11 July 2024

With the right planning and preparation, women with diabetes can “absolutely” have a healthy pregnancy and a healthy baby.

This positive message from mother-of-two, Rachel Hicks (pictured), comes as National Diabetes Week, 14 to 21 July, focuses on improving access to the life-saving technology people with diabetes need to live well.

Mrs Hicks, from the Southern Highlands, who was diagnosed with type 1 diabetes when she was five years old, said access to an insulin pump and a continuous glucose monitor had been life-changing for her.

“Having diabetes as a child and a teenager, you get a lot of pressure to just fit in,” she said. “So, I was on manual injections for a very long time, and I was very against having an insulin pump for a long time as a kid.

“Encouragement from my team (at Macarthur Diabetes Service at Campbelltown Hospital) and being able to access an insulin pump through private health insurance, changed this when I was 17. I was told the pump would really help me get my diabetes in the most ideal space for my circumstances.”

For women with diabetes, understanding and managing the risks of unplanned pregnancies, undertaking pre-pregnancy planning and maintaining glycaemic control before and throughout pregnancy can significantly increase the chance of having a healthy baby.

Having high glucose levels during pregnancy, increases the chance the baby may not develop properly. It also can increase the risk of loss or stillbirth.

Mrs Hicks said when she decided to start a family, she’d been lucky enough to be among the first patients to access the Diabetes Contraception and Pre-pregnancy Program (DCAPP) when it was introduced at Campbelltown Hospital.

She said she had understood before becoming pregnant there would be challenges, and her diabetes may cause complications which could have long-term effects for her and her baby.

But, at the same time she knew she could be prepared.

“What really made a difference for me was my treating team, in addition to the introduction of DCAPP thanks to Professor David Simmons.” she said.

“It was really great to have the treating team in Campbelltown. They used language which was empowering and at every appointment they’d emphasise something that I’d done well.”

DCAPP has been designed to develop a more integrated approach to supporting women of childbearing age with type 1 and type 2 diabetes. Similar programs implemented elsewhere have reduced the rates of congenital malformations, miscarriage and stillbirths by up to 70 per cent.

South Western Sydney Primary Health Network is working in partnership with Western Sydney University and South Western Sydney Local Health District to implement the program in our region.

Mrs Hicks said it took a couple of years to get her diabetes in the space where she felt comfortable to be able to manage it and start trying for a baby.

Her pregnancy planning team included a diabetes educator, an endocrinologist and a GP, who worked collaboratively to improve her blood glucose management and put plans in place to prepare for extra low blood sugar levels, and ensure she had access to the most appropriate devices.

She said glucose monitors became more readily available around the time she was thinking about starting a family, with the introduction of a government subsidy.

“The glucose monitor removed a lot of the calculations and the decisions I’d have to make on a daily basis.

“Going through my first pregnancy there was so much more information to take on about what I needed to do for myself, for my baby, for my family during that time, so it was good to have a little bit of pressure relieved with access to a glucose monitor and getting more data on what was happening with my diabetes.

“My team helped me sign up for the glucose monitor subsidy and made sure I had all the tools I needed, even getting an updated ketones tester because I was still testing ketones manually.”

Mrs Hicks is also undertaking PhD research examining lived experiences of diabetes and pregnancy. She said in addition to tailored support like she had received, women with diabetes planning pregnancy could also benefit from the good peer support communities which existed and hearing about the experiences of others.

“As part of my research, I want to develop initiatives which are made by the community, for the community, to help improve pregnancy outcomes for people with diabetes. I also want to improve collaboration between those with lived experience of diabetes and pregnancy and healthcare professionals.”

If you have type 1 or type 2 diabetes and are thinking about having a baby, pre-pregnancy planning is vital. Speak to your GP about how you can prepare your body for a healthy pregnancy.

08 July 2024

Women with diabetes who have glucose levels outside target ranges and become pregnant are at increased risk of pregnancy related complications and poor birth outcomes.

Having support from a GP to plan and manage the pregnancies of women with diabetes can reduce complications for both the mother and baby.

South Western Sydney PHN (SWSPHN) is hosting a webinar during National Diabetes Week, 14 to 21 July, which emphasises the importance of having routine conversations with patients about managing their diabetes before becoming pregnant.

