ausdiab slide kit

Australian Diabetes, Obesity and Lifestyle Study (AusDiab)Australian Diabetes, Obesity and Lifestyle Study (AusDiab)International Diabetes Institute Melbourne 2006International Diabetes Institute Melbourne 20062005

Tracking the Accelerating Epidemic: Tracking the Accelerating Epidemic: Its Causes and OutcomesIts Causes and Outcomes

AusDiab 2005AusDiab 2005

The Australian Diabetes, The Australian Diabetes, Obesity and Lifestyle StudyObesity and Lifestyle Study


Baseline data from AusDiab 2000Baseline data from AusDiab 2000• TheThe AusDiab survey carried out in AusDiab survey carried out in

19991999––2000 provides benchmark Australian 2000 provides benchmark Australian prevalence dataprevalence data

• 2000 findings, Australians 2000 findings, Australians 25 years old: 25 years old:– – 7.4% had diabetes (doubled since 1981)7.4% had diabetes (doubled since 1981)– – 16.3% had pre-diabetes (IFG/IGT*)16.3% had pre-diabetes (IFG/IGT*)– – 59.6% were mildly overweight or obese59.6% were mildly overweight or obese– – 28.8% had hypertension28.8% had hypertension– – 51.2% had total cholesterol 51.2% had total cholesterol ≥ 5.5 mmol/L, and 20.5% had ≥ 5.5 mmol/L, and 20.5% had

elevated triglycerides (≥ 2.0 mmol/L) elevated triglycerides (≥ 2.0 mmol/L) – – 2.5% had proteinuria, 6.4% had haematuria 2.5% had proteinuria, 6.4% had haematuria

and 1.1% had elevated serum creatinine and 1.1% had elevated serum creatinine

* IFG ─ impaired fasting glucose; IGT ─ impaired glucose tolerance.


Aims of the five-year follow-upAims of the five-year follow-up• Describe the natural history of:Describe the natural history of:

– Type 2 diabetesType 2 diabetes– Pre-diabetes (IFG/IGT*)Pre-diabetes (IFG/IGT*)– Associated cardiovascular disease, risk factors Associated cardiovascular disease, risk factors

and complicationsand complications

• Identify risk factors associated with Identify risk factors associated with worsening glucose tolerance status and worsening glucose tolerance status and diabetic complicationsdiabetic complications

• Measure the progression of renal disease in Measure the progression of renal disease in diabetic and non-diabetic populationsdiabetic and non-diabetic populations

* IFG ─ impaired fasting glucose; IGT ─ impaired glucose tolerance.


Definitions for ‘prevalence’ Definitions for ‘prevalence’ and ‘incidence’and ‘incidence’

• 19991999––2000 data:2000 data:Prevalence – the proportion of people within a Prevalence – the proportion of people within a population who have a certain disease or population who have a certain disease or condition at a particular timecondition at a particular time

• 20042004––05 data:05 data:Incidence – number of new cases of a disease Incidence – number of new cases of a disease or condition arising in a population over a or condition arising in a population over a period of timeperiod of time


Diabetes and Diabetes and pre-diabetespre-diabetes


Diabetes mellitusDiabetes mellitus• Is a metabolic disorder with multiple Is a metabolic disorder with multiple

causes characterised by chronically elevated causes characterised by chronically elevated blood glucose levelsblood glucose levels

• Predisposes individuals to:Predisposes individuals to:– Cardiovascular disease Cardiovascular disease –– Visual loss Visual loss– Amputations Amputations –– Renal failure Renal failure

• Has many risk factors including obesity, Has many risk factors including obesity, hypertension and dyslipidaemiahypertension and dyslipidaemia


Classification values for the oral Classification values for the oral glucose tolerance testglucose tolerance test

Plasma glucose (mmol/L)Plasma glucose (mmol/L)

World Health Organization. Department of noncommunicable disease surveillance, 1999

Glucose toleranceGlucose tolerance Fasting glucoseFasting glucose 2-hour glucose2-hour glucose

DiabetesDiabetes ≥ ≥ 7.07.0 oror ≥ ≥ 11.111.1

Impaired glucose tolerance (IGT)Impaired glucose tolerance (IGT) < 7.0< 7.0 and and 7.87.8––11.011.0

Impaired fasting glucose (IFG)Impaired fasting glucose (IFG) 6.16.1––6.96.9 andand < 7.8< 7.8

Normal glucose tolerance (NGT)Normal glucose tolerance (NGT) < 6.1< 6.1 andand < 7.8< 7.8


Diabetes in Australia:Diabetes in Australia:The last 20 yearsThe last 20 years

0

200

400

600

800

1000

’80 ’82 ’84 ’86 ’88 ’90 ’92 ’94 ’96 ’98 ’00

Thou

sand

sTh

ousa

nds

YearYear

a) Busselton

b) Nat HeartFoundation

c) Aust BureauStatistics

d) Aust BureauStatistics

e) AusDiab


From 1999–2000 report:From 1999–2000 report:

0.12.6

6.8

16.1

21.6 22.4

0.42.3

5.5

9.9

16.1

24.5

0

5

10

15

20

25

30

25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75+

MalesFemales

Age- and gender-specific Age- and gender-specific prevalence (%) of diabetesprevalence (%) of diabetes

Age group (years)Age group (years)

Perc

enta

gePe

rcen

tage



3.3

8.59.6

12.411.0

4.6

0.5

2.2

4.6 4.7 4.3

8.0

0

5

10

15

25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75+

MalesFemales


Age-specific Age-specific prevalence (%) of IFGprevalence (%) of IFG

Perc

enta

gePe

rcen

tage

IFG ─ impaired fasting glucose



2.1

4.8

8.4

14.8

20.4

25.5

4.9

8.5

11.2

15.2

22.920.7

0

5

10

15

20

25

30

25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75+

MalesFemales


Age-specific Age-specific prevalence (%) of IGTprevalence (%) of IGT

Perc

enta

gePe

rcen

tage

IGT ─ impaired glucose tolerance


From 1999–2000 report:From 1999–2000 report:Weighted prevalence (%) of associated Weighted prevalence (%) of associated

conditions stratified by glucose tolerance conditions stratified by glucose tolerance statusstatus

Glucose tolerance statusGlucose tolerance statusAssociated conditionAssociated condition DiabetesDiabetes IFGIFG IGTIGT NormalNormal

Hypertension*Hypertension* 69.369.3 43.543.5 50.150.1 21.121.1

Obesity (BMI Obesity (BMI 30 kg/m²) 30 kg/m²) 44.444.4 30.130.1 31.531.5 15.915.9

LDL (LDL ( 3.5 mmol/L) 3.5 mmol/L) 45.945.9 59.659.6 53.053.0 44.144.1

HDL (HDL ( 1.0 mmol/L) 1.0 mmol/L) 23.123.1 16.816.8 11.611.6 10.610.6

Triglycerides (Triglycerides ( 2.0 mmol/L) 2.0 mmol/L) 42.942.9 31.431.4 31.131.1 16.016.0

* On treatment, or systolic pressure * On treatment, or systolic pressure 140 mmHg, 140 mmHg, or diastolic pressure or diastolic pressure 90 mmHg 90 mmHg

IGT ─ impaired glucose tolerance; IFG ─ impaired fasting glucose.


