Funding boost for ‘shared care model’ to improve diabetes outcomes

Enabling people with diabetes to have better control of their condition and maintain a healthy lifestyle are the main objectives of a clinical trial recently awarded RACGP Foundation funding.
 
The Foundation’s largest grant valued at $250,000, the nib foundation/RACGP Foundation Healthcare Systems & Sustainability Grant, will support the adaption and implementation of the Diabetes Remission Clinical Trial (DiRECT) protocol in Australia – which has already been implemented in UK practices.

The full list of RACGP Foundation Grant 2024 recipients will be announced in newsGP this week.
 
University of Melbourne Department of General Practice Associate Professor Ralph Audehm is the Australian lead on the project, which leverages a national network of accredited exercise physiologists in collaboration with general practices.
 
The aim is to help patients newly diagnosed with type 2 diabetes to achieve remission through a structured diet and exercise program, with the goal of nationwide scalability and sustainable impact on diabetes care.
 
‘I have seen too often the devastating complications of diabetes,’ Associate Professor Audehm told newsGP.
 
‘Being able to put people who have diabetes into remission will have great benefits for our patients for years to come.
 
‘It also teaches them how they can take control when they need to, and there is also a reduction in weight which has many other benefits.’
 
DiRECT began in the UK as a research study investigating whether offering an intensive program for weight loss and weight loss maintenance would benefit people with type 2 diabetes.
 
The trial investigates the reasons for the condition developing and the possibility of reversing the process, with Associate Professor Audehm noting there has been no such program set up in Australia.
 
‘I have seen so many pilots and research programs lost when it comes to implementing the program more broadly,’ he said.
 
‘The focus on this is to establish the program and make it accessible in Australia.
 
‘The DiRECT Trial protocol is operationalising a trial in England that put 50% of participants into diabetes remission and improved their hypertension.’
 
Working with exercise physiologists, which Associate Professor Audehm says are accessible in most jurisdictions, to maintain activity and exercise throughout the program, the first year of the Australian rollout is replicating the program in an exercise physiologist practice in Melbourne.  
 
It is a ‘shared care model with defined protocols’ between the exercise physiologist practice and the general practice. The second year will focus on setting up a national network of exercise physiologists to deliver the program.
 
In Australia, type 2 diabetes has been described as an ‘epidemic’ and one of the biggest challenges confronting the health system. Almost 1.3 million Australians are currently living with type 2 diabetes, which represents 85–90% of all cases of diabetes and is increasing each year.
 
And according to Diabetes Australia, more than half of all cases of type 2 diabetes can be delayed or prevented with changes to diet and lifestyle.
 
A recent report released on the state of diabetes in Australia puts forward recommendations to address the nation’s rates and to improve care for people with diabetes.
 
In the UK following trial phases, DiRECT is now routine practice, where latest NHS data on all the original DiRECT participants were collected over five years to examine if the ‘remarkable’ one- and two-year results from a dietary weight management program would be maintained. Remission of diabetes was 46% at one year, and 36% at two years.
 
The latest phase also looked at whether longer durations of weight loss, freedom from diabetes medications and of remissions from type 2 diabetes might be associated with better clinical outcomes.
 
‘Based on all the results from DiRECT and other studies, we are now very confident that achieving and maintaining substantial weight loss (over 10 or 15 kg if possible) is the best start to control a very unpleasant progressive disease,’ the UK DiRECT authors write.
 
They highlight that many people with type 2 diabetes can benefit from ‘consistent, sensible advice and encouragement’ from healthcare providers, and professional diet support programs.
 
Quality of life and wellbeing was also reported to significantly improve at every year up to five years in DiRECT participants who received the intervention within their routine primary care management of diabetes.
 
Meanwhile, Associate Professor Audehm, who sits on the Board of the Primary Care Diabetes Society of Australia and teaches medical students, is looking forward to rolling out the Australian-first DiRECT intervention model.
 
More information on the RACGP Foundation grants and awards is available on the college’s website.
 
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