Head of the Campbelltown Hospital Endocrinology Department, Professor David Simmons, will present the Diabetes Contraception and Pre-pregnancy Program (DCAPP) webinar on Thursday, 18 July, from 7pm.

What is DCAPP?

DCAPP has been designed to develop a more integrated approach to supporting women of childbearing age with type 1 and type 2 diabetes.

SWSPHN is working in partnership with Western Sydney University and South Western Sydney Local Health District to implement the program in our region.

For women with pre-existing diabetes, understanding and managing the risks of unplanned pregnancies, undertaking pre-pregnancy planning and maintaining glycaemic level target ranges before and throughout pregnancy can significantly increase the likelihood of having a healthy baby.

Similar programs implemented elsewhere have reduced the rates of congenital malformations, miscarriage and stillbirths by up to 70 per cent.

DCAPP aims to open up early conversations between GPs and their patients about the seriousness and potential complications of becoming pregnant if the patients’ diabetes is not well-managed.

It provides GPs with guidance on managing these patients, including about referring patients with diabetes who are planning pregnancy to one of the diabetes pre-pregnancy clinics across our region. For patients who are not planning pregnancy, GPs are encouraged to discuss the importance of contraception with your patients with diabetes.

How are patients benefiting from DCAPP?

Mother of two, Rachel Hicks (pictured), was diagnosed with type 1 diabetes when she was five.

She said encouragement and support from her treating team at Macarthur Diabetes Service at Campbelltown Hospital, and Professor David Simmons introducing the Diabetes Contraception and Pre-pregnancy Program (DCAPP) at Campbelltown, made all the difference when she decided to start trying for a family.

Her team included a diabetes educator, an endocrinologist and a GP, who worked collaboratively to improve her blood glucose management and put plans in place to prepare for extra low blood sugar levels, and ensure she had access to the most appropriate devices like an insulin pump and a continuous glucose monitor.

“Going through my first pregnancy there was so much more information to take on about what I needed to do for myself, for my baby, for my family during that time. It was good to have a little bit of pressure relieved with access to a glucose monitor and getting more data on what was happening with my diabetes.”

How can diabetes care be more accessible?

Mrs Hicks is also undertaking PhD research examining lived experiences of diabetes and pregnancy, including working with DCAPP to look at peer support models.

She said her research had highlighted how there couldn’t be a one-size fits all approach to providing accessible care to, and engaging with vulnerable communities across South Western Sydney, including people from culturally linguistically and diverse (CALD) backgrounds.

“We’ve seen with diabetes programs delivered at Campbelltown Hospital for example, where our treating teams going out into the communities deliver some services in spaces which are more suitable and for those communities.

“And we saw hybrid models of care throughout the pandemic as well – a mixed delivery of services which has been beneficial, especially for women with diabetes who are concerned about how medicalised their pregnancy is going to be.

“If there’s any options for making care more accessible or equitable, like the option of the hybrid model of care, that would be most beneficial.”

Support for your practice

SWSPHN will run a POLAR report for interested practices in our region, to identify patients diagnosed with diabetes who are of childbearing age. The report will help develop a recall list, enabling you to engage those patients in discussions about pre-pregnancy planning and contraception. Our diabetes co-ordinator Alyssa Horgan is available to visit practices to assist in setting up a recall process.

For bookings or enquiries, contact Alyssa via email at alyssa.horgan@swsphn.com.au or phone 4632 3088.

Webinar details

The Diabetes Contraception and Pre-pregnancy Program webinar will:

  • educate GPs on potential maternal and neonatal outcomes if a woman’s diabetes is not controlled before pregnancy
  • which medications should be stopped, substituted or introduced before pregnancy
  • why they should refer patients to a diabetes pre-pregnancy planning clinic

It has been RACGP-approved for 1.5 Educational Activities hours.

Visit the SWSPHN website to register.

Additional resources

Download the flyer for ways to support your at-risk patients

Visit HealthPathways for pre-pregnancy planning for type 1 and type 2 diabetes pathways

Visit SWSPHN’s website to find diabetes resources for GPs

Visit Diabetes Australia for information about National Diabetes Week

24 June 2024

Western Sydney University’s accredited Diabetes Education course has a mid-year intake in July.

The Graduate Certificate in Person-centred Diabetes Care and Education is a clinically focused course which prepares students to support and educate people with diabetes to better self-manage their condition.

