Publications by authors named "Deborah Jane Holmes Walker"

7 Publications

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The impact of continuous glucose monitoring in youth with type I diabetes aged 15-21.

Intern Med J 2021 May 5. Epub 2021 May 5.

Diabetes Transition Support Programme, Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia.

Background: People with T1DM under 21 are eligible for subsidised continuous glucose monitoring (CGM) products under the Australian National Diabetes Services Scheme. There are few real world published studies to evaluate the benefits of CGM in young adults.

Methods: Patients at the Westmead Hospital young adult diabetes clinic aged 15-21 who commenced CGM before July 2018 were followed for 6 months post commencement CGM. Differences in HbA1c and glucose metrics at baseline and follow up are compared between those commencing CGM and those that did not.

Results: 44 of 115 eligible patients (38%) commenced CGM. Demographic characteristics and baseline HbA1c did not differ significantly between those started on CGM and those not. At 6 months, 18 of 44 patients (41%) still used CGM, with discomfort and inconvenience the most common reasons for dropout. In CGM continuers, at 6 months compared to baseline there was no change in HbA1c (8.2% vs 8.0%, P = 0.8), CV of glucose (38% vs 39%, P = 0.5), or % time in range (52% vs 58%, P = 0.3). 6 month follow up HbA1c in CGM non-users deteriorated significantly compared to users. Mean hypoglycaemia fear scores (worry scale) was significantly decreased from baseline at 6 months (33 vs 18, P < 0.01).

Conclusion: There are high rates of discontinuation in CGM use amongst youth with T1DM. At six months of CGM use there was no significant change in glycaemic control, although HbA1c in non-users deteriorated significantly. Worry of hypoglycaemia was significantly decreased amongst those who continued CGM. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/imj.15347DOI Listing
May 2021

Nesidioblastosis following laparoscopic sleeve gastrectomy.

Clin Endocrinol (Oxf) 2019 12 14;91(6):906-908. Epub 2019 Oct 14.

Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia.

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http://dx.doi.org/10.1111/cen.14083DOI Listing
December 2019

Self-management of sick days in young people with type 1 diabetes enhanced by phone support: A qualitative study.

Contemp Nurse 2019 Apr - Jun;55(2-3):171-184. Epub 2019 Jul 10.

b School of Nursing and Midwifery, Western Sydney University , Locked Bag 1797, Penrith , NSW 2751 , Australia.

The aim of this paper was to evaluate the impact of phone support on sick day management of young people with type 1 diabetes. Qualitative exploratory study to understand the usage of a phone support service available, 8am to 8.30pm, seven days a week. Inclusion criteria were: (a) young people with type 1 diabetes who attend an age-specific service; (b) experienced acute diabetes crisis. Interviews were coded for themes using QSR NVivo™ Version 11 software. Findings were examined through the theoretical lens of the Health Belief Model. Of 20 eligible individuals, 8 participated in the study. Five avoided emergency presentation by accessing the phone support service; three who did not were admitted for diabetic ketoacidosis. The interviews generated 3 major themes: (a) self-efficacy, (b) cues to action, (c) susceptibility. Enhancing self-efficacy and promoting confidence to seek help early during an acute health crisis enables young people to effectively self-manage and avoid hospitalization.
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http://dx.doi.org/10.1080/10376178.2019.1640620DOI Listing
February 2020

Islet Transplantation Provides Superior Glycemic Control With Less Hypoglycemia Compared With Continuous Subcutaneous Insulin Infusion or Multiple Daily Insulin Injections.

Transplantation 2017 06;101(6):1268-1275

1 Department of Endocrinology, University of Sydney at Westmead Hospital, NSW, Australia. 2 Centre for Diabetes, Obesity and Endocrinology Research, The Westmead Institute, University of Sydney at Westmead Hospital, Sydney, Australia. 3 Department of Diabetes and Endocrinology, Westmead Hospital Westmead, NSW, Australia. 4 National Pancreas Transplant Unit, University of Sydney at Westmead Hospital, Westmead Hospital, Westmead, NSW, Australia. 5 Centre for Renal and Transplant Research, Westmead Millennium Institute, University of Sydney at Westmead, NSW, Australia. 6 Department of Renal Medicine, Westmead Hospital, NSW, Australia. 7 Department of Paediatrics, Murdoch Children's Research Institute and University of Melbourne, Victoria, Australia. 8 St Vincent's Institute, University of Melbourne, Victoria, Australia. 9 Departments of Endocrinology and Clinical Biochemistry, St Vincent's Hospital, Melbourne, Victoria, Australia. 10 Department of Pathology, University of Melbourne, Melbourne, Victoria, Australia.

