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OP48 DRIVING: ACCELERATING THE MEDICAL LICENCE REVIEW PROCESS FOR FITNESS TO DRIVE
Oral presentation abstracts / Diabetes Research and Clinical Practice 106S1 (2014) S1–S41
Conclusion: The Connect2 service demonstrates the effectiveness of a telephone peer support model utilising motivational interviewing techniques to enable patients to develop and reengage with management practices for type 2 diabetes. This model has the capacity to deliver ongoing support for patients given the longevity of the condition. Results from this pilot study have the potential to inform the delivery of a large scale service to meet the growing demands of people diagnosed with type 2 diabetes. Reference(s) [1] Fisher EB., Boothroyd R. I., Coufal M.M., Baumann L.C., Mbanya J.C., Rotheram-Borus M.J., Sanguanprasit B., Tanasugam C. (2012). Peer support for self-management of diabetes: improved outcomes in international settings. Health Affairs, 31(1): 130–139.
OP48 DRIVING: ACCELERATING THE MEDICAL LICENCE REVIEW PROCESS FOR FITNESS TO DRIVE H.A. Hart1 , P. Clancy1 , T. Streitberger1 , L. Hume1 . 1 Department of Endocrinology and Diabetes, Barwon Health, Geelong, Australia Background: Licencing authorities in Australia require people with diabetes (PWD) who drive to undergo specialist medical examination to assess fitness to drive (FTD) and provide a medical report within a specified time-frame. Obtaining a medical review appointment within the stipulated timeframe can be difficult. Multiple Endocrinologist appointments may be needed if all requirements are not available at the medical review, and PWD may not be aware what constitutes satisfactory diabetes control, driver responsibilities and safe driving. We aimed to develop and implement an accelerated Endocrinologist medical review process within our current resources, that responded to patient needs within the timeframe imposed by the state licencing authority, ensured that all requirements would be available to the Endocrinologist to complete the review at a single appointment and provided education about driving and diabetes. Method: Legislative requirements related to diabetes were reviewed, a checklist was developed and patients requiring a medical licence review were triaged to the Diabetes Educator(DE). The DE conducted a telephone review, explaining the requirements that needed to be available at the medical review such as a HbA1c test result within the previous 3 months, an eye check performed within the previous 12 months, with accompanying report, and evidence of self blood glucose monitoring and diabetes treatment regimen. The DE also provided education about safe driving, discussing the need to test the blood glucose level before driving and ensure that it is above 5 mmol/L, that fast acting carbohydrate and a blood glucose meter is available when driving and that blood glucose levels are tested every 2 hours during driving, and ensure that it remains above 5 mmol/L. The DE then booked an Endocrinolgist appointment in time to complete and return the medical report by the due date. Result: 26 patients were referred for medical licence review. 1 patient cancelled their appointment and 1 patient did not attend their appointment. 24 patients were reviewed in total. 8 patients required medical review within 7 days, 4 within 2 weeks, 7 within 1 month, 4 within 6 weeks and 1 within 12 weeks. All patients reviewed met the requirements for FTD and obtained their medical report within the required timeframe, with one Endocrinologist appointment. Conclusion: We successfully developed and implemented an innovative approach within current resources that responds to patient needs, meets the FTD standards of specialist medical review, with a reduced number of Clinic appointments and provides diabetes and driving education to every patient reviewed
S25
OP49 A LOW COST PRIMARY PREVENTION TOOL: EFFECTS OF NON PHARMACOLOGICAL LIFESTYLE MODIFICATION IN PREVENTION OF TYPE 2 DIABETES MELLITUS IN YOUNG URBAN SRI LANKAN – “DIABRISK-SL” M. Wijesuriya1 , J. Karalliedde2 , M. Gulliford3 , L. Vasantharajah1 , G. Viberti2 , L. Gnudi2 . 1 Diabetes Association of Sri Lanka, Rajagiriya, Sri Lanka ; 2 Cardiovascular Division, 3 Division of Health and Social Care Research, King’s College London, London, United Kingdom Background: Type 2 Diabetes Mellitus (T2DM) and related cardio-vascular disease is increasing in epidemic proportions especially in South East Asia [1]. With 1 in 5 persons afflicted by dysglycaemia [2], an effective low cost primary prevention tool is absolutely essential to reduce the incidence. Our aim was to study the effects of intensive as oppose to less intensive lifestyle modification (LSM) in urban young. Method: A randomised controlled clinical trial to compare an intensive 3-monthly LSM (I-LSM) with a less-intensive 12 monthly LSM (LI-LSM) for a primary composite cardiometabolic endpoint of new onset T2DM, Impaired Glucose Tolerance (IGT), impaired fasting glycaemia (IFG), hypertension, dyslipidaemia and cardio-renal disease in subjects aged 5 to 40 years with 2 or more risk factors namely raised body mass index, raised waist circumference, first degree family history of T2DM and physical inactivity. A cluster sampling strategy was used to select a representative sample of 23,296 [3,4]. 