It’s designed for multidisciplinary clinicians including registered nurses, dietitians, podiatrists, exercise physiologists, pharmacists, physiotherapists, midwives, medical officers and other professionals working with people with diabetes.

The course is part-time with a duration of one year: July to November 2024 and March to  June 2025. Students will also undertake a 40-hour clinical placement in a diabetes service.

A Post Graduate Open Day will take place on Sunday, 30 June 2024 at Western Sydney University South Parramatta Campus.

For enquiries email coursecoordinator.diabetes@westernsydney.edu.au.

Download the flyer

Download course information

21 June 2024

The diabetes annual cycle of care is a checklist designed to help keep diabetes under control to reduce the risk of diabetes-related complications.  

If you have diabetes, your GP can help you manage your condition through a GP management plan which may allow you to receive a Medicare rebate when seeing some health professionals.  

Steps you can take to reduce the risk of complications

  • As part of your daily diabetes management, you can undertake checks of your blood glucose levels (BGLs). Your GP will advise you what your BGL target is and how often you should test. The HbA1c test (also known as glycosylated haemoglobin) demonstrates an overall view of your blood glucose management average over the previous 10 to 12 weeks. Generally, 7 per cent or lower is ideal. This can be checked at least once a year, and up to four times a year.  
  • It is also important your blood pressure is checked because high blood pressure can cause diabetes-related complications. For someone with diabetes, target blood pressure is less than 130/80. It should be checked regularly, at every doctors’ visit. 
  • There is also an increased risk of damage to kidneys over time. A yearly urine microalbumin test can be used to detect early signs of kidney damage in people who are at risk of developing kidney disease.
  • Having high cholesterol (blood fats-lipids) can increase your risk of heart disease and stroke. It is best to have your lipids checked every 12 months. 
  • Diabetes can cause complications to your eyes if left untreated. This damage can be prevented by keeping your BGL’s, HbA1c and blood pressure within target ranges. Have your eyes checked by an optometrist every one to two years or if you notice any change in your vision.
  • Your feet can also be affected by your diabetes. Make sure to look for changes every day, and see a podiatrist at least once a year.

Chart to help you manage your condition

  Check How  Often
Foot assessment for high-risk feet Every 1-3 months
Foot assessment for moderate risk feet Every 3-6 months
Blood pressure At least every 6 months
Weight At least every 6 months
Waist circumference At least every 6 months
HbA1c At least every 6-12 months
Foot assessment for Very-low and low-risk feet At least every year
Kidney health At least every year
Blood fats At least every year
Healthy eating review At least every year
Physical activity review At least every year
Medication review At least every year
Smoking At least every year
Diabetes management At least every year
Eye examination At least every two years
Emotional health As needed

You can find more information about other parts of the diabetes annual cycle of care at

Your diabetes annual cycle of care fact sheet | NDSS 

 

04 June 2024

The Get Healthy Service can help your patients make lifestyle changes to improve their health.

The service, delivered by NSW Health, complements the care provided by a patient’s regular GP by offering free phone and online health coaching to patients over the age of 16.

You can refer your patients to the service to receive six or more confidential coaching calls with a university qualified health coach.

Coaches provide support to patients and will assist them to:

Patients who complete the program have lost an average of 1.79kg, have reduced their waist circumference by 1.64cm and have reduced their BMI by 0.64kg/m2.

They were also more physically active and ate more fruit and vegetables each day.

You can refer your patients to this free service using the Get Healthy website.

07 May 2024

General practices and patients are both benefiting from Type 2 Diabetes Case Conference Clinic Days which are offered across South Western Sydney, according to one local GP who has taken up the opportunity.

Dr Dong Hua (pictured), from Kenyon Street Medical Centre at Fairfield, said he had participated in three clinic days during the past 12 months and had noted marked improvements in the health of his patients.

“In the short term, we’ve noticed improvements in glycaemic control through diet and lifestyle modification, and medication adjustments,” he said.

“It also ensures all the patients’ other diabetes related appointments, such as eye reviews and feet care, are attended to.

“But it is in the long-term where we’ll see the greatest impacts, with the prevention of complications such as blindness and toe amputations.”

What are case conference clinic days?

A specialist diabetes team will attend your practice for the day clinic. Forty-minute case conferences are held for eight eligible patients with type 2 diabetes.

The patient is included in the consultation, meeting with their GP, an endocrinologist and diabetes educator.

