Priority 3

Short-term complications of hypoglycaemia and/or hyperglycaemic hyperosmolar syndrome and ketoacidosis

Priority 3 - Short-term complications of hypoglycaemia and/or hyperglycaemic hyperosmolar syndrome and ketoacidosis leadership team:

Associate Professor Spiros Fourlanos (endocrinologist)
Professor David O’Neal (endocrinologist)
Associate Professor Wendy Davis (epidemiologist)

The acute complications of hypoglycaemia and hyperglycaemic hyperosmolar syndrome (HHS)/diabetic ketoacidosis (DKA) can be devastating, including leading to vital organ injury and death and significant psychological, societal, and economic burdens.

Our projects focus on preventing acute metabolic complications, in T1DM and T2DM, in all individuals (Indigenous populations, rural to metropolitan-based); and primary and secondary prevention. Interventions range from responses initiated by the person with diabetes, to interventions by healthcare professionals, seamlessly bridging care between the community and hospitals and preventing unplanned hospital admissions.

Explore our current projects below to find out what we're working on across prevention, diagnosis, management and new therapies.

  • Preventing Blood Sugar Extremes in Hospitalised People Living with Diabetes
    | New Therapies |

    Led by Associate Professor Spiros Fourlanos from the University of Melbourne

    Did you know that more than a quarter of people admitted to Australian hospitals have diabetes? Unfortunately, these individuals are at higher risk of experiencing dangerous blood sugar fluctuations during their hospital stay, like diabetic ketoacidosis or severe hypoglycaemia.

    Hypoglycaemia, where blood sugar levels drop too low, affects around 16-24% of hospitalised people living with diabetes. While frequently reported, the exact rates of hyperglycaemia, or high blood sugar, incidents are harder to determine.

    Our project aims to address this issue by implementing a real-time electronic alert system called REGAS in hospital wards. This digital technology solution will help healthcare teams monitor and manage people’s blood sugar levels more effectively, hopefully reducing the frequency of extreme blood sugar episodes.

    We plan to conduct a large-scale trial to test the effectiveness of this digital solution. If successful, hospitals and healthcare networks may consider adopting this technology more widely, improving outcomes for people living with diabetes during their hospital stays.

    Project Title
    Project 3A: A Real-time Electronic Glucometric Alert System (REGAS) to decrease hypoglycaemia and DKA/HHS in people admitted to hospital
    Project LeadAssociate Professor Spiros Fourlanos (University of Melbourne)
  • Improving Diabetes Care with REMODEL-IPC Mobile Health System
    | Management |

    Led by: Dr. Anish Menon from the University of Queensland

    Even with advancements in diabetes treatment, less than half of people living with diabetes are reaching their target blood sugar levels (HbA1c of less than 7%), putting them at higher risk for complications. To address this challenge, we've developed a mobile health solution called the Mobile Diabetes Management System (MDMS), which enables a new model of care called REMODEL (Rethinking Model of Outpatient Diabetes Care using eHealth) program.

    The MDMS includes several components: a blood glucose monitor, a smartphone app, and a dashboard with automated alerts for healthcare professionals. It also automatically sends personalised SMS text messages to individuals with diabetes, offering feedback and access to educational resources.

    With REMODEL-IPC, our goal is to see improvements in HbA1c and quality of life for participants over a 12-month period. Additionally, we'll assess whether this approach is cost-effective for both individuals with diabetes and the healthcare system as a whole.

    By leveraging mobile technology and personalised support, we aim to empower individuals with diabetes to better manage their condition and ultimately improve their health outcomes.

