Prevention of diabetes after gestational diabetes: better translation of nutrition and lifestyle messages needed

Type 2 Diabetes Mellitus (T2DM) and Gestational Diabetes (GDM) are important and escalating problems worldwide. GDM increases the risk of complications in pregnancy and birth, as well as a 1 in 2 chance of developing T2DM later in life. The burden of GDM extends to offspring, who have an increased risk of obesity and diabetes—further perpetuating the cycle of diabetes within families. Clinical trial evidence demonstrates T2DM incidence reduced by up to 50% for women with GDM with nutrition and physical activity changes and the economic modeling suggests cost effectiveness. The key diet-related changes to reduce T2DM risk are reviewed, in addition to breastfeeding. The difficulties associated with the delivery of dietary and lifestyle behaviour change to women after GDM are discussed and focus on: complex healthcare system interactions needed for care delivery; women finding postpartum self-care challenging; and low levels of awareness being present across the board. In addition, studies currently underway to improve care provision in this important area will be examine

Supporting culturally and linguistically diverse students during clinical placement: strategies from both sides of the table

Background: Increasing proportions of Culturally and Linguistically Diverse (CALD) students within health professional courses at universities creates challenges in delivering inclusive training and education. Clinical placements are a core component of most health care degrees as they allow for applied learning opportunities. A research gap has been identified in regard to understanding challenges and strategies for CALD students in health professional placements. Methods: A key stakeholder approach was used to examine barriers and enablers experienced by CALD students in clinical placement. Semi-structured focus groups with healthcare students (n = 13) and clinical placement supervisors (n = 12) were employed. The focus groups were analysed using open coding and thematic analysis. Results: Three main barrier areas were identified: placement planning and preparation; teaching, assessment and feedback; and cultural and language issues. Potential solutions included addressing placement planning and preparation barriers, appropriate student placement preparation, pre-placement identification of higher risk CALD students, and diversity training for supervisors. For the barrier of teaching, assessment & feedback, addressing strategies were to: adapt student caseloads, encourage regular casual supervisor-student conversations, develop supportive placement delivery modes and structures, set expectations early, model the constructive feedback process, use visual aids, and tailor the learning environment to individual student needs. The enablers for cultural & language issues were to: build language and practical approaches for communication, raise awareness of the healthcare system (how it interacts with healthcare professions and how patients access it), and initiate mentoring programs. Conclusions: The findings suggest that teaching and learning strategies should be student-centred, aiming to promote awareness of difference and its impacts then develop appropriate responses by both student and teacher. Universities and partnering agencies, such as clinical training providers, need to provide an inclusive learning environment for students from multiple cultural backgrounds

Challenges of diabetes prevention in the real world : results and lessons from the Melbourne diabetes prevention study

OBJECTIVE: To assess effectiveness and implementability of the public health programme Life! Taking action on diabetes in Australian people at risk of developing type 2 diabetes. RESEARCH DESIGN AND METHODS: Melbourne Diabetes Prevention Study (MDPS) was a unique study assessing effectiveness of Life! that used a randomized controlled trial design. Intervention participants with AUSDRISK score ≥15 received 1 individual and 5 structured 90 min group sessions. Controls received usual care. Outcome measures were obtained for all participants at baseline and 12 months and, additionally, for intervention participants at 3 months. Per protocol set (PPS) and intention to treat (ITT) analyses were performed. RESULTS: PPS analyses were considered more informative from our study. In PPS analyses, intervention participants significantly improved in weight (-1.13 kg, p=0.016), waist circumference (-1.35 cm, p=0.044), systolic (-5.2 mm Hg, p=0.028) and diastolic blood pressure (-3.2 mm Hg, p=0.030) compared with controls. Based on observed weight change, estimated risk of developing diabetes reduced by 9.6% in the intervention and increased by 3.3% in control participants. Absolute 5-year cardiovascular disease (CVD) risk reduced significantly for intervention participants by 0.97 percentage points from 9.35% (10.4% relative risk reduction). In control participants, the risk increased by 0.11 percentage points (1.3% relative risk increase). The net effect for the change in CVD risk was -1.08 percentage points of absolute risk (p=0.013). CONCLUSIONS: MDPS effectively reduced the risk of diabetes and CVD, but the intervention effect on weight and waist reduction was modest due to the challenges in recruiting high-risk individuals and the abbreviated intervention

Results of the first recorded evaluation of a national gestational diabetes mellitus register: challenges in screening, registration, and follow-up for diabetes risk

