Research

Our Board announce a series of research initiatives to support South Australians living with diabetes.

As part of our mission – and through the generous support of our members and the community of South Australia – we have funded research into diabetes almost since our inception.

Our Research Grant Program takes this to a new level.

Diabetes SA Research Grant Program

Diabetes SA is pleased to announce six new research initiatives to take place in South Australia as part of our Research Grant Program.

While each area of research is different, all are designed to ultimately lead to better outcomes for people living with diabetes, including those at risk.

Funding was initially set at $200,000 – but given the calibre of applicants and the Board’s commitment to funding research across both main types of diabetes – this was increased to $270,750.   

We extend our special thanks to our four specialist advisors – Professor Michael Horowitz, Professor Jennifer Couper, Associate Professor Stephen Stranks and our Honorary Consultant Endocrinologist Dr Anthony Roberts.

All were very giving of their time, knowledge and expertise and joined our Research Sub-Committee members Geoff Weeks, Peter Crouch, Monika Kruger and Roslyn Hewlett to select the following six successful applicants.

Diabetes SA funding – $50,000

Evaluation of the topical application of high density lipoproteins on wound healing in patients with diabetic foot ulcers – a phase ½ clinical trial.

Dr Christina Bursill
South Australian Health & Medical Research Institute (SAHMRI) and Royal Adelaide Hospital

“Our research focuses on finding new ways to prevent the vascular complications of diabetes.” – Dr Christina Bursill

In some of her more recent studies, Dr Christina Bursill has used the “Good Cholesterol” also known as high-density lipoproteins (HDL) to increase new blood vessel formation.

The growth of new blood vessels is very important in people with peripheral artery disease in which the blood vessels in the leg become blocked so that more blood can be delivered to the lower leg and foot. New blood vessel formation is also essential for wound healing.

As people with diabetes have an impaired ability to grow new blood vessels and therefore experience increased complications in peripheral arterial disease and slower wound healing with an increased risk of requiring minor or major amputations; our research has shown that the Good Cholesterol is able to increase new blood vessel formation in models that represent peripheral arterial disease and wound healing. This leads to improved recovery in peripheral arterial disease and faster rates of wound closure.

We continue to investigate the underlying mechanisms for these effects of the Good Cholesterol so that we can help to overcome the debilitating vascular complications caused by diabetes. Through the support of Diabetes SA, we are now able to conduct for the first time a clinical trial in which we will test the wound healing properties of topically applied HDL to the wounds of patients with diabetic foot ulcers. If successful this work could change standard wound care practice, which currently has very few effective options.

Diabetes SA funding – $50,000

Effects of acute hyperglycaemia on the slowing of gastric emptying induced by short acting GLP-1 receptor agonists in type 2 diabetes.

Dr Chinmay Marathe
Adelaide Medical School – The University of Adelaide

“The human gut plays an important role in regulating blood glucose. After a meal, ingested food empties from the stomach at a constant rate (called ‘gastric emptying’) and determines the absorption of nutrients and the rise in blood glucose following a meal.” – Dr Chinmay Marathe

The prevailing blood glucose environment (or ‘glycaemia’) on the other hand impacts gastric emptying profoundly. Abnormally high blood glucose (or ‘hyperglycemia’) slows gastric emptying while low blood glucose (or ‘hypoglycemia’) accelerates it. Hyperglycemia is characteristic of poorly controlled diabetes and often seen in people with type 2 diabetes with otherwise reasonable control during hospitalisation.

As short-acting GLP-1 receptor agonists are commonly prescribed for the treatment of type 2 diabetes and act by slowing gastric emptying, our study examines whether effects of GLP-1 receptor agonists on slowing of gastric emptying are additive in the presence of hyperglycemia.

“If our hypothesis proves correct, it would suggest that short-acting GLP-1 receptor agonists should be avoided during extreme hyperglycemia (e.g. when hospitalised), since the resulting profound delay in gastric emptying is likely to impair absorption of nutrients and oral medications, and potentially induce gastrointestinal symptoms, and in insulin dependent patients increase the risk of hypoglycemia.” Dr Marathe said.

Diabetes SA funding – $50,000

The impact of modifiable exposures in the parent’s and child’s environment on the risk of type 1 diabetes.