Background: The aim was to compare efficacy of multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) and islet transplantation to reduce hypoglycemia and glycemic variability in type 1 diabetes subjects with severe hypoglycemia.

Methods: This was a within-subject, paired comparison of MDI and CSII and CSII with 12 months postislet transplantation in 10 type 1 diabetes subjects referred with severe hypoglycemia, suitable for islet transplantation. Individuals were assessed with HbA1c, Edmonton Hypoglycemia Score (HYPOscore), continuous glucose monitoring (CGM) and in 8 subjects measurements of glucose variability using standard deviation of glucose (SD glucose) from CGM and continuous overlapping net glycemic action using a 4 hour interval (CONGA4).

Results: After changing from MDI to CSII before transplantation, 10 subjects reduced median HYPOscore from 2028 to 1085 (P < 0.05) and hypoglycemia events from 24 to 8 per patient-year (P < 0.05). While HbA1c, mean glucose and median percent time hypoglycemic on CGM were unchanged with CSII, SD glucose and CONGA4 reduced significantly (P < 0.05). At 12 months posttransplant 9 of 10 were C-peptide positive, (5 insulin independent). Twelve months postislet transplantation, there were significant reductions in all baseline parameters versus CSII, respectively, HbA1c (6.4% cf 8.2%), median HYPOscore (0 cf 1085), mean glucose (7.1 cf 8.6 mmol L), SD glucose (1.7 cf 3.2 mmol/L), and CONGA4 (1.6 cf 3.0).

Conclusions: In subjects with severe hypoglycemia suitable for islet transplantation, CSII decreased hypoglycemia frequency and glycemic variability compared with MDI whereas islet transplantation resolved hypoglycemia and further improved glycemic variability regardless of insulin independence.
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http://dx.doi.org/10.1097/TP.0000000000001381DOI Listing
June 2017

Australian standards of care for cystic fibrosis-related diabetes.

Respirology 2014 Feb 23;19(2):185-192. Epub 2013 Dec 23.

Sydney Children's Hospital Network, Sydney, New South Wales, Australia.

Multiple guidelines have been published over the last few years for the diagnosis and management of cystic fibrosis (CF) and cystic fibrosis related diabetes (CFRD), although some of the recommendations are based on extrapolation from other forms of diabetes and/or expert opinions. This document seeks to combine the guidelines to provide an Australian approach to the management of CFRD and establish the guidelines within the Australian CF Standards of Care. It is intended that this document will provide assistance to doctors, nurses, dietitians, physiotherapists, diabetes educators and CF patients concerning the issues surrounding CFRD, and will be reviewed and updated in 2016.
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http://dx.doi.org/10.1111/resp.12227DOI Listing
February 2014

Crossing the divide: transition care services for young people with HIV-their views.

AIDS Patient Care STDS 2011 Aug 11;25(8):465-73. Epub 2011 Jul 11.

Department of Cardiology, St. Mary's Hospital, London, UK.

Following the introduction of highly active antiretroviral therapy, an expanding cohort of adolescents with perinatally acquired HIV (PaHIV) is surviving and emerging from pediatric services with complex transition health care requirements. Transfer from pediatric to adult services has been associated with poorer health outcomes in other chronic diseases. Young people with HIV have the additional burden of stigma, secrecy, and the risk of transmitting HIV to partners and offspring. Maintaining engagement in health care during adolescence is critical. We compare reported satisfaction surveys of health care experiences and preferences of young people with PaHIV attending a U.K. transition outpatient service with young people attending a young persons' diabetes transition service in Australia. All 21 patients in the United Kingdom and 39 young people approached in Australia agreed to participate. The median age for both groups was 19 years, 67% of the PaHIV group were black African and 74% of diabetic group white Australian. Ninety-five percent (18/19) of those with PaHIV and 87% (34/39) with diabetes felt their transition was an easy process. Sixty-eight percent (13/19) of young people with PaHIV and 72% (28/39) of diabetic patients felt moving to their current service had a positive effect on their health. Being treated as an individual, comprehensive management explanations and encouragement to develop independence were cited as "strongly important" by over three quarters of participants with PaHIV. This service evaluation illustrates that careful transition can be a positive event for young people with PaHIV, comparable to that of a well-established diabetes services.
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http://dx.doi.org/10.1089/apc.2010.0279DOI Listing
August 2011