OBJECTIVE:Gestational Diabetes Mellitus (GDM) increases the risk of type 2 diabetes. A register can be used to follow-up high risk women for early intervention to prevent progression to type 2 diabetes. We evaluate the performance of the world's first national gestational diabetes register. RESEARCH DESIGN AND METHODS:Observational study that used data linkage to merge: (1) pathology data from the Australian states of Victoria (VIC) and South Australia (SA); (2) birth records from the Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM, VIC) and the South Australian Perinatal Statistics Collection (SAPSC, SA); (3) GDM and type 2 diabetes register data from the National Gestational Diabetes Register (NGDR). All pregnancies registered on CCOPMM and SAPSC for 2012 and 2013 were included-other data back to 2008 were used to support the analyses. Rates of screening for GDM, rates of registration on the NGDR, and rates of follow-up laboratory screening for type 2 diabetes are reported. RESULTS:Estimated GDM screening rates were 86% in SA and 97% in VIC. Rates of registration on the NGDR ranged from 73% in SA (2013) to 91% in VIC (2013). During the study period rates of screening at six weeks postpartum ranged from 43% in SA (2012) to 58% in VIC (2013). There was little evidence of recall letters resulting in screening 12 months follow-up. CONCLUSIONS:GDM Screening and NGDR registration was effective in Australia. Recall by mail-out to young mothers and their GP's for type 2 diabetes follow-up testing proved ineffective.Douglas I. R. Boyle, Vincent L. Versace, James A. Dunbar, Wendy Scheil, Edward Janus, Jeremy J. N. Oats, Timothy Skinner, Sophy Shih, Sharleen O'Reilly, Ken Sikaris, Liza Kelsall, Paddy A. Phillips, James D. Best, on behalf of MAGDA Study Grou

Transitions in reflective practice: exploring student development and preferred methods of engagement

Aim: Health-care professional students are required to demonstrate their reflective practice skills during their degree training programme. Online and digital technologies are increasingly being used to support this skill development. Our study aimed to explore whether different technology-based methods supported student growth and skill development in reflective practice at separate developmental time points (novice and competent). Methods: Third- (n = 23) and fourth-year undergraduate dietetic students (n = 22) from a single university were cross-sectionally surveyed via an online anonymous questionnaire at the end of the academic year. The mixed methods survey of 37 questions investigated the student experience of different reflective practice activities, their effect on a student\u27s ability to self-reflect and whether using them aided a student\u27s perceived transition towards becoming a competent dietitian. The data analysis included brief thematic enquiry, descriptive and independent t-test statistical examination. Results: Differences emerged in the way students engaged in reflection over time. Fourth-year students preferred to use more independent methods such as e-journaling (fourth- vs third-year students, P = 0.003) and engaged in reflection for reasons outside assessment (fourth- vs third-years, P = 0.027). Fourth-year students also identified fewer negative barriers to participating in reflection and reported being comfortable engaging in reflective practice. Conclusions: Overall, offering students a range of ways to engage in reflective practice over time supported their understanding and increased confidence in their reflective practice skills, thus potentially enabling a smoother transition into their profession where reflective practice is an essential and autonomous skill. © 2014 Dietitians Association of Australia

Transitions in reflective practice: exploring student development and preferred methods of engagement

Aim: Health-care professional students are required to demonstrate their reflective practice skills during their degree training programme. Online and digital technologies are increasingly being used to support this skill development. Our study aimed to explore whether different technology-based methods supported student growth and skill development in reflective practice at separate developmental time points (novice and competent). Methods: Third- (n = 23) and fourth-year undergraduate dietetic students (n = 22) from a single university were cross-sectionally surveyed via an online anonymous questionnaire at the end of the academic year. The mixed methods survey of 37 questions investigated the student experience of different reflective practice activities, their effect on a student\u27s ability to self-reflect and whether using them aided a student\u27s perceived transition towards becoming a competent dietitian. The data analysis included brief thematic enquiry, descriptive and independent t-test statistical examination. Results: Differences emerged in the way students engaged in reflection over time. Fourth-year students preferred to use more independent methods such as e-journaling (fourth- vs third-year students, P = 0.003) and engaged in reflection for reasons outside assessment (fourth- vs third-years, P = 0.027). Fourth-year students also identified fewer negative barriers to participating in reflection and reported being comfortable engaging in reflective practice. Conclusions: Overall, offering students a range of ways to engage in reflective practice over time supported their understanding and increased confidence in their reflective practice skills, thus potentially enabling a smoother transition into their profession where reflective practice is an essential and autonomous skill