student profile: Mr George Siopis


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Thesis work

Thesis title: A study of access to and effectiveness of dietetic services for people with type 2 diabetes

Supervisors: Margaret ALLMAN-FARINELLI

Thesis abstract:

�strong�Epidemiological and Economic Significance�/strong��br /� �br /� Type 2 Diabetes Mellitus is one of the most disabling chronic conditions worldwide, resulting in significant human, social and economic costs and placing huge demands on health care systems. Around «a href="http://www.diabetesatlas.org/"»half a billion people have diabetes«/a», with global numbers on a rise according to the «a href="http://www.who.int/mediacentre/factsheets/fs312/en/" target="_blank"»World Health Organisation«/a». Diabetes prevalence rates «a href="http://www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/CDA852A349B4CEE6CA257F150009FC53/$File/national%20health%20survey%20first%20results,%202014-15.pdf" target="_blank"»increase with age«/a», which is concerning considering our «a href="http://www.who.int/gho/mortality_burden_disease/life_tables/situation_trends_text/en/" target="_blank"»ever increasing ageing population«/a». Improvements in life expectancy due to the triumph of public health projects of the past when people were immunised against infectious and parasitic diseases have allowed the emergence of non-communicable, chronic conditions such as diabetes, cardiovascular disease and cancer as the main causes of morbidity and mortality in the western world. Diabetes is leading the lot in several countries and has thus been dubbed as the "«a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068646/" target="_blank"»epidemic of the 21st century«/a»". It it is the biggest challenge confronting Australia’s health system, with around «a href="https://www.diabetesaustralia.com.au/diabetes-in-australia" target="_blank"»1.7 million Australians having diabetes«/a» and the total annual cost impact being estimated at «a href="https://www.diabetesaustralia.com.au/diabetes-in-australia" target="_blank"»$14.6 billion«/a». Australia has the highest «br /» «strong»Dietary Intervention as a modality to improve clinical outcomes«/strong»«br /» «br /» Diet is a critical determinant for both the «a href="http://jandonline.org/article/S2212-2672(14)01145-9/fulltext" target="_blank"»prevention«/a» and «a href="http://onlinelibrary.wiley.com/doi/10.1002/oby.21172/epdf" target="_blank"»management«/a» of type 2 diabetes mellitus (T2DM). Changing one’s eating habits is a complex undertaking requiring detailed nutrition knowledge, skills in food preparation, access and affordability for healthy foods such as vegetables, fish, and very grainy breads of low glycaemic index as well as the motivation to change. Accredited practising dietitians have the training and experience to deliver the type of health care to counsel and support the patient journey to achieve the dietary patterns that optimize control of blood glucose concentration and other risk factors such as hyperlipidemia, hypertension and obesity. «a href="https://www.ncbi.nlm.nih.gov/pubmed/19169063" target="_blank"»Studies«/a» have shown that better clinical outcomes are achieved when the intervention is led by a dietitian as opposed to any other medically or pedagogically qualified professional. Even a «a href="http://apjcn.nhri.org.tw/server/APJCN/24/3/438.pdf" target="_blank"»single session with a dietitian improves HbA1c levels«/a». Yet it seems that most people with type 2 diabetes never consult with a dietitian. There are «a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-13-504" target="_blank"»several explanations«/a» for this which includes «a href="https://link.springer.com/article/10.1007%2Fs10900-015-0024-2" target="_blank"»lack of referral from general practitioners«/a», limited visits to allied health allowed on health care plans, lack of health insurance and unable to afford to see a private dietitian and a lack of awareness as to the benefits of dietetic intervention and counseling on clinical outcomes.«br /» «br /» «strong»Objectives«/strong»«br /» «br /» This works aims to «a href="http://www.diabetesmap.com.au/#/" target="_blank"»map the distribution of type 2 diabetes populations«/a» and of dietitians across Australia to evaluate the access to and effectiveness of dietetic services for people with type 2 diabetes. This will provide us with insight in the match or mismatch of services to prevalence and allow for educated recommendations to be made and thus guide public health initiatives. We also aim to evaluate what do health professionals, such as dietitians and GPs, as well as patients think of the current services provided for patients with type 2 diabetes and if they consider them effective as well as how (if) they can be further improved for the best management of this condition.«br /» «br /» «strong»Synopsis of Methodology«/strong»«br /» «br /» The planned program of research will use a combination of geographical information system (GIS) mapping, systematic literature review and meta-analysis, and in-depth semi-structured interviews with dietitians, general practitioners, diabetes educators and patients to answer the following questions: «ul» «li»What is the current evidence base to demonstrate that the inclusion of dietetic services in the care of patients with type 2 diabetes results in better outcomes such as HbA1c, body weight, diet quality and complications? - Any evidence concerning cost effectiveness will also be included.«/li» «li»What is the distribution of the dietetic workforce across Australia and how does it compare with the distribution of people with type 2 diabetes?«/li» «li»What is the current level of dietitian consultations for people with type 2 diabetes according to National Health Surveys and other available data sets? e.g the 45 and up cohort study and datasets from health insurance companies.«/li» «li»What do dietitians think about services for type 2 diabetes and what recommendations would they make?«/li» «li»What do general practitioners think about dietetic services and type 2 diabetes?«/li» «li»What do patients who have dietetic services and those who do not think about consultations with dietitians?«/li» «li»A sub question will be: What other services do dietitians recommend for people with type 2 diabetes such as access to an exercise physiologist or psychologist?«/li» «/ul» These data will be triangulated to produce recommendations concerning the delivery of dietetic services to people with type 2 diabetes based on medical outcomes, the current state of play and patient and health professionals expert opinions. Insight gained from this work will assist in health services planning and advocacy for better patient care.

Note: This profile is for a student at the University of Sydney. Views presented here are not necessarily those of the University.