0.9

0.7

0.8

0.0

0.2

0.4

0.6

0.8

1.0

Males Females All

Incidence of diabetes Incidence of diabetes according to genderaccording to genderIn

cide

nce

(% p

er y

ear)

Inci

denc

e (%

per

yea

r)


0.2

0.6 0.6

1.5 1.5

1.2

0.70.6

1.3 1.3

0.40.5

0.7

1.0

1.41.3

0.50.4

0.0

0.4

0.8

1.2

1.6

2.0

25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 > 75

MalesFemalesAll

Incidence of diabetes according Incidence of diabetes according to baseline ageto baseline age

Inci

denc

e (%

per

yea

r)In

cide

nce

(% p

er y

ear)

Baseline age (years)Baseline age (years)≥


0.2

2.0

4.4

2.9

0.2

2.5

3.5

0.2

4.0

0

1

2

3

4

5

NGT IFG IGT

MalesFemalesAll

Incidence of diabetes accordingIncidence of diabetes accordingto baseline glucose tolerance to baseline glucose tolerance

statusstatusIn

cide

nce

(% p

er y

ear)

Inci

denc

e (%

per

yea

r)

Baseline glucose toleranceBaseline glucose tolerance

NGT ─ normal glucose tolerance; IFG ─ impaired fasting glucose; IGT ─ impaired glucose tolerance.


1.41.3 1.3

0.9

0.50.6

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

Males Females All

IGTIFG

Incidence of IGT and IFGIncidence of IGT and IFGIn

cide

nce

(% p

er y

ear)

Inci

denc

e (%

per

yea

r)

IGT ─ impaired glucose tolerance; IFG ─ impaired fasting glucose.


0.4

1.8

0.4

0.7

1.4

0.4

0.8

1.6

0.8

0.0

0.4

0.8

1.2

1.6

2.0

Normal Overweight Obese

MalesFemalesAll

Incidence of diabetes Incidence of diabetes according according

to baseline body mass indexto baseline body mass index

Baseline BMI statusBaseline BMI status

Inci

denc

e (%

per

yea

r)

Body mass index (BMI: weight/height2) was categorised into three groups: (i) normal: BMI < 25.0 kg/m2; (ii) overweight: 25.0─29.9 kg/m2; and (iii) obese: ≥ 30.0 kg/m2.


0.8

1.6

0.3

1.4

0.5

1.5

0.4 0.4 0.4

0.0

0.4

0.8

1.2

1.6

2.0


MalesFemalesAll

Incidence of diabetes according to Incidence of diabetes according to baseline waist circumference baseline waist circumference

categoriescategories

Baseline waist circumference categoriesBaseline waist circumference categories

Inci

denc

e (%

per

yea

r)

Waist circumference: (i) normal: < 94.0 cm for males, < 80.0 cm for females; (ii) overweight: 94.0─101.9 cm for males, 80.0─87.9 cm for females; (iii) obese: ≥ 102.0 cm for males, ≥ 88.0 cm for females.


1.4

0.7

0.90.8

0.5

1.1

0.9

0.6

1.1

0.0

0.4

0.8

1.2

1.6

Sedentary Insufficient Sufficient

MalesFemalesAll

Incidence of diabetes Incidence of diabetes accordingaccording

to baseline physical activityto baseline physical activity

Baseline physical activities categoriesBaseline physical activities categories

Inci

denc

e (%

per

yea

r)


1.6

1.4

0.5

1.5

0.5 0.5

0.0

0.4

0.8

1.2

1.6

2.0

Normal Hypertension

MalesFemalesAll


to baseline hypertension to baseline hypertension statusstatus

Baseline hypertension statusBaseline hypertension status

Inci

denc

e (%

per

yea

r)

Hypertension (high blood pressure) was defined as having a blood pressure ≥ 140/90 mmHg and/or taking blood-pressure lowering medication.


0.7

1.4

1.9

1.6

0.5 0.5

0.0

0.4

0.8

1.2

1.6

2.0

2.4

Normal Dyslipidaemia

MalesFemalesAll


to baseline dyslipidaemia to baseline dyslipidaemia statusstatus

Dyslipidaemia status at baselineDyslipidaemia status at baseline

Inci

denc

e (%

per

yea

r)

Dyslipidaemia was defined as those with triglycerides ≥ 2.0 mmol/L or high-density lipoprotein cholesterol levels < 1.0 mmol/L.


0.5

1.71.7

0.4

1.7

0.4

0.0

0.4

0.8

1.2

1.6

2.0

Normal Metabolic syndrome

MalesFemalesAll

Incidence of diabetes according Incidence of diabetes according to baseline metabolic syndrome statusto baseline metabolic syndrome status

Baseline metabolic syndrome statusBaseline metabolic syndrome status

Inci

denc

e (%

per

yea

r)

Metabolic syndrome was defined according to the definition by the International Diabetes Federation.