A follow-up telehealth clinic is held six months after the initial clinic.Under The Microscope feature article

The clinics were developed by SWSPHN in collaboration with South Western Sydney Local Health District (SWSLHD) and aim to enhance diabetes care in our region.

To date, 68 clinics have been held across 26 practices in South Western Sydney. Another 60 clinics are scheduled for this year across 33 practices.

As a result of these clinics, 74 per cent of patients have had a drop in HbA1c. Of these patients, there has been an average decrease in HbA1c of 1.76 per cent (based off their initial pathology and the review at six months).

Why hold the clinics?

Dr Hua said the clinics gave his high-risk patients – often those from culturally and linguistically diverse and low socioeconomic backgrounds – access to an endocrinologist and diabetes educator which were not readily available in his community.

“We only have one local endocrinologist in Fairfield and while he is bulk billing the wait times can be up to three to four months to see him,” he said.

“The clinics also provide great education to my registrar and I as there are a number of new diabetic drugs available and the treatment of diabetes is dynamic, it’s changing all the time.”

How has your practice benefited from the clinics?

Dr Hua said his practice and staff had benefited from the one-on-one education they had received during the case conferences.

“The education gives GPs greater confidence in adjusting patients’ medications and initiating insulin,” he said.

“We’ve noticed better compliance with treatment.

“The program has also instigated preventative recalls in our practice for diabetic patients who are not up-to-date with their annual cycle of care.”

Benefits include:

  • access to billing for MBS chronic disease items for case conferencing, GP management plans, Team Care Arrangements and items of Diabetes Cycles of Care, as eligible
  • increased patient satisfaction with a comprehensive, integrated and interdisciplinary management approach in the one location
  • GPs upskilling in diabetes management
  • access to CPD hours

How have your patients benefited from the clinics?

Dr Hua said all his patients who had attended the clinics had had a positive experience.

“It helps improve their health literacy and compliance with treatment, and they are appreciative of being educated about their diabetic health,” he said.

Benefits include:

  • a diabetes specialist service without extra cost to the patient
  • reduced waiting time for patients to access specialist care like access to an endocrinologist and diabetes educator
  • patient access to diabetes education which such as: how to eat healthy; how to monitor blood sugar levels; managing medications; setting goals and making lifestyle changes
  • continuity of care for the patient with the GP present during the consultation with the specialist

Are the clinics extra work for you?

Dr Hua said the clinics did not require any extra work from the GP.

“I usually identify the eligible patients on my routine screening and management of patients,” he said.

“Once identified and consent is obtained from the patient, I ask my practice nurse to complete the referral and schedule the patients in for the clinic.

“SWSPHN and SWSLHD support us by providing access to an endocrinologist and diabetic educator, co-ordinating the case conferences and arranging the follow-up with patients.

“Also, I find the clinic days very enjoyable and relaxing. It is good to get a break from the usual consulting days which can be busy and tiresome.”

Would you encourage other GPs to get involved?

Dr Hua said other GPs should take the opportunity to hold the clinics which provide great benefits to not only the GP and the practice, but also for high-risk patients who are given access to free specialist and diabetic education.

“The education provided allows GPs to provide better care to their other complex patients who have similar presentations,” he said.

Telehealth type 2 diabetes case conferencing

If a full-day clinic doesn’t work for you, free telehealth type 2 diabetes case conferencing is also available, providing GPs with access to an endocrinologist and diabetes educator for advice on the management of patients with type 2 diabetes. Find out more

Book your clinic

Contact Alyssa Horgan for bookings and enquiries via email at alyssa.horgan@swsphn.com.au or phone on 4632 3088.

06 May 2024

When was the last time you thought about changing your diet and lifestyle to improve your type 2 diabetes, and overall health? Knowing how to eat well, exercise and manage your medication is important.

 

Health risks of uncontrolled diabetes

Diabetes is a silent disease. You may not be aware of the damage and risks that uncontrolled diabetes may have on your health until it is too late.

Common diabetes health complications include:

  • heart disease
  • chronic kidney disease
  • nerve damage
  • problems with feet due to poor circulation
  • poor oral health
  • vision impairment
  • hearing impairment
  • mental health

The good news is positive food and activity choices can have a lot of health benefits including:

  • better blood glucose levels
  • lower blood pressure
  • lower cholesterol
  • weight loss
  • lower risk of diabetes complications
  • more energy
  • better sleep

 

FREE type 2 diabetes management session

This healthy lifestyle program will help people with type 2 diabetes, and their families, know how to manage their diabetes to stay healthy and well.