    Project Title
    Project 3B: REMODEL-IPC mHealth system
    Project LeadDr Anish Menon (University of Queensland)
    CollaboratorsProfessor Anthony Russell (Monash University), Professor Clair Sullivan (University of Queensland), Dr Namal Balasooriya (University of Queensland), Dr Charles Okafor (University of Queensland), Ms Keren Pointon (University of Queensland)
  • Keeping Diabetes Therapy Safe: A New Ketone Sensor Approach
    | Management |

    Led by Professor David O'Neal from the University of Melbourne

    A type of diabetes therapy called SGLT2 inhibitor (SGLT2i) has shown great promise in controlling blood sugar, aiding in weight loss, and even protecting against heart and kidney diseases in people with type 2 diabetes (T2D). It can also help manage blood sugar levels in those with type 1 diabetes (T1D). However, this therapy faced hurdles in receiving approval from regulatory agencies like the FDA in the USA and the TGA in Australia due to an increased risk of a serious complication called diabetic ketoacidosis (DKA).

    When you have severe high blood sugar levels, and not enough insulin to break it down, your body turns to another energy source, breaking down fat instead, and in the process produces acids called ketones. DKA occurs when there are dangerously high levels of these ketones in the blood, a condition that can be life-threatening.

    Detecting these ketones often doesn't happen quickly enough to prevent hospitalisation. To address this problem, we're working on a prototype ketone sensor. This sensor aims to provide early detection of ketones in people with T1D who are using SGLT2i therapy. If successful, this could lead to the approval of these therapies and ultimately reduce the risk of long-term complications and death in people with T1D.

    Project Title
    Project 3C: Preventing ketoacidosis in SGLT2i therapy using a novel ketone sensor
    Project LeadProfessor David O'Neal (University of Melbourne)
    CollaboratorsSt Vincent's Hospital Melbourne, Diabetes Technology Research Group, Austin Health, Melbourne Health, Southern Adelaide Local Health Network, Canberra Health Service,  Abbott Diabetes Care, Lexicon Pharmaceuticals Inc
  • Advancing Glucose Management for Indigenous Australians
    | Management |

    Led by Professor Elif Ekinci from the University of Melbourne

    We're conducting a nationwide clinical trial to evaluate the benefits of flash glucose monitoring (FlashGM) for Indigenous Australians. Our project goes beyond just studying the effectiveness of this technology, and will also look to improving the quality of life assessment tools for health economic analysis in Indigenous communities.

    To achieve this, we're funding a PhD student from Indigenous background. Their research will focus on developing assessment tools that are culturally appropriate and validated specifically for Indigenous communities. These tools will help us better understand the impact of FlashGM on the quality of life of Indigenous Australians participating in our study. This project will also contribute to better assessment of quality of life in diabetes trials. Ultimately, our goal is to ensure that our research is not only effective but also respectful and relevant to the communities we serve.

    Project Title
    Project 3D: Flash Glucose Monitoring (FlashGM) to improve glucose management in Indigenous Australians - Enhancing Quality of Life assessment for Health Economic Analysis
    Project LeadElif Ekinci (University of Melbourne)
    CollaboratorsCoralie Cross (University of Melbourne,  ADEA)
  • Protecting Beta Cells in Early Type 1 Diabetes
    | New Therapies |

    Led by Professor Josephine Forbes from the University of Queensland

    Our project aims to collaborate with Australian and international biotechnology companies to develop and test medications that can stop the onset of type 1 diabetes (T1D). We're focusing on targeting a specific receptor called the Receptor for Advanced Glycation End-products (RAGE) to reduce damage to beta cells, which are crucial for insulin production.

    These studies will help us understand if these medications are both safe and effective in humans, paving the way for further clinical development.

    Ultimately, our goal is to find new treatments that can protect beta cells and potentially delay or prevent the onset of T1D, improving the lives of those affected by this condition.

    Project Title
    Project 3E: Targeting the Receptor for Advanced Glycation End-products (RAGE) to reduce beta cell damage at the onset of type 1 diabetes
    Project LeadProfessor Josephine Forbes (University of Queensland)
  • Exploring the Link Between Sleep, Blood Sugar, and Quality of Life in Diabetes
    | Management |

    Led by Professor Elif Ekinci from the University of Melbourne

    Sleep is essential for good health, especially when managing diabetes. Yet, we don't fully understand how sleep impacts blood glucose levels and overall diabetes management. That's where our research comes in.

    We're investigating sleep patterns and behaviors alongside blood glucose monitoring and analysis. By studying the different ways in which sleep influences blood glucose control, we aim to uncover valuable insights that can help improve diabetes management strategies.

