DiabetesNetwork_Spring2013

Spring 2013 network THE DIABETES NEWSLETTER FOR HEALTH PROFESS IONALS Something to shout about: exposing a “silent killer”

Diabetes is often called the “silent killer” – an epidemic that knows no prejudice when it comes to race, creed, age or culture. It has reached record levels and continues to escalate in all its forms (type 1, type 2 and gestational diabetes), now affecting more than 370 million people across the planet. Of greatest concern, and despite years of warnings, the epidemic shows little sign of turning, with latest research – most notably, the landmark Australian Diabetes Obesity and Lifestyle Study (AusDiab) – prompting calls for “radical action” to change community mindsets and drive healthier lifestyle choices. Twelve years on, the AusDiab study, which tracked 11,000 Australians, found the incidence of diabetes remains “alarmingly high”, with around 269 adults (aged over 25) developing the condition every day and, of particular note, facing mortality rates on a par with smoking. Professor Jonathan Shaw, Associate Director of the Baker IDI Heart and Diabetes Institute and the study’s co-chief investigator, said tough decisions needed to be made in the face of evidence that Australians are failing to make the necessary lifestyle changes to address serious health risks associated with obesity, high blood pressure and diabetes. “The health and wellbeing of a whole generation of young Australians is being compromised by a lifestyle rich in

energy dense foods and low on physical activity,” Professor Shaw said on the day of the study’s release (19 August). “As a community, we need to be prepared to take some tough decisions around these issues. It’s not impossible. Look at what we’ve achieved with gun control, smoking cessation and water restrictions. “On the one hand, we need to encourage and support people to make healthier lifestyle choices by providing the right incentives and on the other, we need to apply appropriate measures to discourage behaviours that lead to poor health and increased pressures on the health budget.” As detailed in the last issue of Diabetes Network , which focused on the cost of obesity in Queensland and the success of the Swap It program, the AusDiab study identified the ongoing issue of obesity as one of the biggest risk-factors behind type 2 diabetes. It found a greater trend of weight gain in the 25-34 age group (6.7kg increase), with 36 per cent of all people not meeting existing physical activity guidelines, also underestimating how much time they spent sitting each day. A portable measurement device recorded an average 500 minutes spent sitting per day, more than double the time participants thought they were sedentary (200 minutes). The study also found that the incidence of diabetes is five times higher in people who are obese and two times higher in those who are overweight, with depression also nearly twice as common among those with obesity.

In Australia, at least 1.5 million people have diabetes, which ranks as the nation’s sixth-leading cause of death. In Queensland, 62 people are diagnosed with the condition every day (60 type 2 and two type 1 cases). More than 2 million Australian adults have pre-diabetes and are at high risk of developing type 2, with cases also being diagnosed in an increasingly younger population. On current trends, diabetes is tipped to become the No. 1 health burden over the next five years, with health costs associated with type 2 diabetes expected to double to $30 billion by 2025 in the absence of a more robust national approach to preventing diabetes and its complications. It’s why Diabetes Australia recently released a National Diabetes Strategy and Action Plan as a framework for the incoming government after the 2013 federal election. Read it via http://www. diabetesaustralia.com.au/ PageFiles/3/National%20 Diabetes%20Strategy%20 and%20Action%20Plan.pdf

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feature story

Lisa | WA People with diabetes like me are three times more likely to develop kidney damage and need dialysis.

John | VIC Over 1.5 million Australians like me have diabetes.

Kelly | About 100,000 developed diabe

Something to shout about:

Every day 60 Queenslanders learn they have type 2 diabetes Freya | VIC 280 Australians like me develop diabetes every day.

exposing a “silent killer”

Simon | NSW Amputations are 15 times more common in people with diabetes like me.