Diabetes Diabetes Key findings Key findings• Every year 0.8% of Australian adults Every year 0.8% of Australian adults

develop diabetesdevelop diabetes• Every day in Australia approximately Every day in Australia approximately

275 adults develop diabetes275 adults develop diabetes• Those with pre-diabetes were 10Those with pre-diabetes were 10––20 times 20 times

more likely to develop diabetes than those with more likely to develop diabetes than those with normal blood glucose levelsnormal blood glucose levels

• Obesity, hypertension, dyslipidaemia, physical Obesity, hypertension, dyslipidaemia, physical inactivity and the metabolic syndrome each inactivity and the metabolic syndrome each increased the risk for developing diabetesincreased the risk for developing diabetes


ObesityObesity


Body mass index classificationBody mass index classification

Body mass index (kg/mBody mass index (kg/m22))

NormalNormal < 25.0< 25.0

OverweightOverweight 25.0 25.0 – 29.9– 29.9

ObeseObese ≥ 30.0≥ 30.0


Classification of abdominal Classification of abdominal obesityobesity

by waist circumference by waist circumference

Waist circumference (cm)Waist circumference (cm)

NormalNormal < 94.0 < 94.0 < 80.0< 80.0

OverweightOverweight 94.0 94.0 – 101.9– 101.9 80.0 80.0 – 87.9– 87.9

ObeseObese ≥ 102.0≥ 102.0 ≥ 88.0≥ 88.0

MalesMales FemalesFemales


From 1999–2000 report:From 1999–2000 report:Age-specific prevalence (%) of obesity*Age-specific prevalence (%) of obesity*

by BMI & waist circumferenceby BMI & waist circumferenceAge (years)Age (years)

ClassificationClassification 25-3425-34 35-4435-44 45-5445-54 55-6455-64 65-7465-74 75+75+ TotalTotalBMI BMI

MalesMales 17.017.0 17.517.5 20.520.5 25.525.5 20.520.5 11.611.6 19.119.1FemalesFemales 12.212.2 19.419.4 26.026.0 31.931.9 29.729.7 14.914.9 21.821.8PersonsPersons 14.714.7 18.418.4 23.223.2 28.728.7 25.525.5 13.513.5 20.520.5

Waist Waist MalesMales 13.613.6 24.624.6 27.427.4 35.835.8 41.241.2 36.836.8 26.626.6FemalesFemales 17.117.1 25.625.6 37.637.6 46.746.7 52.252.2 43.043.0 33.933.9PersonsPersons 15.315.3 25.125.1 32.432.4 41.241.2 47.347.3 40.540.5 30.330.3

* BMI * BMI 30 kg/m²; Waist circumference: males 30 kg/m²; Waist circumference: males 102 cm; females 102 cm; females 88 cm 88 cm


3.4

1.6

0.4

-1.9

1.3

1.9

0.7

-2.4

1.5

3.5

2.5

1.8

0.5

-0.3

1.4

-0.3

2.52.5

3.5

-3.0

-2.0

-1.0

0.0

1.0

2.0

3.0

4.0

MalesFemalesAll

Mean weight change over five Mean weight change over five years according to baseline years according to baseline

ageage

Baseline age (years)Baseline age (years)

Mea

n ch

ange

in w

eigh

t (kg

)

25 – 34 35 – 44 45 – 54 55 – 64 65 – 74 ≥ 75 Total

- 0.3

- 2.2


1.2

0.8

0.5

0

0.7

1.4

0.7

-0.3

0.9

1.3

0.9

0.6

0.4

0.8

0.40.4

1.11.1

-0.4

0.0

0.4

0.8

1.2

1.6

MalesFemalesAll

Mean body mass index change Mean body mass index change over over

five years according to baseline five years according to baseline ageage


Mea

n ch

ange

in B

MI (

kg/m

2 )

25 – 34 35 – 44 45 – 54 55 – 64 65 – 74 ≥ 75 Total

- 0.2

1.0 1.0


2.11.9 1.9

1.2 1.2

0.3

1.6

3.5

2.9 3

2

1.6

-0.1

2.52.9

2.5 2.5

1.61.4

0.1

2.1

-0.5

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

MalesFemalesAll

Mean waist circumference change Mean waist circumference change over five years according to over five years according to

baseline agebaseline age


Mea

n ch

ange

in w

aist

ci

rcum

fere

nce

(cm

)

25 – 34 35 – 44 45 – 54 55 – 64 65 – 74 ≥ 75 Total

3.0

2.0

3.0


1.8

11.1

1.3

0.8

1.2

0.9

1.9 1.9

0.0

0.5

1.0

1.5

2.0

2.5


MalesFemalesAll

Mean weight change over five years Mean weight change over five years according to baseline body mass index according to baseline body mass index

statusstatusM

ean

wei

ght c

hang

e (k

g)

1.0



1.6 1.6 1.6

2.9

2.4

1.9

2.5

21.8

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5


MalesFemalesAll

Mean waist circumference change over Mean waist circumference change over five years according to baseline BMI five years according to baseline BMI

status status

Mea

n w

aist

circ

umfe

renc

e ch

ange

(cm

)

2.0



0

3.1

4.9

2

0.1

3.9

1.91.9

0.10.0

1.0

2.0

3.0

4.0

5.0

6.0

Normal Overweight All

MalesFemalesAll


Incidence of obesity according to Incidence of obesity according to baseline body mass index statusbaseline body mass index status

Inci

denc

e (%

per

yea

r)

2.0


nnNormalNormal

n (%)n (%)

OverweightOverweight

n (%)n (%)

ObeseObese

n (%)n (%)

NormalNormal 2,3692,369 1,831 (77.3)1,831 (77.3) 530 (22.4)530 (22.4) 8 (0.34)8 (0.34)

OverweightOverweight 2,5602,560 194 (7.6)194 (7.6)1,917 1,917 (74.9)(74.9)

449 (17.5)449 (17.5)

ObeseObese 1,3561,356 6 (0.4)6 (0.4) 120 (8.9)120 (8.9) 1,230 (90.7)1,230 (90.7)

TotalTotal 6,2856,285 2,0312,031 2,5672,567 1,6871,687

Proportion of individuals classified by Proportion of individuals classified by body mass index in 2004body mass index in 2004–0–05 5

according to baseline body mass according to baseline body mass index statusindex status

BMI status at baselineBMI status at baseline BMI in 2004BMI in 2004–05–05

Body mass index (BMI: weight/height2) was categorised into three groups: (i) normal: BMI < 25.0 kg/m2; (ii) overweight: 25.0─29.9 kg/m2; and (iii) obese: ≥ 30.0 kg/m2.


nnNormalNormal

n (%)n (%)

OverweightOverweight

n (%)n (%)

ObeseObese

n (%)n (%)

NormalNormal 2,4962,496 1,752 (70.2)1,752 (70.2) 628 (25.2)628 (25.2) 116 (4.7)116 (4.7)

OverweightOverweight 1,6371,637 301 (18.4)301 (18.4) 771 (47.1)771 (47.1) 565 (34.5)565 (34.5)

ObeseObese 2,1632,163 44 (2.0)44 (2.0) 238 (11.0)238 (11.0) 1,881 (87.0)1,881 (87.0)

TotalTotal 6,2966,296 2,0972,097 1,6371,637 2,5622,562

Proportion of individuals classified by Proportion of individuals classified by waist circumference in 2004waist circumference in 2004–0–05 5

according to baseline waist according to baseline waist circumference categoriescircumference categories

Waist circumference categories in 2004Waist circumference categories in 2004–05–05Waist circumference categories at Waist circumference categories at baselinebaseline

Waist circumference: (i) normal: < 94.0 cm for males, < 80.0 cm for females; (ii) overweight: 94.0─101.9 cm for males, 80.0─87.9 cm for females; (iii) obese: ≥ 102.0 cm for males, ≥ 88.0 cm for females.