4606 subjects were randomised where 3,685 (48% males) qualified for analyses at the National Diabetes Centre, Colombo between 2008 to 2013. 50% of subjects were under 16 years. Intervention: Subjects received individualised peer related LSM advice to reduce weight, improve diet, increase physical activity and reduce stress and depression at 3 monthly (ILSM) or 12 monthly (LI-LSM) for 4 years to correct risk factors. Poisson regression analyses were performed to estimate the risk reduction of I-LSM as compared to LI-LSM. Result: There were no significant baseline differences in anthropometric, clinical and demographic measures between I-LSM (n = 1807, mean ± SD age, 22.4±10 yrs) and LI-LSM (n = 1878 age, 22.4±9.8 yrs). A significant 26% relative risk reduction (RRR) (95% CI 2% to 44%) in new onset T2DM p = 0.04, and 18% RRR (95% CI 7% to 28%) in new onset IGT p = 0.002. The cumulative incidence of the primary end point after 4 years was n = 270 in I-LSM vs. n = 302 in LI-LSM, a 9% (95% CI 1.0% to 16%) RRR, which was independent of baseline age, gender, p = 0.02. At baseline there were 296 subjects with IFG (I-LSM n = 141 and LI-LSM n = 155) and 299 subjects with IGT (I-LSM n = 143 Vs LI-LSM n = 156) with no statistically significant difference between the two groups. In the I-LSM group of the 141 patients with baseline IFG, 59% (n = 83) regressed to normoglycaemia compared to 49% (n = 76) in the LI-LSM by the end of the study p = 0.16. Similarly regression of IGT to normoglycaemia occurred in 52.4% (n = 75) in the I-LSM group and 52% (n = 81) in the LI-LSM group p = 0.91. Regression of both groups IGT and IFG of approximately 50% to normoglycaemia is evidence of the importance and effectiveness of LSM in general. Conclusion: Our results demonstrate for the first time that in a young healthy urban at risk Sri Lankan population (South Asian), I-LSM significantly reduces the development of T2DM, IGT and a primary composite cardio-metabolic endpoint. Early intervention of this low cost primary prevention tool of I-LSM is greatly beneficial to the general public and is translatable globally. Reference(s) [1] IDF Diabetes Atlas [Internet]. 2013. [cited 19th November 2013]. Available from: http://www.idf.org/diabetesatlas. [2] Katulanda P, Constantine GR, Mahesh JG, Sheriff R, Seneviratne RD, Wijeratne S, et al. Prevalence and projections of diabetes
Conclusion: The Connect2 service demonstrates the effectiveness of a telephone peer support model utilising motivational interviewing techniques to enable patients to develop and reengage with management practices for type 2 diabetes. This model has the capacity to deliver ongoing support for patients given the longevity of the condition. Results from this pilot study have the potential to inform the delivery of a large scale service to meet the growing demands of people diagnosed with type 2 diabetes. Reference(s) [1] Fisher EB., Boothroyd R. I., Coufal M.M., Baumann L.C., Mbanya J.C., Rotheram-Borus M.J., Sanguanprasit B., Tanasugam C. (2012). Peer support for self-management of diabetes: improved outcomes in international settings. Health Affairs, 31(1): 130–139.
OP48 DRIVING: ACCELERATING THE MEDICAL LICENCE REVIEW PROCESS FOR FITNESS TO DRIVE H.A. Hart1 , P. Clancy1 , T. Streitberger1 , L. Hume1 . 1 Department of Endocrinology and Diabetes, Barwon Health, Geelong, Australia Background: Licencing authorities in Australia require people with diabetes (PWD) who drive to undergo specialist medical examination to assess fitness to drive (FTD) and provide a medical report within a specified time-frame. Obtaining a medical review appointment within the stipulated timeframe can be difficult. Multiple Endocrinologist appointments may be needed if all requirements are not available at the medical review, and PWD may not be aware what constitutes satisfactory diabetes control, driver responsibilities and safe driving. We aimed to develop and implement an accelerated Endocrinologist medical review process within our current resources, that responded to patient needs within the timeframe imposed by the state licencing authority, ensured that all requirements would be available to the Endocrinologist to complete the review at a single appointment and provided education about driving and diabetes. Method: Legislative requirements related to diabetes were reviewed, a checklist was developed and patients requiring a medical licence review were triaged to the Diabetes Educator(DE). The DE conducted a telephone review, explaining the requirements that needed to be available at the medical review such as a HbA1c test result within the previous 3 months, an eye check performed within the previous 12 months, with accompanying report, and evidence of self blood glucose monitoring and diabetes treatment regimen. The DE also provided education about safe driving, discussing the need to test the blood glucose level before driving and ensure that it is above 5 mmol/L, that fast acting carbohydrate and a blood glucose meter is available when driving and that blood glucose levels are tested every 2 hours during driving, and ensure that it remains above 5 mmol/L. The DE then booked an Endocrinolgist appointment in time to complete and return the medical report by the due date. Result: 26 patients were referred for medical licence review. 