Case story

Using Evidence from a Diabetes Study to Change Local Clinical Guidelines

In 2006 the Kimberley Aboriginal Medical Services Council, the Rural Clinical School of WA and the WA Country Health Service, Kimberley, conducted a study to see whether point-of-care (POC) capillary blood glucose meters were sufficiently accurate to diagnose or exclude diabetes as part of remote primary health care practice. Early diagnosis and treatment of diabetes leads to improved outcomes, but diabetes goes undiagnosed in up to 50 per cent of patients.

The 2001 National Evidence Based Guidelines for the Management of Type 2 Diabetes Mellitus stated that tests to exclude or diagnose diabetes “this should be performed by a laboratory (rather than with a blood glucose meter)”. However this can cause logistical problems and delays in diagnosis in remote communities where many clinics are a long distance from a laboratory and transport links are limited. Also, many people move between communities and venous glucose results may not be available when the person is next seen. As a result diagnosis, patient feedback and education are often delayed.

The Kimberley Capillary POC Glucose Study looked at whether blood glucose meters could be used to diagnose or exclude diabetes. It compared POC capillary glucose results across seven health care sites in the Kimberley with venous glucose levels measured in a reference laboratory. The researchers found a high overall correlation between the laboratory and POC samples (i.e. the results obtained by each method were quite similar).

Local changes were made, based on the results. The method of diagnosing Type 2 diabetes in the Kimberley was modified, and the Kimberley Chronic Disease Protocol for Type 2 Diabetes was updated.

The study contributed to changes to the National Evidence Based Guidelines for Case Detection and Diagnosis of Type 2 Diabetes. The guidelines have been changed to state that ‘POC capillary glucose testing is sufficiently accurate to be a useful component in the diagnosis of diabetes in remote communities throughout Australia’ (Colagiuri et al. 2009:54).

Factors that contributed to knowledge exchange were that:

• people involved in the research were well placed to use the findings for change.  The Kimberley Chronic Disease Therapeutic Guidelines are written by a subcommittee of the Kimberley Aboriginal Health Planning Forum, some of whom were investigators on the study. This allowed the evidence from this study to be quickly incorporated into the regional guidelines. 
• stakeholders were engaged and consulted throughout the study, including regional and local health services
• findings were disseminated in various ways. After the study finished Drs Marley & Davis travelled to some of the sites involved in the study and presented the study’s findings to the community and clinic staff.  The results were also presented at the Kimberley Health Research Network (via videoconference) and at scientific meetings (General Practice and Primary Health Care Research Conference, Rural Clinical School of Western Australia Annual Scientific Meeting).
• publication in scientific literature, where it was read by those revising the national guidelines
• plain language reports were produced for clinic staff and community members, and sent to all clinics in the Kimberley (Marley et al. 2007:500–03).

For plain language reports, see the Kimberley Aboriginal Medical Services Council website.

See bibliography for full references.