Obesity Obesity Key findings Key findings• People aged < 65 years showed an average weight People aged < 65 years showed an average weight

increase of 1.8 kg over five yearsincrease of 1.8 kg over five years• People aged People aged ≥ ≥ 65 years showed a loss in weight of 65 years showed a loss in weight of

0.8 kg over the same period0.8 kg over the same period• Waist circumference Waist circumference average gain over five years average gain over five years

was 2.1 cm; greater in females than maleswas 2.1 cm; greater in females than males• Younger people gained more weight and had a Younger people gained more weight and had a

greater increase in waist circumference than did greater increase in waist circumference than did older people older people

• Twice as many overweight people became obese Twice as many overweight people became obese as reverted to normalas reverted to normal


HypertensionHypertension


Role of hypertensionRole of hypertension• High blood pressure is a risk factor for High blood pressure is a risk factor for

cardiovascular and renal diseasecardiovascular and renal disease

• For individuals with diabetes, high blood pressure is For individuals with diabetes, high blood pressure is a risk factor for microvascular complications as well a risk factor for microvascular complications as well as cardiovascular diseaseas cardiovascular disease

• The baseline study found that 28.8% of adults The baseline study found that 28.8% of adults ≥≥ 25 years of age were classified as 25 years of age were classified as hypertensive (BP hypertensive (BP ≥ 140/90 mmHg or taking ≥ 140/90 mmHg or taking BP lowering medication) BP lowering medication)


Classification of blood pressureClassification of blood pressure

Systolic blood Systolic blood Diastolic blood Blood-pressure Diastolic blood Blood-pressure pressure (mmHg) pressure (mmHg) pressure (mmHg) lowering medication pressure (mmHg) lowering medication

Normal Normal < 140< 140 and and < 90< 90 and and No No

HypertensionHypertension ≥ 140≥ 140 oror ≥ 90≥ 90 oror Yes Yes

Guidelines Subcommittee. J Hypertens 1999; 17: 15183.


From 1999–2000 report:From 1999–2000 report:Prevalence (%) of adequate blood Prevalence (%) of adequate blood

pressurepressure** control among people on control among people on anti-hypertensive therapyanti-hypertensive therapy

Age (years)Age (years)25–3425–34 35–4435–44 45–5445–54 55–6455–64 65–7465–74 75+75+ TotalTotal

MalesMales 55.855.8 45.345.3 37.437.4 28.728.7 20.120.1 34.334.3

FemalesFemales 75.575.5 75.975.9 59.259.2 47.647.6 43.243.2 33.733.7 46.446.4

PersonsPersons 75.575.5 66.466.4 52.652.6 42.642.6 37.337.3 29.329.3 41.441.4

*Systolic pressure *Systolic pressure 140 mmHg, and a diastolic pressure 140 mmHg, and a diastolic pressure 90 mmHg, 90 mmHg, and on anti-hypertensive medicationand on anti-hypertensive medication


nnNormal BPNormal BP

n (%)n (%)

HypertensionHypertension

n (%)n (%)

Normal BPNormal BP 4,3534,353 3,749 (86.1)3,749 (86.1) 604 (13.9)604 (13.9)

HypertensionHypertension 1,9651,965 354 (18.0)354 (18.0) 1,611 (82.0)1,611 (82.0)

TotalTotal 6,3186,318 4,1034,103 2,2152,215

Proportion of individuals classified Proportion of individuals classified with hypertension in 2004with hypertension in 200405 05

according to baseline hypertensionaccording to baseline hypertensionHypertension status in 2004Hypertension status in 2004–05–05Hypertension status at baselineHypertension status at baseline


1.72.2

3.0

5.2

8.8 8.5

2.8

4.9

8.0

6.9

1.01.6

2.9

5.0

8.47.6

0.61.2

0

2

4

6

8

10

25 – 34 35 – 44 45 – 54 55 – 64 65 – 74 > 75

MalesFemalesAll

Incidence of hypertension Incidence of hypertension according according

to baseline ageto baseline ageIn

cide

nce

(% p

er y

ear)

Inci

denc

e (%

per

yea

r)


≥


3.0

4.2

5.2

7.5

4.8

8.5

2.6

4.44.9

7.9

2.3

5.0

0

1

2

3

4

5

6

7

8

9

NGT IFG IGT DM

MalesFemalesAll

Incidence of hypertension Incidence of hypertension according to baseline glucose according to baseline glucose

tolerance statustolerance statusIn

cide

nce

(% p

er y

ear)

Inci

denc

e (%

per

yea

r)

Baseline glucose tolerance statusBaseline glucose tolerance statusNGT ─ normal glucose tolerance; IFG ─ impaired fasting glucose;

IGT ─ impaired glucose tolerance; DM – diabetes mellitus


2.4

3.5

5.2

1.5

3.4

5.6

1.8

5.4

3.5

0

1

2

3

4

5

6


MalesFemalesAll

Incidence of hypertension Incidence of hypertension according to baseline body mass according to baseline body mass

index statusindex status


Inci

denc

e (%

per

yea

r)

BMI: Body mass index; where (i) normal was a BMI of < 25.0 kg/m2; (ii) overweight was a BMI of 25.0─29.9 kg/m2; and (iii) obese was a BMI of ≥ 30.0 kg/m2.