1 patient cancelled their appointment and 1 patient did not attend their appointment. 24 patients were reviewed in total. 8 patients required medical review within 7 days, 4 within 2 weeks, 7 within 1 month, 4 within 6 weeks and 1 within 12 weeks. All patients reviewed met the requirements for FTD and obtained their medical report within the required timeframe, with one Endocrinologist appointment. Conclusion: We successfully developed and implemented an innovative approach within current resources that responds to patient needs, meets the FTD standards of specialist medical review, with a reduced number of Clinic appointments and provides diabetes and driving education to every patient reviewed
S25
OP49 A LOW COST PRIMARY PREVENTION TOOL: EFFECTS OF NON PHARMACOLOGICAL LIFESTYLE MODIFICATION IN PREVENTION OF TYPE 2 DIABETES MELLITUS IN YOUNG URBAN SRI LANKAN – “DIABRISK-SL” M. Wijesuriya1 , J. Karalliedde2 , M. Gulliford3 , L. Vasantharajah1 , G. Viberti2 , L. Gnudi2 . 1 Diabetes Association of Sri Lanka, Rajagiriya, Sri Lanka ; 2 Cardiovascular Division, 3 Division of Health and Social Care Research, King’s College London, London, United Kingdom Background: Type 2 Diabetes Mellitus (T2DM) and related cardio-vascular disease is increasing in epidemic proportions especially in South East Asia [1]. With 1 in 5 persons afflicted by dysglycaemia [2], an effective low cost primary prevention tool is absolutely essential to reduce the incidence. Our aim was to study the effects of intensive as oppose to less intensive lifestyle modification (LSM) in urban young. Method: A randomised controlled clinical trial to compare an intensive 3-monthly LSM (I-LSM) with a less-intensive 12 monthly LSM (LI-LSM) for a primary composite cardiometabolic endpoint of new onset T2DM, Impaired Glucose Tolerance (IGT), impaired fasting glycaemia (IFG), hypertension, dyslipidaemia and cardio-renal disease in subjects aged 5 to 40 years with 2 or more risk factors namely raised body mass index, raised waist circumference, first degree family history of T2DM and physical inactivity. A cluster sampling strategy was used to select a representative sample of 23,296 [3,4]. 4606 subjects were randomised where 3,685 (48% males) qualified for analyses at the National Diabetes Centre, Colombo between 2008 to 2013. 50% of subjects were under 16 years. Intervention: Subjects received individualised peer related LSM advice to reduce weight, improve diet, increase physical activity and reduce stress and depression at 3 monthly (ILSM) or 12 monthly (LI-LSM) for 4 years to correct risk factors. Poisson regression analyses were performed to estimate the risk reduction of I-LSM as compared to LI-LSM. Result: There were no significant baseline differences in anthropometric, clinical and demographic measures between I-LSM (n = 1807, mean ± SD age, 22.4±10 yrs) and LI-LSM (n = 1878 age, 22.4±9.8 yrs). A significant 26% relative risk reduction (RRR) (95% CI 2% to 44%) in new onset T2DM p = 0.04, and 18% RRR (95% CI 7% to 28%) in new onset IGT p = 0.002. The cumulative incidence of the primary end point after 4 years was n = 270 in I-LSM vs. n = 302 in LI-LSM, a 9% (95% CI 1.0% to 16%) RRR, which was independent of baseline age, gender, p = 0.02. At baseline there were 296 subjects with IFG (I-LSM n = 141 and LI-LSM n = 155) and 299 subjects with IGT (I-LSM n = 143 Vs LI-LSM n = 156) with no statistically significant difference between the two groups. In the I-LSM group of the 141 patients with baseline IFG, 59% (n = 83) regressed to normoglycaemia compared to 49% (n = 76) in the LI-LSM by the end of the study p = 0.16. Similarly regression of IGT to normoglycaemia occurred in 52.4% (n = 75) in the I-LSM group and 52% (n = 81) in the LI-LSM group p = 0.91. Regression of both groups IGT and IFG of approximately 50% to normoglycaemia is evidence of the importance and effectiveness of LSM in general. Conclusion: Our results demonstrate for the first time that in a young healthy urban at risk Sri Lankan population (South Asian), I-LSM significantly reduces the development of T2DM, IGT and a primary composite cardio-metabolic endpoint. Early intervention of this low cost primary prevention tool of I-LSM is greatly beneficial to the general public and is translatable globally. Reference(s) [1] IDF Diabetes Atlas [Internet]. 2013. [cited 19th November 2013]. Available from: http://www.idf.org/diabetesatlas. [2] Katulanda P, Constantine GR, Mahesh JG, Sheriff R, Seneviratne RD, Wijeratne S, et al. Prevalence and projections of diabetes