, gangrene and amputations,” said Associate Professor Parm Naidoo, an Interventional Radiologist and Director of Radiology, Dandenong Hospital, Monash Health.

“Patients with longstanding and/or poorly controlled diabetes are at risk of chronic irreversible damage to the small nerves of the feet (peripheral neuropathy), and are prone to injuries without feeling or realizing it, which in some instances triggers a cascade of inflammatory events resulting in severe and permanent damage to the bones of the foot, known as Charcot’s osteoneuropathy.”

Weekly diabetic foot clinic meeting at Dandenong

The high risk diabetic foot clinic at Dandenong Hospital brings together

subspecialist radiologists, vascular surgeons, podiatrists, infectious disease physicians, endocrinologists, nurses and ultrasonographers to manage these complex and often difficult cases.

Associate Professor Naidoo, who chairs the weekly meeting, said up to 15% of people with diabetes develop a foot ulcer at some point, and left untreated, has the potential to lead to serious complications including amputation.

“These complications of diabetes in the feet can be devastating for these patients. Early diagnosis, intervention and management not only saves limbs but significantly improves quality of life,” said Associate Professor Naidoo.

“Our weekly interdisciplinary meetings started about five years ago, and we discuss around ten to fifteen cases at each sitting.”

“Our aim is to accurately diagnose these patients as early as possible, and to quickly intervene with the highest level of care,” said Associate Professor Naidoo.

“Aggressive treatment is the key to minimising complications and long term morbidity.”

Associate Professor Naidoo said there are huge resultant dollar savings to the health networks in terms of reduced length of inpatient stay and major surgical interventions. 

“Our unique case management saves patients taking time off work to attend multiple appointments, and being assessed by multiple specialists or allied health care providers, which is often spread out over months.”

Professor Tim Buckenham, specialist Vascular and Interventional Radiologist and Head of Vascular Imaging at Monash Health said the clinical leads at the weekly meetings are the podiatrists at Dandenong Hospital, as they are the primary care givers of these patients.

“We have the highest level expertise in the same room, so between the podiatrists, vascular surgeons, diagnostic and interventional radiologists, and other staff, we make a treatment decision about a patient in about ten minutes, rather than two months of consultations with individual specialists,” said Professor Buckenham.

A treatment plan for each patient is decided and activated at the meeting. Treatments include specialised dressings, antibiotics, debridement, orthotics, pressure off-loading and casting of the affected limb.

“Having an adequate blood supply to the affected limb is crucial to the ‘healing process’, and increasingly, these diseased arteries are being treated using minimally-invasive techniques, with excellent results,” said Professor Buckenham.

“We have significant expertise at Dandenong Hospital in treating these types of arteries—these are delicate procedures and the skill level of our interventional radiologists, led by Professor Buckenham, and surgeons is excellent because we are collegial, collaborative and perform so many of these procedures,” said Associate Professor Naidoo.

“While our work is certainly not glamorous, we know we’re providing the best model of care and the best possible outcomes for this very vulnerable patient group.”

Borne out of his experience chairing the high risk diabetic foot meeting at Dandenong hospital and research into this topic, Associate Professor Naidoo has published several articles on the imaging of these disease processes, with an emphasis on the role of MRI in early detection and characterisation of abnormalities in the diabetic foot. Associate Professor Naidoo and his colleagues have published the largest and most up-to-date review paper on the Radiology of the complications of diabetes in the feet (British Journal of Radiology, 2015), and was subsequently invited to lecture on the topic at the world’s largest annual MRI meeting (the International Society of Magnetic Resonance in Medicine, in Honolulu last month, as well as at the Global Foot and Ankle Congress in Chongqing, China in May.

The Diabetic Foot Clinic at Dandenong Hospital is the biggest clinic of its type in Victoria, managing more than 140 patients, including in and out patients.

Monash project to improve Chinese Australians’ type 2 diabetes self-management

Tammie Choi

A Monash University research project will help older Chinese Australians with type 2 diabetes better manage the condition following a $60,000 grant from the ADEA Diabetes Research Foundation.

Type 2 diabetes affects 80 per cent of Chinese Australians aged over 60, significantly higher than the general population, but many don’t access health management programs due to cultural reasons.