3.1

3.8

2.82.4

2.93.1

0

1

2

3

4

5

Non-smokers Smokers

MalesFemalesAll

Incidence of hypertension Incidence of hypertension according to baseline smoking according to baseline smoking

statusstatus

Baseline smoking statusBaseline smoking status

Inci

denc

e (%

per

yea

r)


Hypertension Hypertension Key findings Key findings• 3.0% of adults develop hypertension 3.0% of adults develop hypertension

every yearevery year• The risk increases with age from 1.0% per year The risk increases with age from 1.0% per year

at 25at 2534 years of age to 8.4% per year at 6534 years of age to 8.4% per year at 6574 74 years of ageyears of age

• Those at greatest risk are people:Those at greatest risk are people:– With diabetes and pre-diabetes (females With diabetes and pre-diabetes (females

higher risk than males)higher risk than males)– Who are overweight or obese (females higher Who are overweight or obese (females higher

risk than males)risk than males)– Who smoke (males higher risk than females)Who smoke (males higher risk than females)


Metabolic Metabolic syndromesyndrome


Significance of the metabolic Significance of the metabolic syndromesyndrome

• The metabolic syndrome is characterised by The metabolic syndrome is characterised by central or abdominal obesity, and a clustering of central or abdominal obesity, and a clustering of cardiovascular risk factors, such as:cardiovascular risk factors, such as:– Abnormal glucose toleranceAbnormal glucose tolerance– Raised triglyceridesRaised triglycerides– Decreased HDL-cholesterolDecreased HDL-cholesterol– HypertensionHypertension– Hyperinsulinaemia (with underlying insulin resistance)Hyperinsulinaemia (with underlying insulin resistance)

• The metabolic syndrome confers a higher risk of The metabolic syndrome confers a higher risk of diabetes and cardiovascular diseasediabetes and cardiovascular disease


Waist circumferenceWaist circumference Europids: Europids: ≥ 94 cm males, ≥ 80 cm females≥ 94 cm males, ≥ 80 cm females

South and South-East Asians: ≥ 90 cm males,South and South-East Asians: ≥ 90 cm males,≥ 80 cm females≥ 80 cm females

Plus two or more of the following:Plus two or more of the following:

• Raised triglyceridesRaised triglycerides ≥ ≥ 1.7 mmol/L or specific treatment for this lipid 1.7 mmol/L or specific treatment for this lipid abnormalityabnormality

• Reduced HDL-CReduced HDL-C < 1.03 mmol/L in males; < 1.29 mmol/L in females < 1.03 mmol/L in males; < 1.29 mmol/L in females or specific treatment for this lipid abnormalityor specific treatment for this lipid abnormality

• Raised blood pressureRaised blood pressure Systolic Systolic ≥ 130 mmHg or diastolic ≥ 85 mmHg or ≥ 130 mmHg or diastolic ≥ 85 mmHg or treatment of previously diagnosed hypertensiontreatment of previously diagnosed hypertension

• Raised plasma glucoseRaised plasma glucose Fasting plasma glucose Fasting plasma glucose ≥ 5.6 mmol/L or previously ≥ 5.6 mmol/L or previously diagnosed type 2 diabetesdiagnosed type 2 diabetes

Classification of the metabolic Classification of the metabolic syndromesyndrome

ThresholdThresholdComponentComponent

Alberti KG Alberti KG et al.et al. LancetLancet 2005; 366: 1059 2005; 366: 105962.62.


3.8

2.4

3

0

1

2

3

4

5

Males Females All

Incidence of the metabolic Incidence of the metabolic syndrome according to gendersyndrome according to gender

Inci

denc

e (%

per

yea

r)In

cide

nce

(% p

er y

ear)

3.0


3.1 3.3

3.9 3.9

5.1

4.4

2.5

3.74.0

3.5

2.2 2.0

3.1

3.8

4.5

3.9

1.61.3

0.0

2.0

4.0

6.0

25 – 34 35 – 44 45 – 54 55 – 64 65 – 74 > 75

MalesFemalesAll

Incidence of the metabolic Incidence of the metabolic syndrome according to baseline syndrome according to baseline

ageageIn

cide

nce

(% p

er y

ear)

Inci

denc

e (%

per

yea

r)



2.4

5.5

8.2

1.1

2.8

5.9

1.7

3.8

6.6

0

2

4

6

8

10


MalesFemalesAll

Incidence of the metabolic Incidence of the metabolic syndrome according to baseline syndrome according to baseline waist circumference categorieswaist circumference categories

Baseline waist circumference categoriesBaseline waist circumference categories

Inci

denc

e (%

per

yea

r)

Waist circumference: (i) normal: < 94.0 cm for males, < 80.0 cm for females; (ii) overweight: 94.0─101.9 cm for males, 80.0─87.9 cm females; (iii) obese: ≥ 102.0 cm for males, ≥ 88.0 cm for females.


4.3

3.5

2.72.2

3.32.8

0

2

4

6

Insufficient Sufficient

MalesFemalesAll


physical activityphysical activity

Baseline physical activity statusBaseline physical activity status

Inci

denc

e (%

per

yea

r)


2.7

5.6

4.6

6.2

0

1

2

3

4

5

6

7

NGT IFG IGT DM


glucose tolerance status glucose tolerance status In

cide

nce

(% p

er y

ear)

Inci

denc

e (%

per

yea

r)

Baseline glucose tolerance statusNGT ─ normal glucose tolerance; IFG ─ impaired fasting glucose;



Metabolic syndrome Metabolic syndrome Key Key findingsfindings

• The risk of developing the metabolic The risk of developing the metabolic syndrome:syndrome:– Was six times greater in people who were obese Was six times greater in people who were obese

than those who were normal weightthan those who were normal weight– Was two times greater in people with diabetes Was two times greater in people with diabetes

than those with normal glucose tolerancethan those with normal glucose tolerance– Was greater in physically inactive peopleWas greater in physically inactive people– Increased with increasing ageIncreased with increasing age– Was greater for males than femalesWas greater for males than females


Chronic kidney Chronic kidney diseasedisease


Significance of chronic kidney Significance of chronic kidney diseasedisease

• Individuals with chronic kidney disease are Individuals with chronic kidney disease are at increased risk of end-stage renal failure, at increased risk of end-stage renal failure, and premature cardiovascular diseaseand premature cardiovascular disease1,21,2

• The incidence of end-stage kidney disease The incidence of end-stage kidney disease is 95 cases/million population per annumis 95 cases/million population per annum33

• Diabetes is a leading cause Diabetes is a leading cause –– responsible for responsible for 30% of all new cases30% of all new cases33

1. Anavekar NS et al. N Engl J Med 2004; 351: 128595. 2. Go AS et al. N Engl J Med 2004; 351: 1296305. 3. McDonald SP et al. The 28th report of the Australia and New Zealand Dialysis and Transplant Registry 2006.


