Structured type 1 diabetes education delivered in routine care in Australia reduces diabetes-related emergencies and severe diabetes-related distress: the OzDAFNE program

AIMS: To evaluate structured type 1 diabetes education delivered in routine practice throughout Australia.

METHODS: Participants attended a five-day training program in insulin dose adjustment and carbohydrate counting between April 2007 and February 2012. Using an uncontrolled before-and-after study design, we investigated: HbA1c (% and mmol/mol); severe hypoglycaemia; diabetes ketoacidosis (DKA) requiring hospitalisation, and diabetes-related distress (Problem Areas in Diabetes scale; PAID), weight (kg); body mass index. Data were collected pre-training and 6-18 months post-training. Change in outcome scores were examined overall as well as between groups stratified by baseline HbA1c quartiles. Data are mean±SD or % (n).

RESULTS: 506 participants had data eligible for analysis. From baseline to follow-up, significant reductions were observed in the proportion of participants reporting at least one severe hypoglycaemic event (24.7% (n=123) vs 12.1% (n=59), p<0.001); and severe diabetes-related distress (29.3% (n=145) vs 12.6% (n=60), p<0.001). DKA requiring hospitalisation in the past year reduced from 4.1% (n=20) to 1.2% (n=6). For those with above target baseline HbA1c there was a small, statistically significant improvement (n=418, 8.4±1.1% (69±12mmol/mol) to 8.2±1.1% (66±12mmol/mol). HbA1c improvement was clinically significant among those in the highest baseline quartile (n=122, 9.7±1.1% (82±11mmol/mol) to 9.0±1.2% (75±13mmol/mol), p<0.001).

CONCLUSIONS: The proportion of participants reporting severe hypoglycaemia, DKA and severe diabetes-related distress was at least halved, and HbA1c reduced by 0.7% (7mmol/mol) among those with highest baseline levels. Structured type 1 diabetes education delivered in routine practice offers clinically important benefits for those with greatest clinical need.

Estimating animal populations and body sizes from burrows: marine ecologists have their heads buried in the sand

Most ecological studies require knowledge of animal abundance, but it can be challenging and destructive of habitat to obtain accurate density estimates for cryptic species, such as crustaceans that tunnel deeply into the seafloor, beaches, or mudflats. Such fossorial species are, however, widely used in environmental impact assessments, requiring sampling techniques that are reliable, efficient, and environmentally benign for these species and environments.2.Counting and measuring the entrances of burrows made by cryptic species is commonly employed to index population and body sizes of individuals. The fundamental premise is that burrow metrics consistently predict density and size. Here we review the evidence for this premise. We also review criteria for selecting among sampling methods: burrow counts, visual censuses, and physical collections.3.A simple 1:1 correspondence between the number of holes and population size cannot be assumed. Occupancy rates, indexed by the slope of regression models, vary widely between species and among sites for the same species. Thus, 'average' or 'typical' occupancy rates should not be extrapolated from site- or species specific field validations and then be used as conversion factors in other situations.4.Predictions of organism density made from burrow counts often have large uncertainty, being double to half of the predicted mean value. Whether such prediction uncertainty is 'acceptable' depends on investigators' judgements regarding the desired detectable effect sizes.5.Regression models predicting body size from burrow entrance dimensions are more precise, but parameter estimates of most models are specific to species and subject to site-to-site variation within species.6.These results emphasise the need to undertake thorough field validations of indirect census techniques that include tests of how sensitive predictive models are to changes in habitat conditions or human impacts. In addition, new technologies (e.g. drones, thermal-, acoustic- or chemical sensors) should be used to enhance visual census techniques of burrows and surface-active animals.