Dr Rebecca Thomson
Robinson Research Institute and Adelaide Medical School, The University of Adelaide

“This research project is part of the Environmental Determinants of Islet Autoimmunity (ENDIA) study (www.endia.org.au) which is investigating what may be driving the increased incidence of type 1 diabetes in Australian children. ENDIA is the first study in the world following 1,400 children at risk of type 1 diabetes from early pregnancy to understand how the interactions between genes and the modern environment are driving this increase in type 1 diabetes.” ­– Dr Rebecca Thomson

Research in other conditions has shown that modifiable lifestyle factors in the three months before conception and during pregnancy and early life can induce epigenetic changes that alter the offspring’s health. This has not yet been studied in type 1 diabetes, but it is important as preschool children develop the first signs of developing type 1 diabetes often years before any symptoms develop. The modern environment has changed substantially over the last 50 years and factors such as age at conception, weight and nutrition could be having an impact on future generations.

As part of the ENDIA study participants provide stool samples during pregnancy and early life to investigate the gut microbiome. There are trillions of microorganisms living inside your gut which influence your health, and how your immune system functions. Your microbiome is acquired before and at birth and is dynamically modified by early life events.

“With the help of funding from Diabetes SA, we will be able to combine data about the composition of the gut microbiome and nutrition, growth and lifestyle data from preconception, pregnancy and early life. We will be comparing children who have developed the first signs of type 1 diabetes (islet autoimmunity) with those who have not. We will be able to look at how the child’s gut microbiome before the onset of islet autoimmunity relates to the microbiomes of their parents and also to different factors in the parents’ and child’s environments (such as weight and child’s growth, smoking and alcohol intake, nutrition and infant feeding, exercise, antibiotic and medication intake, animal exposure, and mode of birth).Type 1 diabetes is a complex condition and we need to understand what causes it in early life before we can find treatments to prevent it in childhood. The discovery of what is modifiable in our modern environment during preconception, pregnancy and early life that increases risk, or even reduces risk and is protective, will drive the development of strategies to reduce the incidence of type 1 diabetes in childhood.” Dr Thomson said.

Diabetes SA funding – $50,000

A bitter tale of artificial sweeteners in type 2 diabetes.

Associate Professor Richard Young
Adelaide Medical School – The University of Adelaide

“Type 2 diabetes is a modern epidemic, but effective control of blood glucose can reduce the incidence and progression. Artificial sweeteners are generally viewed as ‘inert’ and it is widely assumed that replacing sugar with artificial sweeteners will reduce the risk of diabetes and obesity. We have discovered, on the contrary, that diets high in artificial sweeteners can enhance the absorption of glucose from the gut and worsen control of blood sugar in healthy people.” – Associate Professor Richard Young

Is regular and high consumption of artificial sweeteners helpful or harmful? Researchers from The University of Adelaide and South Australian Health & Medical Research Institute (SAHMRI) are set to find out.

Having shown that artificial sweeteners worsen the control of blood sugar in healthy people, the world class team of Associate Professor Richard Young, Professor Chris Rayner, Associate Professor Geraint Rogers and Professor Michael Horowitz will now set out to test whether these same sweeteners also impact blood glucose control in people with type 2 diabetes, who are typically high consumers of artificial sweeteners.

“Our research will show how the gut detects and increases the absorption of glucose due to exposure to artificial sweeteners. It will also prove for the first time whether artificial sweeteners alter gut bacteria in a way that impairs blood glucose control in people with type 2 diabetes and we’ll compare this with data we have collected in healthy people. Our study findings will help drive public health policy on artificial sweetener consumption with the potential to reduce the global incidence and burden of type 2 diabetes. In the longer term our findings will have potential to lead to the development of new antidiabetic medication that targets novel mechanisms we are investigating.” Associate Professor Young said.

Diabetes SA funding – $50,000

Understanding the regulation of gut derived glucagon and its implications for type 2 diabetes treatment.

Professor Damien Keating
College of Medicine – Flinders University of South Australia

“This is a truly novel research discovery about a hormone that is central to the control of blood glucose levels. If we can understand how to control the release of this hormone from the gut wall, we may then be able to identify drugs that can control glucagon levels in our blood. As such our ultimate aim would be to lower blood glucagon levels as a novel treatment approach for high blood glucose levels in people with diabetes.” – Professor Damien Keating

As glucagon is a peptide hormone of essential importance for glucose homeostasis, it has always been considered a pancreas-specific hormone and one that plays a central role in maintaining blood glucose levels through its stimulatory effects on glucose production from the liver. When glucose concentrations are high, glucagon secretion is suppressed, and during low glucose concentrations (such as between meals), glucagon secretion is increased. This ensures an essential supply of energy (i.e. glucose) to the central nervous system and muscles.

In patients with diabetes, glucagon concentrations are elevated in the fasting state and fail to decrease appropriately (or even increase) after ingestion of a meal. Such inappropriately high glucagon concentrations result in increased glucose production in the body and, thereby, contribute significantly to hyperglycaemia in patients with diabetes.