DefinitionsDefinitions• Estimated impaired glomerular filtration rate, Estimated impaired glomerular filtration rate,

eGFR, defined as < 60 mL/min/1.73 meGFR, defined as < 60 mL/min/1.73 m2 2

• Abnormal albuminuria defined as spot urine Abnormal albuminuria defined as spot urine albumin:creatinine albumin:creatinine ≥ 2.5 mg/mmol for males ≥ 2.5 mg/mmol for males and ≥ 3.5 mg/mmol for femalesand ≥ 3.5 mg/mmol for females


0.4

1.3

0.9

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

Males Females All

Incidence of impaired glomerular Incidence of impaired glomerular filtration rate according to filtration rate according to

gendergenderIn

cide

nce

(% p

er y

ear)

Inci

denc

e (%

per

yea

r)


0.0 0.1 0.1 0.2 0.3

3.2

0.6

1.72.1

6.3

0.1 0.2 0.3

1.0 1.1

4.6

0.2 0.3

0

1

2

3

4

5

6

7

25 – 29 30 – 39 40 – 49 50 – 59 60 – 69 > 70

MalesFemalesAll

Incidence of impaired glomerular Incidence of impaired glomerular filtration rate according to baseline filtration rate according to baseline

ageageIn

cide

nce

(% p

er y

ear)

Inci

denc

e (%

per

yea

r)



0.20.5

1.10.8

1.1

1.7

2.4

3.0

0.7 0.8

1.8 1.7

0

1

2

3

4

NGT IFG IGT DM

MalesFemalesAll


glucose tolerance statusglucose tolerance statusIn

cide

nce

(% p

er y

ear)

Inci

denc

e (%

per

yea

r)

Baseline glucose tolerance statusNGT ─ normal glucose tolerance; IFG ─ impaired fasting glucose;

IGT ─ impaired glucose tolerance; DM ─ diabetes mellitus.


0.1

0.90.8

2.9

0.5

1.8

0

1

2

3

Normal blood pressure Hypertension

MalesFemalesAll


hypertension statushypertension status


Inci

denc

e (%

per

yea

r)



1

0.6

0.8

0.0

0.2

0.4

0.6

0.8

1.0

1.2

Males Females All

Incidence of albuminuria Incidence of albuminuria according to genderaccording to gender

Inci

denc

e (%

per

yea

r)In

cide

nce

(% p

er y

ear)

1.0


0.2 0.3 0.40.8

1.5

4.7

0.4 0.4

0.9

2.3

0.4 0.3 0.40.6

1.2

3.4

0.50.2

0

1

2

3

4

5

25 – 29 30 – 39 40 – 49 50 – 59 60 – 69 > 70

MalesFemalesAll

Incidence of albuminuria Incidence of albuminuria according according

to baseline ageto baseline ageIn

cide

nce

(% p

er y

ear)

Inci

denc

e (%

per

yea

r)



0.81.0

1.5

3.6

0.7

2.5

0.6

1.31.0

3.1

0.5

2.3

0

1

2

3

4

NGT IFG IGT DM

MalesFemalesAll


to baseline glucose tolerance to baseline glucose tolerance statusstatus

Inci

denc

e (%

per

yea

r)In

cide

nce

(% p

er y

ear)

Baseline glucose tolerance statusBaseline glucose tolerance statusNGT ─ normal glucose tolerance; IFG ─ impaired fasting glucose;



2.2

0.4

1.2

0.5

1.7

0.5

0

1

2

3

Normal blood pressure Hypertension

MalesFemalesAll


to baseline hypertension statusto baseline hypertension status


Inci

denc

e (%

per

yea

r)



Chronic kidney disease Chronic kidney disease Key Key findingsfindings

• Approximately 1% of adults developed chronic Approximately 1% of adults developed chronic kidney disease each yearkidney disease each year

• Approximately 1% of adults developed albuminuria Approximately 1% of adults developed albuminuria each yeareach year

• People with hypertension have three times the risk People with hypertension have three times the risk of developing impaired GFR and albuminuriaof developing impaired GFR and albuminuria

• People with diabetes have five times the risk of People with diabetes have five times the risk of developing albuminuria, and twice the risk of developing albuminuria, and twice the risk of developing reduced kidney functiondeveloping reduced kidney function


MortalityMortality


Mortality ratesMortality rates• AusDiab 2005 examined the 5-year all-cause AusDiab 2005 examined the 5-year all-cause

mortality rates for males and females, for different mortality rates for males and females, for different age groups and for different levels of glucose age groups and for different levels of glucose tolerancetolerance

• The relative mortality risk was calculated for The relative mortality risk was calculated for independent risk factorsindependent risk factors

• Over a median time of 5.2 years there were 355 Over a median time of 5.2 years there were 355 deaths (208 males, 147 females). This represents a deaths (208 males, 147 females). This represents a mortality rate of 6.1 per 1,000 person yearsmortality rate of 6.1 per 1,000 person years


5.17.6

13.815.2

31.6

9.0

13.6

19.7

3.6

7.0

10.9

14.4

26.1

2.5

5.7

0

5

10

15

20

25

30

35

NGT IFG IGT NDM KDM

MalesFemalesAll

Total mortality according to Total mortality according to baseline glucose tolerance statusbaseline glucose tolerance status

Mor

talit

y ra

te (p

er 1

000

py)

Mor

talit

y ra

te (p

er 1

000

py)

Baseline glucose toleranceBaseline glucose toleranceNGT ─ normal glucose tolerance; IFG ─ impaired fasting glucose; IGT ─ impaired glucose tolerance;

NDM ─ newly diagnosed diabetes; KDM ─ previously diagnosed diabetes.


Relative risk of mortality for people Relative risk of mortality for people with pre-diabetes and diabetes with pre-diabetes and diabetes

compared with people with NGT*compared with people with NGT*

Baseline glucose tolerance statusBaseline glucose tolerance status* After accounting for other risk factors. Bars represent 95% confidence intervals

0

0.5

1

1.5

2

2.5

3

3.5

NGTIGTIFGNDMKDM

NGT IGT IFG NDM KDM

NGT ─ normal glucose tolerance; IFG ─ impaired fasting glucose; IGT ─ impaired glucose tolerance; NDM ─ newly diagnosed diabetes; KDM ─ previously diagnosed diabetes.

AllAll --

caus

e m

orta

lity

haza

rd ra

tioca

use

mor

talit

y ha

zard

ratio


Relative risk of mortality Relative risk of mortality associated with various risk associated with various risk

factors*factors*

Baseline risk factorsBaseline risk factors0

1

2

3

4Hy

perte

nsio

n

Albu

min

uria

Impa

ired

GFR

Smok

ing

CVD

KDM

AllAll ––

caus

e m

orta

lity

haza

rd ra

tioca

use

mor

talit

y ha

zard

ratio

* After accounting for other risk factors. Bars represent 95% confidence intervals


NGTKDMNDMIFGIGT

Baseline glucose tolerance Baseline glucose tolerance status among those dying of status among those dying of

cardiovascular diseasecardiovascular disease

33%

20%13%

13%

21%

NGT ─ normal glucose tolerance; KDM – previously diagnosed diabetes; NDM – newly diagnosed diabetes IFG ─ impaired fasting glucose; IGT ─ impaired glucose tolerance.