Paul Zi DIABETES EXP have pre-diabet type 2 diabetes.

continued from page 1

Over 12 years, it showed the average gain in waist circumference among participants was 5.3cm, and greater in women than men. Similarly, latest data produced by the Australian Bureau of Statistics, arising from its 2011-13 Australian Health Survey, 62.7 per cent of Australian adults are overweight (BMI 25.00 – 29.99) or obese (BMI 30.00 or more), broken down to 35.5 per cent and 27.2 per cent respectively. Of particular interest, the AusDiab study found that diabetes risk doubled for people living in the most socially- disadvantaged areas of Australia. And, for those living with diabetes in the 60+ age group, the prevalence of cognitive impairment was twice that of people without diabetes. Similar to the AusDiab study, which raised concern about community complacency, a Diabetes Queensland survey conducted in the lead up to Diabetes Week (14-20 July) revealed a startling community mindset concerning the diabetes risk, best summarised as “it won’t happen to me”. While respondents recognised that the growing incidence of type 2 diabetes is an issue of concern in their community, they rated their own likelihood of developing the condition as very low, regardless of risk factors. A paper arising from the survey has been selected as one of five Diabetes Queensland abstracts to be showcased at this year’s World Diabetes Conference in Melbourne (2-6 December). Of note, the survey’s findings also echo the results of a recent Newspoll survey that showed nearly 80 per cent of all Australians don’t think they are at risk of developing type 2 diabetes in the next few years. A further 7.7 per cent already know they have diabetes and 11.5 per cent

Dave | Diabetes is a m Australia, it is t with diabetes li

Amanda | QLD Everyday 8 people like me lose their sight due to diabetes related eye disease.

Connor & Ayden | VIC Over 1.5 million Australians like us have diabetes.

88% Diabetes Queensland has launched a specially designed web portal to help schools and parents manage diabetes in the school community. On page 3 , we review some lessons for health professionals in supporting parents. Also in this issue, Diabetes Queensland dietitian Michelle Tong talks about a new education project aimed at breaking through language/cultural barriers. See page 6 . % agree diabetes is increasing in the community THE FACE OF DIABETES Currently there are about 2000 Queensland children aged between five and 18 with type 1 diabetes and, with type 2 cases now spiralling, it is expected m re children will be diagnosed with type 2. Assess your risk www.diabetesqld.org.au Call 1300 136 588 National Diabetes Week 8 - 14 July 2012 More disturbing still – only about a quarter of parents agreed they were concerned about their own children developing the condition. Raising diabetes awareness as part of the National Diabetes Week campaign recognise they will probably develop type 2 diabetes in the next few years. In a separ te survey commissioned by Diabetes Queensland, Roy Morgan esearch found most respondents gree that there should be coordinated federal and state government action to fund the fight against diabetes. However, little more than a third agreed they felt personal concern about developing diabetes (type 2). Rachel | WA Nearly 120,000 Australians like me have type 1 diabetes and need multiple daily insulin injections to live. Stephen Colagiuri | NSW DIABETES EXPERT The cost of diabetes will cripple the health system unless we take action now. Take action and visit faceofdiabetes.org.au or call 1300 136 588

% agree diabetes is increasing in the community

Anna | Heart attacks a likely in people

88%

% agree it is important they do not develop diabetes

92%

Community Mindset – Survey results, conducted by Diabetes Queensland

% agree diabetes is increasing in the community

% agree they feel concerned about developing diabetes themselves

% agree it is important they do not develop diabetes

38%

88%

92%

% agree they feel concerned about developing diabetes

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Diabetes Network – Spring 2013