This project, funded by Diabetes SA, is focused on a new discovery by local and international researchers that glucagon is not derived only from the pancreas. Professor Damien Keating at Flinders University along with a team of research collaborators from The University of Adelaide, SAHMRI, Flinders Medical Centre and the University of Copenhagen, have identified that the human gut is also capable of synthesising and secreting glucagon. Furthermore, their data indicates that nutrients from food stimulate the release of gut-derived glucagon.

The aims of this project are to understand how nutrients trigger glucagon secretion from the gut, what other signals control its secretion, and whether or not gut-derived glucagon release is increased in humans with diabetes.

Diabetes SA funding – $20,750

Reconstructing the stigma and blame, a critical pedagogy for stigmatised persons living with type 2 diabetes.

Professor Paul Ward
College of Medicine and Public Health – Flinders University of South Australia

“Why do certain individuals feel ashamed, blamed, or devalued on account of their diabetes and what can be done about it? Supported by Diabetes SA, these are the questions that Public Health researchers within Flinders University’s College of Medicine and Public Health are attempting to address.” – Professor Paul Ward

There is a growing field of Australian and international research that has highlighted the importance of stigma within the lives of persons with diabetes. Stigma is harmful because it can make a person feel tainted or spoiled in comparison to others. It is thought to occur when people with type 2 diabetes are unfairly judged according to generalised negative beliefs (or stereotypes) about diabetes.

As a result, some individuals will conceal their diabetes status (or self-care activities) in order to avoid the negative reactions of others. Despite the existence of these commonly held stereotypes, it is important to recognise that not everyone living with diabetes may feel stigmatised. Some may reject these negative stereotypes or feel that they are not applicable to themselves.

Although researchers are beginning to better understand the process of stigmatisation, there are currently few tried and tested approaches for dismantling this stigma. In addressing this problem, Public Health researchers at Flinders University have turned to educational models that have previously been used to change harmful social beliefs and practices.

Conducted within the southern Adelaide metropolitan area, their research will examine the effects of a six-week education program for persons with type 2 diabetes who are feeling ashamed, blamed, or devalued because of their condition. At the end of the program, it is hoped that participants will experience helpful changes in their understanding of diabetes and recognise how they might challenge negative societal beliefs about diabetes. 

“Although participation in the education program is expected to assist individuals to be less affected by negative stereotypes, resulting in improved quality of life and improved self-management, it is also expected to start to shift in the way that people understand and talk about diabetes. This will help reduce the barriers to people with diabetes in realising their full potential as members of society.” Professor Ward said.

For further information, please contact Professor Ward at diabetes.stigma@flinders.edu.au.

Diabetes Services Under the Spotlight. A Flinders University Study.

As a person-centred organisation, we place paramount importance on the quality of our service delivery.

This Flinders University study engages with the community to identify opportunities for service enhancement.

To ensure our continuing relevance to people with diabetes, in particular our members, our Board has engaged Flinders Business from Flinders University of South Australia to undertake a year-long market research program.

This program is aimed at understanding the current utilisation of Diabetes SA services and the overlap with the National Diabetes Services Scheme and services available through other organisations, as well as the perceptions of Diabetes SA services and future needs and preferred channels for accessing these services.

Dr Lara Stocchi is a senior lecturer and researcher in marketing at the College of Business, Government and Law at Flinders University and is the main academic lead in the market research project Flinders University is conducting for Diabetes SA. She brings to the project her extensive knowledge of consumer behaviour and brand management. Her colleagues Dr Ashokkumar Manoharan and Miss Bryony Jardine are also involved in the project and bring to the team extensive insights on strategic management in profit and not-for-profit organisations.

The first phase of this research saw Flinders University conduct a series of focus group discussions involving more than 50 people, including members of Diabetes SA as well as non-members. The aim of the research conducted on behalf of Diabetes SA was to gather ample feedback from the community of people living with diabetes, so that the organisation can revitalise the range of services and programs offered.

The focus groups with current members were perceived as a venue to share views on individual needs, and provided very exciting suggestions on possible modifications and extensions of Diabetes SA services. For example, several members indicated that they would like to see more flexibility (e.g. around the time and day during which key services are available) and innovation in Diabetes SA’s services (e.g. a stronger connection with scientific research).

Many members also indicated that they continue to see great value in what the organisation offers, regardless of the recent changes to the NDSS. Above all, for its members, Diabetes SA remains the key hub for specialist knowledge and specialist support. To a certain extent, this is why many people have remained affiliated for many years, motivated by philanthropic reasons and the desire to support the organisation in its mission, and to belong to a community of people living with diabetes.