The program is delivered in an informal interactive small group setting with up to eight people. This will allow you plenty of opportunities to ask questions, and to meet others with type 2 diabetes and learn from their experiences too.

If you are recently diagnosed with type 2 diabetes, attending this program will help you set up healthy lifestyle routines.

If you have been living with type 2 diabetes for some time, this program is also for you. It can serve as a ‘refresher course’ by helping you get back on track and increase your motivation
to change unhealthy habits which may have crept into your life.

You will receive advice to effectively manage your diabetes.

Topics discussed include:

  • how to eat well
  • managing your blood sugar levels
  • recommended exercises and how often
  • why avoiding alcohol is important and tips to help you
  • questions to ask your GP

FREE type 2 diabetes management sessions are for people living with type 2 diabetes who reside in South Western Sydney.

There will be a maximum of eight people per session.

Education will be held at
Rosemeadow Community Health Centre
5 Thomas Rose Drive, Rosemeadow.

 

FREE type 2 diabetes management session

Complete this expression of interest to receive an invitation to attend a type 2 diabetes coaching session on a date which is suitable to you. Session dates are set once enough attendees have confirmed their interest to attend.  You will receive a phone call from Campbelltown Hospital, which will appear as PRIVATE CALLER (No Caller ID).

"*" indicates required fields

Do you speak English

Choose your session*
Sessions are held at Rosemeadow Community Health Centre, 5 Thomas Rose Drive, Rosemeadow.

The program is funded by South Western Sydney PHN and delivered by South Western Sydney Local Health District.

South Western Sydney PHN would like to thank Pharmacy Focus Rosemeadow for their interest and assistance with caring for community members living with type 2 diabetes.

20 March 2024

A new eight-session program for women in Bankstown who are under 40 and have weight issues, will begin at Bankstown Diabetes Centre on Thursday, 16 May, from 9.30am to 11.30am.

In the Metabolic Transformation Through Action (META) group, young women will have expert help from a clinical psychologist and dietitian in navigating the barriers to change.

They will learn about weight stigma, sustainable lifestyle change, goal setting, relapse prevention.

Find out more:

Information for health professionals

Information for patients

20 February 2024

SWSPHN is seeking expressions of interest (EOIs) from GPs who are willing to provide diabetes management care to patients being discharged from hospital psychiatric units. 

GPs will participate in a diabetes case conference alongside an endocrinologist and community mental health teams.

GPs will be able to claim $221.90 through Medicare for participating in a 40-minute case conference consultation.

Patients will continue to be supported with psychiatric care by the community mental health service.

GPs will continue to provide ongoing care for these patients.

EOIs close on Friday, 15 March.

06 February 2024

SWSPHN and South Western Sydney Local Health District are working together to enhance diabetes care in the region. Diabetes Case Conference Clinic Days are now available for GPs in South Western Sydney.

 

What are the benefits of case conferencing?

  • Case conferencing can assist GPs to support patients who present with diabetes (type 2)
  • Case conferencing with an endocrinologist in collaboration with the patients GP will provide robust clinical care and decrease admissions to the hospital 
  • Prior verbal or written consent from patient is required 

An endocrinologist and diabetes educator will attend your practice for the day, where eight eligible patients will each receive a 40-minute case conference. A follow up half-day will occur six months later, where each patient will have a 20-minute case conference. Education will be provided and you will be supported to run quality improvement initiatives for diabetes.

 

What are the benefits to my practice?

  • Access to billing for MBS chronic disease items for case conferencing, GP management plans, Team Care Arrangements and items of Diabetes Cycles of Care, as eligible
  • Diabetes Specialist service without extra cost to the patient 
  • Reduce waiting time for patients to access specialist care 
  • Increased patient satisfaction with a comprehensive, integrated and interdisciplinary management approach in the one location   

 

For more information, or to discuss booking a Case Conference clinic day, please contact SWSPHN Priority Populations Program Advisor Alyssa Horgan at Alyssa.Horgan@swsphn.com.au

 

Read more: Type 2 Diabetes Case Conferencing Clinics