The Clinical Diabetes and Epidemiology group has two main focuses. The first relates to the epidemiology of type 2 diabetes, examining trends in prevalence and incidence of diabetes (predominantly type 2) in Australia as well as the rest of the world. The work in this area, pioneered by Professor Paul Zimmet, has been instrumental in demonstrating the rapid growth of the emerging global diabetes epidemic. The surveys undertaken for this work also provide rich data for interrogating a range of putative and novel risk factors for diabetes and its complications, of which lifestyle factors have been studied extensively and remain an important target. The group also has a specific interest in the impact of diabetes on indigenous populations. The second focus capitalises on the large patient population in our Diabetes Clinic. This facilitates examination of novel treatments, and of observational data on real world responses to therapies.
- Trends in diabetes prevalence and incidence.
- Identifying novel risk factors for type 2 diabetes at a population level.
- The interactions between sleep apnoea and diabetes.
- Diabetes and indigenous health.
- Novel therapies for diabetes.
AusDiab - Australian Diabetes Obesity and Lifestyle Study
Leader: Professor Jonathan Shaw
The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) is the largest Australian longitudinal population-based study examining the natural history of diabetes, pre-diabetes (in which glucose metabolism is impaired but not to the level to cause diabetes), heart disease and kidney disease. The 1999/2000 AusDiab study was the first National Diabetes prevalence study to be conducted in Australia, and included 11,247 adults from 42 different locations across Australia. The participants were followed up in 2004/2005 and again in 2011/12 to provide the first ever information about the incidence (or development) of diabetes and other non-communicable diseases in Australia over time. AusDiab has investigated a wide array of risk factors for diabetes, obesity and kidney disease, and has made a major contribution to understanding the importance of sedentary time in relation to diabetes, cardiovascular disease and obesity. In addition to continuing to further the work in this area, the 2011/2012 follow-up added measures of cognitive function and physical disability.
Diabetes epidemiology in Mauritius
The multicultural island of Mauritius has, through a series of health surveys since 1987, undertaken with collaborators in the UK, Finland and Mauritius, provided a window into the global diabetes epidemic. A series of studies has described a rapidly rising diabetes prevalence, identified ethnic influences on diabetes and its outcomes, and insights into the influence of ethnicity on the use of HbA1c as a diagnostic tool for diabetes. Most recently, a community-based diabetes prevention trial has been commenced.
Global diabetes projections
Leader: Professor Jonathan Shaw
Since the mid-1990s, our group has been involved in estimating the global prevalence of diabetes, and forecasting the future numbers. This work has developed into the International Diabetes Federation's series of Diabetes Atlases. The work, which continues to be undertaken in collaboration with the International Diabetes Federation has revealed that the greatest burden of diabetes is in the developing world, and among people of working age, rather than the elderly.
Sleep apnoea, diabetes and related conditions
Leader: Professor Jonathan Shaw
Obstructive sleep apnoea is recognised to be intimately linked to obesity and metabolic disorders, such as diabetes. We recently completed data collection in a large multicentre trial, including sites in Australia and in the United States examining the hypothesis that treating obstructive sleep apnoea in people with diabetes will lead to improvements in metabolic and blood pressure control. Analyses of the data are currently underway. We are also collaborating with other clinical groups at Baker IDI and The Alfred hospital to identify improved ways of screening for obstructive sleep apnoea in high-risk groups including type 2 diabetes, resistant hypertension, heart failure and obesity.
Leaders: Dr Liz Barr, Professor Jonathan Shaw
The substantial gap in health outcomes for indigenous people compared to the rest of the population demands solutions at many levels. Two studies are currently being undertaken to address this issue, both of them in collaboration with the Menzies Centre in Darwin. In the first, we are following up the DRUID study cohort of over 1000 indigenous people in and around Darwin to better understand cardiovascular risk and to develop a specific risk equation to be used in indigenous people. In the second, a broad range of collaborators are developing a register of diabetes in pregnancy across the Northern Territory. The registry will address the clinical challenges of coordinating care across urban and remote indigenous communities, and will also provide a large of amount of data with which to better understand the complexities of diabetes in pregnancy in indigenous people in relation to both mother and child.
Clinical trials in diabetes
The clinical trials group undertakes a wide range of studies in people with diabetes. A number of these are as sites for large, multinational trials run by pharmaceutical companies, examining new drugs for the treatment of diabetes. Other important investigator-initiated studies include a recently completed trial of flavanols looking at their impact on blood pressure and endothelial function; a study, in collaboration with the Murdoch Childrens Research Institute, examining the effects of remote ischaemic preconditioning on metabolic function; a study of a novel needle-free injection technique for insulin administration; and a trial of a DPP4 inhibitor in the management of type 1 diabetes. Other areas of active investigation include analyses of the large clinic database looking at real world responses to drugs such as GLP1 analogues and insulin pumps; the effects of gastric banding on albuminurua and quality of life in relation to frequency and severity of type 1 diabetes.
Professor Bob Atkins
Dr Liz Barr
Associate Professor Neale Cohen
Dr Anne Reutens