18.2

31.4

50.4

13.1

22.6

64.3

15.6

26.9

57.5

0

20

40

60

80

Smoker Ex-smoker Never

MalesFemalesTotal

Prevalence (%) of smoking status Prevalence (%) of smoking status among Australian residentsamong Australian residents

Smoking statusSmoking status

Perc

enta

gePe

rcen

tage



45.3

34.8 33.1

26.322.4

29.4

23.0 21.016.0 15.6

0

20

40

60

1980 1983 1989 1995 2000

MalesFemales

YearYear

Trends in the age-standardised* Trends in the age-standardised* prevalenceprevalence

(%) of hypertension: 1980 – 2000(%) of hypertension: 1980 – 2000

* Age standardised to the 1991 Australian population* Age standardised to the 1991 Australian population

ABS. Population by age and sex. Canberra: ABS, 1999ABS. Population by age and sex. Canberra: ABS, 1999

Perc

enta

gePe

rcen

tage


Mortality Mortality Key findings Key findings• Over five years:Over five years:

– People with previously known diabetes were twice as likely People with previously known diabetes were twice as likely to die as were those with normal glucose toleranceto die as were those with normal glucose tolerance

– People with previously known diabetes had a similar risk of People with previously known diabetes had a similar risk of mortality to smokers and people with previous mortality to smokers and people with previous cardiovascular diseasecardiovascular disease

– Pre-diabetes was associated with a 45Pre-diabetes was associated with a 4555% increase in 55% increase in mortality riskmortality risk

– Over two-thirds of all cardiovascular disease deaths Over two-thirds of all cardiovascular disease deaths occurred in people with diabetes or pre-diabetesoccurred in people with diabetes or pre-diabetes


Survey methods Survey methods and response ratesand response rates


Sampling frame for the AusDiab Sampling frame for the AusDiab follow-up 2004follow-up 2004 –– 0505

Individuals participating in the baseline surveyn = 11,247

Individuals ineligible for invitation n = 459• Requested no further contact = 128• Deceased = 310• Excluded* = 21

Total individuals eligible for invitation to AusDiab 2004–05 n = 10,788

* ‘Excluded’ – included participants who had moved into a nursing facility classified for high care, or were ineligible due to chronic or terminal * ‘Excluded’ – included participants who had moved into a nursing facility classified for high care, or were ineligible due to chronic or terminal illnessillness


Response rates to the AusDiab Response rates to the AusDiab survey 2004survey 2004 ––55

Eligible participants10,788

Cancelled1,990

Participated in AusDiab survey 2004–05 8,798

Attendance at external pathology

laboratory137

Health conditions telephone

questionnaire only2,261

On-site attendance6,400


StateState NumberNumber On-siteOn-site PathologyPathology Self-reportedSelf-reported OverallOverall eligible eligible testingtesting laboratorylaboratory medicalmedical respondersresponders

attendance* attendance* conditions onlyconditions only n n n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%)

Response rates by state or Response rates by state or territoryterritory

VICVIC 1,4291,429821 (57.5)821 (57.5)52 (3.6)52 (3.6) 337 (23.6)337 (23.6) 1,210 (84.7)1,210 (84.7)

WAWA 1,5261,526990 (64.9)990 (64.9)28 (1.8)28 (1.8) 210 (13.8)210 (13.8) 1,228 (80.5)1,228 (80.5)

NSWNSW 1,4581,458871 (59.7)871 (59.7)14 (1.0)14 (1.0) 323 (22.1)323 (22.1) 1,209 (82.9)1,209 (82.9)

TASTAS 1,7001,7001,102 (64.8)1,102 (64.8)2 (0.1)2 (0.1) 296 (17.4)296 (17.4) 1,400 (82.4)1,400 (82.4)

SASA 1,7001,700945 (55.6)945 (55.6)29 (1.7)29 (1.7) 467 (27.5)467 (27.5) 1,441 (84.8)1,441 (84.8)

NTNT 1,2021,202702 (58.4)702 (58.4)5 (0.4)5 (0.4) 189 (15.7)189 (15.7) 895 (74.5)895 (74.5)

QLDQLD 1,7481,748 954 (54.6) 954 (54.6) 7 (0.4)7 (0.4) 433 (24.8)433 (24.8) 1,394 (79.7)1,394 (79.7)

ACTACT 2525 15 (60.0) 15 (60.0) 0 (0)0 (0) 6 (24.0)6 (24.0) 21 (84.0)21 (84.0)

TotalTotal 10,78810,7886,400 (59.3)6,400 (59.3)137 (1.3)137 (1.3)2,261 (21.0)2,261 (21.0) 8,798 (81.6)8,798 (81.6)

* External pathology laboratory facilities were either not available or were limited in TAS, SA, NT and QLD* External pathology laboratory facilities were either not available or were limited in TAS, SA, NT and QLD


SponsorsSponsors

• Abbott Australasia Abbott Australasia • AlphapharmAlphapharm• AstraZenecaAstraZeneca• Aventis PharmaAventis Pharma• Bio-Rad LaboratoriesBio-Rad Laboratories• Bristol-Myers SquibbBristol-Myers Squibb• City Health Centre – Diabetes Service, CanberraCity Health Centre – Diabetes Service, Canberra• Department of Health and Community Services, Department of Health and Community Services,

Northern TerritoryNorthern Territory• Department of Health and Human Services, Department of Health and Human Services,

TasmaniaTasmania• Department of Health, NSWDepartment of Health, NSW• Department of Health, WADepartment of Health, WA• Department of Health, SADepartment of Health, SA• Department of Human Services, VICDepartment of Human Services, VIC• Diabetes AustraliaDiabetes Australia• Diabetes Australia Northern TerritoryDiabetes Australia Northern Territory• Eli Lilly AustraliaEli Lilly Australia