    Using the data from this project, we also plan to develop a digital health application. This app will enable users to monitor their sleep patterns and improve their sleep health specifically in the context of their diabetes management and blood glucose control. By empowering individuals to play a proactive role in their sleep health and diabetes care, our objective is to improve diabetes-related outcomes and overall quality of life for people living with diabetes.

    Project Title
    Project 3F: Associations between glycaemic extremes on quality of sleep and quality of life in diabetes
    Project LeadElif Ekinci (University of Melbourne)
    CollaboratorsDr Cecilia Pham (University of Melbourne,  Austin Health), Professor Leonid Churilov (University of Melbourne),  Associate Professor Sara Baqar (University of Melbourne,  Austin Health), Dr Christel Hendrieckx (Deakin University), Professor David O’Neal (University of Melbourne, St Vincent’s Hospital Melbourne),  Associate Professor Mark E Howard (University of Melbourne, Austin Health, Monash University), Dr Elizabeth Holmes-Trustcott (Deakin University)
  • Improving Decision Making for Diabetes Treatments in Australia
    | Management |

    Led by Associate Professor An Duy Tran and Professor Philip Clarke from the University of Melbourne

    In Australia, decisions about which diabetes treatments to subsidise are crucial for ensuring affordable access to new technologies through programs like the Pharmaceutical Benefits Scheme (PBS). However, these decisions often rely on detailed cost-effectiveness evaluations, which can take time and delay access to new treatments due to a lack of economic evidence.

    There's a significant gap in healthcare when it comes to quality economic modelling, especially for diabetes interventions. To address this, our project aims to develop new tools and a framework specifically tailored for evaluating the cost-effectiveness of diabetes interventions in the Australian healthcare system. We will adapt existing economic models from other countries to fit the Australian context, creating a set of tools and a comprehensive evaluation framework. This will provide Australian government regulators with the data they need to make informed decisions about which treatments to supply and subsidies for new treatments in diabetes.

    Ultimately, our goal is to ensure that Australians have timely access to effective diabetes treatments while also ensuring that healthcare resources are used efficiently.

    Project Title
    Project 3G: Development of tools and a framework for economic evaluations of interventions for diabetes and its complications in the Australian healthcare system setting
    Project LeadsAssociate Professor An Duy Tran & Professor Philip Clarke (University of Melbourne and University of Oxford)
    CollaboratorsProfessor Elif Ekinci (University of Melbourne), Professor David O’Neal (University of Melbourne), Dr Ting Zhao (University of Melbourne and University of Tasmania), Mr Paul Amores (University of Melbourne), Mr Dennis La (University of Melbourne), Dr Liam Fernando-Canavan (University of Melbourne), Dr Abdur Sarker (University of Melbourne and Bangladesh Institute of Development Studies), Dr Helen Dakin (University of Oxford), Associate Professor Jose Leal (University of Oxford).
  • Using Technology to Empower People with Type 1 Diabetes
    | Management |

    Led by Professor David O'Neal from the University of Melbourne

    We've partnered with Diabetes Victoria to develop a program called Making Sense. This program is specifically designed to help individuals with type 1 diabetes better understand and interpret data from their continuous glucose monitors and insulin pumps.

    Making Sense brings together input from various experts including endocrinologists, diabetes educators, dietitians, psychologists, and peers who live with type 1 diabetes. The program runs for two weeks in groups of 8, led by a peer who also has type 1 diabetes. Sessions will be a mix of remote educational modules and in-person study visits.

    Through this project, we aim to gather results and feedback to refine the Making Sense program. Ultimately, we hope to create a remote educational tool that empowers individuals with type 1 diabetes to effectively manage their glucose levels using technology.

    Project Title
    Project 3H: Empowering people with T1D with technology to manage glucose levels
    Project LeadProfessor David O’Neal (University of Melbourne)
    CollaboratorsSt Vincent's Hospital Melbourne, Diabetes Technology Research Group,  Austin Health, Melbourne Health, Diabetes Victoria

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