The diagnosis and management of diabetes in Australia: Does the “Rule of Halves” apply?

Sainsbury, Emma; Shi, Yumeng; Flack, Jeff R.; Colagiuri, Stephen

doi:10.1016/j.diabres.2020.108524

Cited by 10 publications

(9 citation statements)

References 62 publications

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“…10 Applications of the ROH from high-income settings are equally inconsistent: evidence from Denmark outlined performance far in excess of 'halving'-in particular for diagnosing diabetes and providing treatment, 11 whereas evidence from Australia indicated that the ROH does in fact generally apply for diabetes care and management. 12 Recent studies have updated historical evidence on the detailed pattern of the ROH for other chronic illnesses such as hypertension and osteoarthritis in England. [13][14][15] However, there are no recent efforts to update historical evidence on the ROH for England despite innovations in diabetes care and prevention over recent decades.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…10 Applications of the ROH from high-income settings are equally inconsistent: evidence from Denmark outlined performance far in excess of ‘halving’—in particular for diagnosing diabetes and providing treatment, 11 whereas evidence from Australia indicated that the ROH does in fact generally apply for diabetes care and management. 12 …”

Section: Introductionmentioning

confidence: 99%

“…For example, estimates from India suggests a rule of ‘two-thirds’ (ie, a better performance than halving across levels),9 whereas evidence from Peru comparing ROH patterns in urban and rural settings suggests considerably worse performance than halving on both care quality and treatment targets 10. Applications of the ROH from high-income settings are equally inconsistent: evidence from Denmark outlined performance far in excess of ‘halving’—in particular for diagnosing diabetes and providing treatment,11 whereas evidence from Australia indicated that the ROH does in fact generally apply for diabetes care and management 12…”

Section: Introductionmentioning

confidence: 99%

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Variation in appropriate diabetes care and treatment targets in urban and rural areas in England: an observational study of the ‘rule of halves’

et al. 2022

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ObjectivesTo estimate the ‘rule of halves’ for diabetes care for urban and rural areas in England using several data sources covering the period 2015–2017; and to examine the extent to which any differences in urban and rural settings are explained by population characteristics and the workforce supply of primary care providers (general practices).DesignA retrospective observational study.SettingPopulations resident in predominantly urban and rural areas in England (2015–2017).ParticipantsN=33 336 respondents to the UK Household Longitudinal Survey in urban and rural settings in England; N=4913 general practices in England reporting to the National Diabetes Audit and providing workforce data to NHS Digital.OutcomesDiabetes prevalence; administrative records of diagnoses of diabetes; provision of (all eight) recommended diabetes care processes; diabetes treatment targets.ResultsDiabetes prevalence was higher in urban areas in England (7.80% (95% CI 7.30% to 8.31%)) relative to rural areas (7.24% (95% CI 6.32% to 8.16%)). For practices in urban areas, relatively fewer cases of diabetes were recorded in administrative medical records (69.55% vs 71.86%), and a smaller percentage of those registered received the appropriate care (45.85% vs 49.32%). Among estimated prevalent cases of diabetes, urban areas have a 24.84% achieving these targets compared with 25.16% in rural areas. However, adjusted analyses showed that the performance of practices in urban areas in providing appropriate care quality was not significantly different from practices in rural areas.ConclusionsThe ‘rule of halves’ is not an accurate description of the actual pattern across the diabetes care pathway in England. More than half of the estimated urban and rural diabetes population are registered with clinical practices and have access to treatment. However, less than half of those registered for treatment have achieved treatment targets. Appropriate care quality was associated with a greater proportion of patients with diabetes achieving treatment targets.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Variation in appropriate diabetes care and treatment targets in urban and rural areas in England: an observational study of the ‘rule of halves’

et al. 2022

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“…The total burden of type 2 diabetes is largely attributable to modifiable risk factors such as overweight and obesity (36%), diet (19%), physical inactivity (13.8%) and tobacco use (2%) (1). Self-management education for adults with type 2 diabetes has been shown to improve health outcomes (4), however access and attendance in Australia is poor (5,6), and only half of those with the disease meet the recommendations for type 2 diabetes management (7).…”

Section: Introductionmentioning

confidence: 99%

Economic evaluation of a mobile phone text-message intervention for Australian adults with type 2 diabetes

Waller¹,

Killedar²,

Furber³

et al. 2023

mHealth

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Background: The rising prevalence of type 2 diabetes in Australia is a public health concern, contributing to significant disease burden and economic costs. Text-message programs have been shown to improve health outcomes for people with type 2 diabetes, however they remain underutilized, and no evidence exists on their cost-effectiveness or costs of scale up to a population level in Australia. This study aimed to determine the cost-effectiveness and cost-utility of a 6-month text-message intervention (DTEXT) to improve glycated hemoglobin (HbA1c) and self-management behaviors for Australian adults with type 2 diabetes.Methods: A within-trial economic evaluation was conducted on the DTEXT randomized controlled trial.Incremental cost-effectiveness ratios (ICERs) were determined per 11 mmol/mol (1%) reduced HbA1c and per quality adjusted life year (QALY) gained, compared to usual care. Cost-effectiveness acceptability curves (CEAC) determined the probability of the intervention being cost-effective over a range of willingness to pay thresholds. A scenario analysis was conducted to determine how cost-effectiveness was impacted by using current implementation costs.

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“…Globally, the International Diabetes Federation (IDF) estimates that 451 million adults have diabetes worldwide in 2017 and a further 352 million adults have impaired glucose tolerance (prediabetes) [ 1 ]. It is estimated that 1.2 million (6%) Australian adults aged 18 years and over had diabetes (type 1 diabetes and type 2 diabetes) in 2017–2018 [ 2 ]. In addition, the prevalence of previously undiagnosed diabetes may be approximately 25% of that of known diabetes [ 3 ] and one in six Australian adults have prediabetes [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review

et al. 2022

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With type 2 diabetes prevalence increasing in Australia, and the condition associated with significant morbidity and mortality, screening for dysglycaemia in the dental setting has been proposed to identify asymptomatic individuals. Screening commences with a risk assessment, and individuals identified at elevated risk for having diabetes are then referred to their medical practitioner for confirmation of their glycemic status. Therefore, for screening to be effective, individuals need to adhere to their oral health professionals’ (OHP) advice and attend their medical follow-ups. This review aims to investigate the literature on referral compliance following a risk assessment in the dental setting and identify barriers and facilitators to screened individuals’ referral compliance. A scoping review of the literature was undertaken, selecting studies of diabetes screening in a dental setting that recorded compliance to referral to follow-up, and explored any barriers and facilitators to adherence. Fourteen studies were selected. The referral compliance varied from 25 % to 90%. Six studies reported barriers and facilitators to attending medical follow-ups. Barriers identified included accessibility, cost, knowledge of the condition, and OHP characteristics.

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The diagnosis and management of diabetes in Australia: Does the “Rule of Halves” apply?

Cited by 10 publications

References 62 publications

Variation in appropriate diabetes care and treatment targets in urban and rural areas in England: an observational study of the ‘rule of halves’

Variation in appropriate diabetes care and treatment targets in urban and rural areas in England: an observational study of the ‘rule of halves’

Economic evaluation of a mobile phone text-message intervention for Australian adults with type 2 diabetes

Referral Compliance Following a Diabetes Screening in a Dental Setting: A Scoping Review

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