• Estate of the Late Edward WilsonEstate of the Late Edward Wilson• GlaxoSmithKlineGlaxoSmithKline• Highpoint Shopping CentreHighpoint Shopping Centre• Jack Brockhoff FoundationJack Brockhoff Foundation• Janssen-CilagJanssen-Cilag• Kidney Health AustraliaKidney Health Australia• Marian & EH Flack TrustMarian & EH Flack Trust• Menzies Research InstituteMenzies Research Institute• Merck Sharp & DohmeMerck Sharp & Dohme• MultiplexMultiplex• Novartis PharmaceuticalsNovartis Pharmaceuticals• Novo Nordisk PharmaceuticalsNovo Nordisk Pharmaceuticals• Pfizer Pty LtdPfizer Pty Ltd• Pratt FoundationPratt Foundation• Queensland HealthQueensland Health• Roche Diangonostics AustraliaRoche Diangonostics Australia• Royal Prince Alfred Hospital, SydneyRoyal Prince Alfred Hospital, Sydney• Sanofi-SynthelaboSanofi-Synthelabo

The AusDiab study gratefully acknowledges the generous support given by:The AusDiab study gratefully acknowledges the generous support given by:

National Health and Medical Research Council (NHMRC)National Health and Medical Research Council (NHMRC)

Australian Government Department of Health and AgingAustralian Government Department of Health and Aging


ContributorsContributorsPrincipal InvestigatorsPrincipal Investigators

Stan Bennett Stan Bennett Australian Institute of Health and WelfareAustralian Institute of Health and Welfare

Damien Jolley Damien Jolley Monash Institute of Health Services Research, Monash UniversityMonash Institute of Health Services Research, Monash University

Terry Dwyer AMTerry Dwyer AM Murdoch Children’s Research InstituteMurdoch Children’s Research Institute

Stephen ColagiuriStephen Colagiuri Department of Endocrinology, Prince of Wales HospitalDepartment of Endocrinology, Prince of Wales Hospital

Pat Phillips Pat Phillips Department of Endocrinology, Queen Elizabeth HospitalDepartment of Endocrinology, Queen Elizabeth Hospital

Kerin O’DeaKerin O’Dea Department of Medicine, University of MelbourneDepartment of Medicine, University of Melbourne

Liz BinghamLiz Bingham Department of Health and Human Services, TasmaniaDepartment of Health and Human Services, Tasmania

Steve ChadbanSteve Chadban Royal Prince Alfred Hospital and University of SydneyRoyal Prince Alfred Hospital and University of Sydney

Terry CoyneTerry Coyne School of Population Health, University of QueenslandSchool of Population Health, University of Queensland

John McNeilJohn McNeil Department of Epidemiology and Preventive Medicine, Monash UniversityDepartment of Epidemiology and Preventive Medicine, Monash University

Neville OwenNeville Owen School of Population Health, University of QueenslandSchool of Population Health, University of Queensland

Kevan PolkinghorneKevan Polkinghorne Department of Nephrology, Monash Medical CentreDepartment of Nephrology, Monash Medical Centre

Robyn TappRobyn Tapp Department of Epidemiology and Preventive Medicine, Monash UniversityDepartment of Epidemiology and Preventive Medicine, Monash University

Hugh TaylorHugh Taylor Centre for Eye Research AustraliaCentre for Eye Research Australia

Andrew TonkinAndrew Tonkin Department of Epidemiology and Preventive Medicine, Monash UniversityDepartment of Epidemiology and Preventive Medicine, Monash University

Tien WongTien Wong Centre for Eye Research AustraliaCentre for Eye Research Australia

Paul Z Zimmet AOPaul Z Zimmet AO International Diabetes InstituteInternational Diabetes Institute

Robert Atkins AMRobert Atkins AM Department of Epidemiology and Preventive Medicine, Monash UniversityDepartment of Epidemiology and Preventive Medicine, Monash University

Timothy Welborn AOTimothy Welborn AO Department of Medicine, University of Western AustraliaDepartment of Medicine, University of Western Australia

Jonathan ShawJonathan Shaw International Diabetes InstituteInternational Diabetes InstituteAssociate InvestigatorsAssociate Investigators

CollaboratorsCollaborators


AusDiab report authorsAusDiab report authors

• D DunstanD Dunstan

• P ZimmetP Zimmet

• T WelbornT Welborn

• R SicreeR Sicree

• T ArmstrongT Armstrong

• R AtkinsR Atkins

• A CameronA Cameron

• J ShawJ Shaw

• S ChadbanS Chadban

• E BarrE Barr

• D MaglianoD Magliano

• P ZimmetP Zimmet

• K PolkinghorneK Polkinghorne

• R AtkinsR Atkins

• D DunstanD Dunstan

• S MurrayS Murray

• J ShawJ Shaw

1999/2000 report1999/2000 report 2004/2005 report2004/2005 report


AusDiab StaffAusDiab Staff• AusDiab Project Manager: Shirley MurrayAusDiab Project Manager: Shirley Murray

• Epidemiologists: Elizabeth Barr, Adrian Cameron, David Epidemiologists: Elizabeth Barr, Adrian Cameron, David Dunstan, Dianna Magliano, Richard Sicree.Dunstan, Dianna Magliano, Richard Sicree.

• IDI Field Staff: Annaliese Bonney, Nicole Meinig, Theresa IDI Field Staff: Annaliese Bonney, Nicole Meinig, Theresa Whalen.Whalen.

• IDI Support Staff: Travis Clarke, Gay Filby, Sue Fournel, Hasan IDI Support Staff: Travis Clarke, Gay Filby, Sue Fournel, Hasan Jahangir, Larna Prout, Carol Robinson, Marc Seifman, Debbie Jahangir, Larna Prout, Carol Robinson, Marc Seifman, Debbie Shaw, Lisa Southgate, Ray Spark, Kajen Vivekananthan, Shaw, Lisa Southgate, Ray Spark, Kajen Vivekananthan, Jonathan Zimmerman.Jonathan Zimmerman.

• Other contributors: Theresa Dolphin, Irene Tam, Gabriella Other contributors: Theresa Dolphin, Irene Tam, Gabriella Tikellis, Adam Meehan, Genevieve Healy, Sarah White.Tikellis, Adam Meehan, Genevieve Healy, Sarah White.


AusDiab informationAusDiab information

For more information and publications visit:For more information and publications visit:

Reports and newsletters available:Reports and newsletters available:

• AusDiab Report 2001AusDiab Report 2001

• AusDiab Report 2006AusDiab Report 2006

• Newsletter September 2004Newsletter September 2004

• Newsletter September 2006Newsletter September 2006

http//:www.diabetes.com.au/research.php?regionID=181&page=ausdiab_homehttp//:www.diabetes.com.au/research.php?regionID=181&page=ausdiab_home

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