Established Research Projects
Longitudinal clinical epidemiology studies of diabetic vascular disease in large cohorts
CIs O'Dea, Jenkins, and Best with AIs O'Neal, Rowley, Keech, Wong and English are studying risk factors for vascular complications of diabetes in the Melbourne Collaborative Cohort Study (over 40,000 people over-sampled with southern European migrants), the Fenofibrate Intervention and Event Lowering in Diabetes study cohort (10,000 people with type 2 diabetes), the Veterans Affairs Diabetes Trial (VADT, over 1,000 people with type 2 diabetes) and the Diabetes Complications and Control Trial / Epidemiology of Diabetes Interventions and Complications study (DCCT / EDIC, over 1,000 people with type 1 diabetes). These longitudinal studies in Australia (MCCS and FIELD) and North America (VADT and DCCT / EDIC) provide a unique opportunity to study factors predictive of macrovascular and microvascular disease, with an emphasis on inflammation, oxidation and glycation as important aetiological factors. Of the 40,000 participants in the MCCS, 10,000 were born in southern Europe, and have lower all-cause and CVD mortality, but higher prevalence of diabetes than the Australian born population. This provides a unique opportunity to examine diet and vascular disease in a diabetic cohort with a very wide range of dietary exposures and different patterns of chronic disease. In both MCCS and FIELD studies AI Wong is studying retinal markers for macrovascular disease and predictors for development of diabetic retinopathy and nephropathy. CIs Best, O'Dea and Jenkins already have publications in relation to these major cohorts, and dissemination of the research findings is expected to lead to further publications.
Cross-sectional patient-focused clinical research studies of diabetic vascular disease
CIs Jenkins, Kay and Best with AIs Langham, O'Neal, Wong and Ward are undertaking cross-sectional studies into the markers and mediators of atherosclerosis, retinopathy and nephropathy in patient cohorts with type 1 and type 2 diabetes. Biochemical and tissue-based assays of glycation, inflammation and oxidation, and assessments of insulin resistance and beta cell function will be related to measures of macrovascular function and retinal vascular structure, with the goal of establishing early markers for complications. These markers can also act as surrogate measures for the effectiveness of potential interventions, particularly dietary studies by CI O'Dea and AI Vale and insulin sensitising studies by CI Jenkins and AIs O'Neal and Rowley. The equipment and laboratory methodology for these studies, including dietary markers, are established. CIs Jenkins and Best have a 15 year record of patient recruitment, research higher degree training and publications in studies of this kind.
Clinical observation and intervention studies in Indigenous populations with diabetes
CIs O'Dea, Best and Jenkins, with AIs Rowley, Maple-Brown and DeWitt are undertaking nutritional and pharmaceutical interventions in Indigenous people with type 2 diabetes. These clinical studies include continuation of CI O'Dea's ‘fruit and fish' intervention in Aboriginal patients on dialysis for kidney failure, as well as use of long acting insulin analogues and insulin sensitising agents in diabetes therapy. Studies are being undertaken in Darwin, NT and the Goulburn Valley region of Victoria. CI Taylor and AI Wong have extended preliminary studies on diabetic retinopathy by AI Maple-Brown and will study retinal markers of macrovascular disease in these populations. CI O'Dea has a strong track record of research in this area and of developing processes for consultation and management of health issues relating to Indigenous Australians, particularly with regard to nutrition. CI Taylor also has extensive experience of working in Indigenous communities. CIs Taylor and AI Wong are conducting studies on vascular changes detected in retinal photographs taken prospectively in Aboriginal men participating in the Heart of the Heart Study in Central Australia. These studies will enhance research capacity in the areas where they will be conducted.
Clinical observation and intervention studies in patients with Type 1 diabetes using novel diabetes care technologies
CIs Best and Jenkins and AI O'Neal are conducting cross-sectional and intervention studies in Type 1 diabetes patients using insulin pumps and continuous glucose monitoring systems. With AI Farrish they have designed and led a 60 person study related to an algorithm to guide improved blood glucose control in insulin pump and real time glucose sensor users. Effects on vascular risk factors and patient well-being are also being assessed. They are also evaluating the benefits and challenges of insulin pump use and of continuous glucose monitor use. They communicate their findings to professional and lay groups. They are also exploring the incorporation of other technologies such as ultraportable retinal cameras and mobile phones and internet into diabetes care.
Clinical studies of patients with type 1 diabetes undergoing beta cell transplantation
CIs Kay and Jenkins with AI Ward are studying the effect of inflammation, oxidative stress, growth factors and insulin resistance from hepatic steatosis, on beta-cell function after transplantation for treatment of type 1 diabetes. Better knowledge of mediators of beta-cell injury will guide development of beta-cell replacement, which is the ultimate therapy to prevent and reverse the vascular complications of type 1 diabetes. CI Kay is leading a Melbourne-wide collaboration that will work in this area linked closely with islet transplant groups in other states. Funding for these studies has recently been approved and medical graduate PhD student Sachithanandan, trainee endocrinologist, is working under the joint supervision of CIs Kay and Jenkins. Although only a small number of patients will benefit from this high-cost therapy, it is important to the type 1 diabetes community because of the hope that it offers for an eventual cure for this very burdensome disease.
Studies of translation of research findings into clinical practice for diabetes management
CIs Young and Best, with AIs Vale, Furler, Dunning and Dunbar are investigating the implementation of evidence from research studies into clinical practice in the primary care setting. The technique developed in the Coaching patients On Achieving Cardiovascular Health (COACH) study is being used by trained Practice Nurses to encourage patients to engage with their General Practitioners to achieve treatment goals for prevention of vascular complications of type 2 diabetes (NHMRC funded “Patient Engagement And Coaching for Health” or PEACH study). One of the CIs on the PEACH study, AI Walker, is a social researcher with expertise in consumer engagement and advocacy on health issues. Techniques tested successfully in the Diabetes Prevention Program led by AI Dunbar with Young and Best as CIs will also be studied in the prevention and management of diabetes in general practice. This project is part of a program to develop research capacity for General Practitioners and Practice Nurses, with CCRE support. As the vast majority of diabetes care is delivered in the community, the CCRE is focussing on translation of research findings into clinical practice in this setting.