Monash dietitian researcher and lead investigator, Ms Tammie Choi, said  lifestyle factors such as diet and exercise could reduce the disease’s impact on individuals and the healthcare system, pointing to  a need for a structured diabetes education program for this group.

“Currently there is a lack of culturally appropriate diabetes education for Chinese Australians to support them manage their blood sugar levels.”

To address this, the pilot project, ‘不再慌糖講座 Not Scared of Sugar’ will focus on Chinese Australians currently missing out on structured diabetes education services.

Studies have shown that Chinese Australians don’t like the translated diabetes care model and miss out on health professionals’ support and care.

 “They tend to rely on unstructured and potentially misleading diabetes management information and many of my Chinese patients expressed feeling lost and overwhelmed,” said Ms Choi.

After being diagnosed with type 2 diabetes a few years ago, a Hong Kong Melbourne couple attended translated consultations with a diabetes educator and a dietitian.

“The individual consultations with professionals were good but we’re not used to being at the centre of attention so we felt very uncomfortable and didn’t return to the review appointments,” said Mr Lee.

Ms Choi said the Not Scared of Sugar pilot project will enable Chinese Australians with diabetes to live well every day by providing culturally-tailored diabetes education programs in a format that matches their expectations while measuring its effectiveness.

“Through this study we hope to use the diabetes education program as a forum to reconnect the affected Chinese people with health services and support them better in their diabetes self-management.”

Chair of the ADEA Diabetes Research Foundation Council, Professor Trisha Dunning, said the study would lead to significant health benefits.

“This culturally tailored Chinese diabetes education program has the potential to improve clinical outcomes for participants and has implications for other populations in Australia,” said Professor Dunning. 

The ADEA Diabetes Research Foundation are funding three universities in Australia and their partners to conduct research projects that help Australians with diabetes to live well every day.

Watch a video about Tammie's project HERE.

Ms Choi's project will be undertaken in partnership with Carrington Health, Box Hill.

Monash National Diabetes Centre of Excellence

Professor Helena Teede

A new Centre of Excellence in diabetes at Monash has been accredited by the National Association of Diabetes Centres (NADC).

Monash Diabetes in association with the Monash Centre for Health Research and Implementation (MCHRI), a collaborative Centre across the School of Public Health Monash University and Monash Health, have been accreditation as a ‘National Diabetes Centre of Excellence’.

“Accreditation recognises Monash Diabetes and MCHRI as a provider of excellence across all categories including clinical care, education, service advocacy, research and national leadership in the area of diabetes,” said MCHRI Director Professor Helena Teede.

Already acknowledged as a leader in diabetes research, Professor Sophia Zoungas is Chair of the NADC and Monash Health / MCHRI hold the federal government contract for national data collection, quality indicators, benchmarking and reporting.

“We are now accredited for four years and are the only accredited Centre of excellence in Victoria. Our work was specifically cited for consumer engagement in research and clinical care design and delivery,” added Professor Teede, who is also Executive Director Monash Partners Academic Health Sciences Centre.

“Our success in attaining this accreditation can be attributed to all the members of the Monash Health and Monash University team who work very hard to deliver in all critical areas.” said Deputy Director Dr Georgia Soldartos.

“Special thanks must go to Helena Teede for her vision and leadership,” said Diabetes Clinical Director, Dr Jennifer Wong.

“Together we have transformed Monash Diabetes over the last ten years and established and grown the Monash Centre for Health Research and Implementation.” Professor Teede noted.

Ten years ago Monash Diabetes included one inpatient service, three ambulatory care services at Monash Medical Centre and a small pharmaceutical research program.

“We have built this to five inpatient and 26 ambulatory care services and have co-developed these services with our partners and patient groups to increase services overall by 800%,” said Professor Teede.

Monash Diabetes now provide approximately 40,000 episodes of care per year from Monash Link in the community Health setting to Koo Wee Rup in a regional hospital setting.

While rapidly expanding their services to patients, Professor Teede and her team have also developed an internationally recognised and competitively funded research program within MCHRI, and the team has a significant national and international leadership profile.

“We remain one of the only operationally integrated interdisciplinary units in the country with no staff working in silos.” said Lorraine Marom, Monash Diabetes Nurse Practitioner.

The Monash Diabetes team would like to acknowledge the support of Monash Health, Monash University and Monash Partners over this time.