ellitus (T2DM) that is first diagnosed at a young age (less than 25 years old). The number of people being diagnosed with young onset diabetes is increasing around Australia, particularly in Aboriginal or Torres Strait Islander youth. This is concerning because young-onset diabetes has been shown to be a more aggressive version of diabetes than the later-onset type, and is associated with earlier progression to complications. These complications can include damage to the eyes (retinopathy), kidneys (nephropathy), nerves (neuropathy) and the heart and brain (cardiovascular disease). Importantly, there are things that can be done, which can prevent or slow down the onset of these complications.
We are concerned at some of the preventable early complications that we are seeing in young people with diabetes in the Region. We would like to be able to work out the best way to support young people with young-onset diabetes across the Kimberley.
What will this evaluation project involve?:
- Describing the current situation of young-onset diabetes in the Kimberley
- Identifying best practice screening guidelines for young-onset diabetes in our region
Progress so far:
We piloted a locally developed evidence-based screening algorithm in a remote Western Australian Kimberley town for 6-month. A retrospective audit of electronic health records for the pilot period and a 6-month period before the screening algorithm was introduced was conducted. Interviews were held with 30 PHC staff at participating services, an Aboriginal Community Controlled Health Service (ACCHS) and a hospital-based general practice service.
During the pilot, significantly more patients received an initial T2D screening test at the ACCHS (22% v. 36%, P = 0.011), but there was no change at the hospital (0.02% v. 0.02%). Staff feedback suggested measures to improve screening: simple guidelines, targeted screening, patient and staff education, point-of-care HbA1c tests and a whole-of-clinic approach to implementation. Implementing a screening algorithm for young-onset diabetes in Aboriginal Australians is challenging, but practical measures can be taken to improve screening.
Andreana Manifold, David Atkinson, Julia V. Marley, Lydia Scott, Gavin Cleland, Paula Edgill and Sally Singleton. Complex diabetes screening guidelines for high-risk adolescent Aboriginal Australians: a barrier to implementation in primary health care. Aust J Prim Health 2019; 25:501-508. https://doi.org/10.1071/PY19030
KIDDY Screening #1 – plain language report for community (181 KB)
KIDDY Screening #1 – plain language report for staff (241 KB)
- Dr Sally Singleton
- Dr Emma Griffiths, KAMS and RCSWA
- Dr Gavin Cleland, WACHS-Kimberley
- Dr Lydia Scott, WACHS-Kimberley
- Dr Andreana Manifold, RCSWA
- Assoc Professor Julia Marley, KAMS and RCSWA
- Prof David Atkinson, RCSWA
End-Stage Kidney Disease (ESKD) rates are much higher for Aboriginal and Torres Strait Islander people, particularly those living in remote areas. Despite this, they are much less likely to receive a transplant. Concerns about this inequity have recently sparked national inquiries and the formation of the National Kidney Transplantation Taskforce (NIKTT), to which Kimberley Renal Services (KRS) provides representation.
Assessment of transplant suitability requires a review with each patient for medical, surgical and social risk factors, however no templates are available to support this process. Elsewhere a formalised process has been found to increase transplant waitlisting, but this was in a metropolitan renal unit with low numbers of Aboriginal and Torres Strait Islander patients. We would like to employ a CQI approach to develop a process for transplant suitability assessment, which will increase access to transplant waitlisting for our patients and contribute to the improvement of access to renal transplantation for Aboriginal and Torres Strait Islander Australians.
This project will have three phases:
- Develop a template and process to improve the transparency and efficiency of transplant suitability assessment. To do 