The discussions with non-members highlighted very important reflections, especially in relation to the need for services linked to prevention. Many participants shared the view that, until the diagnosis, people do not have a key point of reference for support and advocacy for their needs. The attitude that the general public and even health professionals have towards prevention, in fact, can be rather confronting. As a result, people at risk of being diagnosed with diabetes feel that they have nowhere to go, which is why many suggested that Diabetes SA could play a greater role helping lift the stigma of diabetes. Non-members also received very positively the possibility of Diabetes SA providing a prevention program in the future.

More generally, the focus groups returned a lot of feedback in relation to the services that Diabetes SA is already offering, and highlighted the need to strengthen awareness of these services, especially among the newest members and non-members. In fact, the focus groups with new members confirmed the importance of the initial steps into one’s journey with diabetes and the crucial role that Diabetes SA has in providing information and support. Existing members, on the other hand, expressed the desire to be reminded of Diabetes SA services via non-intrusive methods of communication, such as email and newsletters, which were preferred over phone communication.

Importantly, the focus groups highlighted a series of concerns and confusion in relation to the NDSS and the rules for accessing products, which were described as somewhat problematic for prevention and self-management purposes. Thanks to the feedback collected, Diabetes SA can now pinpoint some of the most recurring issues. These insights will inform strategic considerations resulting from this project and beyond.

Finally, the focus groups highlighted the need, for Diabetes SA, to maintain a combination of physical (i.e. store and face-to-face) and digital (especially the web and the newsletter) presence, raising awareness around the services linked to diabetes available to people beyond the NDSS. At the same time, other digital media such as social media and apps were highlighted as a possible way to reach younger generations. Moreover, since most participants claimed that they regularly access other services linked to diabetes via the private and public health system, Diabetes SA will continue to evaluate strategic partnerships that can return great value to members.

Our appreciation is extended to the focus group participants for providing their time, insight and ideas. Your input has been invaluable in this process.

The next phase of the program will see members and non-members participating in an online survey to further extend the scope of the results of the focus groups.

The final phase of the project will be a survey of organisations that Diabetes SA collaborates with and prospective organisations that Diabetes SA could collaborate with to streamline the provision of services linked to diabetes.

Market Research Update: September 2018

Flinders Business has recently concluded the second phase of the one-year long market research project that is conducting on behalf of Diabetes SA. The overall purpose of this phase of the project was to evaluate the thoughts, feelings, and current and future behaviour of both current and prospective members of Diabetes SA. This was in relation to existing as well as potential services for diabetes. Extending from the insights gathered through a series of focus groups conducted earlier this year, two online surveys were conducted: one distributed by Diabetes SA to current members and non-members linked to the organisation; and a second survey targeting the wider South Australian public. In brief, some of the key findings that emerged were the following.

  • Diabetes SA is in a robust position in relation to being at the top of people’s mind when thinking about services for diabetes. In more detail, it is ahead of the NDSS and pharmacies, and mostly on par with GPs and doctors. It also comes to mind to those who are not members and have varying level of potential risk of diabetes, who typically struggle to think of sources of services for diabetes.
  • The greatest overlap as a source of services for diabetes occurs between Diabetes SA and the GPs and doctors; not the NDSS and pharmacies. This result was consistent both in terms of general level of awareness, perceptions and also current behaviour of people living with diabetes. Importantly, considering people’s current behaviour, three ‘star’ Diabetes SA services consistently feature among the small ‘repertoire’ of approximately five or so services for diabetes that people use, which includes: going to the GP/doctors; going to the pharmacy/chemist; reading the Diabetes SA Living Magazine; reading the Diabetes SA newsletter; and buying products at DSA other than the NDSS supply.
  • The most significant individual needs or benefits sought for people living with diabetes are: convenience, professional knowledge and support, informative and accurate service, advocacy, excellent service, constant learning, effectiveness (leads to the desired outcomes), trustworthiness and personal relevance. A few of Diabetes SA services meet these needs and it is a priority to enhance this further. For example, the most popular service extension that is likely to attract a lot of interest and usage is eye-care. Moreover, the wider public seems quite interested in a prevention program, which is currently under development.

The next step of this project will see Flinders Business investigate the opportunities for Diabetes SA to collaborate with other organisations involved in the provision of services linked to diabetes.

Flinders Business and Diabetes SA would like to thank to all people who have been involved in this research project to date. We are particularly grateful for the input of over twelve hundred people who have completed these surveys.