Publications by authors named "Kaye Farrell"

6 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

Women with type 1 diabetes and women with type 2 diabetes differ in knowledge and beliefs about contraception and pregnancy.

Diabet Med 2021 Apr 2;38(4):e14521. Epub 2021 Feb 2.

Royal Prince Alfred Hospital, Camperdown, NSW, Australia.

Aims: To assess differences in knowledge and beliefs about pregnancy in women with diabetes.

Methods: Questions were from the Australian 'Contraception, Pregnancy & Women's Health' survey. Women (18-50 years) were eligible if pregnant or planning pregnancy. Knowledge and beliefs items were adapted from the Reproductive Health and Behaviours Questionnaire.

Results: Compared to women with type 2 diabetes (n = 103), women with type 1 diabetes (n = 526) had higher scores for knowledge about pregnancy in diabetes (type 1 diabetes 9.8 ± 2.4 vs. type 2 diabetes 7.7 ± 3.1), beliefs about benefits (type 1 diabetes 18.4 ± 2.2 vs. type 2 diabetes 17.2 ± 3.3), cues-to-action (type 1 diabetes 2.7 ± 1.4 vs. type 2 diabetes 1.5 ± 1.3) and self-efficacy (type 1 diabetes 22.6 ± 5.5 vs. type 2 diabetes 20.2 ± 6.1 (all p < 0.001) regarding preparing for pregnancy. Major knowledge gaps were the need for higher dose folate compared to women without diabetes and uncertainty about breastfeeding recommendations. Women with type 1 diabetes believed more strongly in the benefits of 'close to target' glucose levels prior to pregnancy and using contraception to prevent unplanned pregnancy; they also felt more confident to access pre-pregnancy care and to wait for optimal glycaemia before pregnancy. Women with type 2 diabetes were less aware of contraceptive choices, and risks associated with hyperglycaemia before or early in pregnancy.

Conclusions: The findings highlighted main gaps in knowledge and beliefs about planning for pregnancy. Especially in type 2 diabetes, there is a need for evidence-based messaging and strategies addressing these gaps, to raise understanding to prepare for future pregnancies.
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http://dx.doi.org/10.1111/dme.14521DOI Listing
April 2021

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

Factors associated with attendance for pre-pregnancy care and reasons for non-attendance among women with diabetes.

Diabetes Res Clin Pract 2018 Aug 24;142:269-275. Epub 2018 May 24.

Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Bankstown-Lidcombe Hospital, Bankstown, NSW, Australia.

Aims: To describe factors associated with the uptake of diabetes-specific pre-pregnancy care (PPC), determine the perceived helpfulness of attending, reasons for non-attendance and intention to seek PPC in the future.

Methods: A cross-sectional 66-item survey was administered to Australian women with type 1 or type 2 diabetes mellitus (DM) aged 18-50 years.

Results: Of 429 eligible women, 54% reported having attended PPC. In multivariable logistic regression analysis, having Type 1 DM [adjusted OR 1.89, 95% CI (1.07, 3.33)], being married or in a defacto relationship [OR 2.43 (95% CI 1.27, 4.65)], tertiary educated [OR 1.91 (95% CI 1.27, 2.88)] or employed [OR 1.80 (95% CI 1.14, 2.82)] were associated with being more likely to attend PPC. Sixty eight percent (68%) rated attending PPC as helpful. A lack of awareness about the availability of PPC (48%) and unplanned pregnancy (47%) were the main reasons for non-attendance. Of women with future pregnancy plans, 43% were aware of local services offering PPC and 84% indicated they would attend PPC if available.

Conclusion: Australian women who attend PPC differ by type of diabetes and socioeconomic characteristics. Initiatives are needed to address this disparity and encourage all women with diabetes to plan and prepare for pregnancy. Reasons reported for non-attendance suggest that strategies to increase awareness about the availability of diabetes-specific PPC and the risks of unplanned pregnancy are warranted.
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http://dx.doi.org/10.1016/j.diabres.2018.05.030DOI Listing
August 2018

Access to a youth-specific service for young adults with type 1 diabetes mellitus is associated with decreased hospital length of stay for diabetic ketoacidosis.

Intern Med J 2018 Apr;48(4):396-402

Diabetes Transition Support Program, Department Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.

Background: Management of type 1 diabetes mellitus in youth with diabetes (YWD) is complex, and glycaemic control often deteriorates during this challenging period. We hypothesise that attendance at a youth-specific diabetes clinic reduces hospital admission rates and length of stay (LOS) for diabetic ketoacidosis (DKA).

Aims: To assess the impact of a youth-specific diabetes service for YWD on DKA admissions in two adjacent local health districts.

Methods: A retrospective cohort analysis of admissions for DKA in YWD aged 15-25 years, presenting to four hospitals in Western Sydney in 2011 was performed. Number of admissions, LOS and DKA severity were assessed. Cost was analysed as a function of LOS. Groups were divided by attendance at a youth-specific diabetes service and no record of attendance.

Results: There were 55 DKA admissions from 39 patients (median age 20.0 years); the majority of admissions (82%) was YWD not supported by a youth-specific diabetes service. Median LOS was significantly longer in the unsupported group (3.0 vs 1.5 days, P = 0.028). Median pH at presentation in the unsupported group was significantly lower, 7.11 versus 7.23 (P = 0.05). The admission rate was four times greater for those not supported by youth-specific diabetes services, 5.5% compared with 1.6% (P = 0.001). The estimated cost saved by youth-specific services was over $250,000 pa.

Conclusions: Lack of access to supported care for YWD during transition from paediatric to adult care has an adverse impact on subsequent DKA admission rates and LOS.
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http://dx.doi.org/10.1111/imj.13649DOI Listing
April 2018

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