resources

helping parents know best

An estimated 2000 Queensland children and adolescents aged between five and 18 currently live with type 1 diabetes and the number is increasing, with type 2 cases also being diagnosed at a younger age. In response, Diabetes Queensland has launched a web portal called DiabetesBasics, designed as a resource for schools, teachers, support staff and parents of students living with all types of diabetes. While it is critical that diabetes is not ignored in the school environment, it is also important for health professionals and educators to remain ever mindful of the fact that the diabetes journey can be a lonely path for parents, who require a lot of support – medical, educational and psychological. As detailed in research commissioned by Diabetes Queensland as part of its examination of needs and issues in the Queensland schools context, many parents do not grasp the full extent of type 1 diabetes at the time of their child’s diagnosis. The 2011 study revealed how parents were often devastated to learn that type 1 diabetes can only be managed and not cured. In the words of one parent: “I thought, yeah, with diabetes you got better. I had no idea. I knew about type 2 diabetes but I had no idea about type 1. It came as a real shock.” As health professionals know, type 1 diabetes is the type most commonly found in children and adolescents. However, the prevalence of type 2 diabetes in Australian children has been raising concern for some time. In 2004, a West Australian study pointed to an annual increase of 27 per cent in the rates of type 2 diabetes diagnosed in children during the period 1990 to 2002. Even a cursory glance at people registered on the National Diabetes Services Scheme in the 12 months to June 2013 shows an increasing incidence in type 2 cases in children and adolescents aged four to 18. That said, type 1 diabetes remains the biggest challenge for parents caring for children diagnosed with the condition. Parents face a steep learning curve and, in the 2011 study, reported feeling that they were “still learning” even after 12 months had passed. Of interest for health professionals and, in particular, diabetes educators, many parents shielded children from the realities of possible long-term health implications of type 1 diabetes, resulting in children not fully understanding the repercussions of eating the wrong types of food.

Some parents admitted finding chocolate and snacks hidden in their child’s bedroom – often reported as “a new behaviour” and perhaps indicating frustration felt by the child in being deprived of treats they were once permitted to eat, before diabetes. After their child’s diagnosis, parents also felt that they could not take their eyes off their child, reported feeling constantly worried and were reluctant to allow their child to have sleepovers or to visit with friends. The results of the study provide a reminder to health professionals about focus areas when providing advice and support to parents whose children have recently been diagnosed with diabetes. The study cast a spotlight on daily challenges experienced by parents, as follows Challenges faced by parents at home: • Nutrition – learning to count carbohydrates and understanding the likely impact of various food types on blood glucose levels (BGLs) • Disciplining the child with type 1 / managing behaviour (are they being naughty or is their behaviour due to diabetes?) • Remembering to check BGLs • Sleep deprivation (caused by checking BGLs of the child during the night) • Lack of support network / lack of relief • Lack of storage space (for pumps, medical supplies etc.) • Ensuring siblings without diabetes receive an equal amount of attention Challenges faced by parents when away from home: • Amount of planning required • Needing to stick to rigid schedule • Eating out / not knowing the amount of carbohydrates in foods / finding appropriate food if necessary • Remembering to check BGLs The new DiabetesBasics website provides an invaluable resource, hosting downloadable versions of the school guidelines (Students with diabetes – Guidelines for Queensland schools) , practical advice and templates for developing individual and emergency health plans. For more information, check out DiabetesBasics at www. diabetesqld.org.au/diabetes-school-guidelines Plus, for information on a separate Diabetes Queensland program, Need for Feed, designed to improve secondary school students’confidence and skills in cooking healthy food, visit www.needforfeed.org.au • Needing to take fully stocked kit everywhere • Explaining to others / misguided judgements

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Diabetes Network – Spring 2013

under the spotlight

Jason Warnock

Born and educated in far north Queensland, Jason Warnock has more than 30 years experience as a podiatrist, specialising in Indigenous health. In 2008, he received a Churchill Fellowship award to investigate diabetic foot programs for Indigenous peoples of the United States and Canada, building on his work developing the Townsville-based Indigenous Diabetic Foot Program. In the lead-up to national Foot Health Month, in October, Jason shares some career insights.

What have you been doing after completing the Churchill Fellowship Study Tour (2009)? I’ve literally been rushed off my feet, if you’ll excuse the pun. There’s the ongoing rollout of the Indigenous Diabetic Foot Program, in particular, working with partners in the Northern Territory. I resigned as Chair of the Australian and New Zealand Podiatry Accreditation Council to become Chair of the Podiatry Board of Australia, and I’ve delivered presentations at the 2010 National SARRAH Conference in Broome, Western Australia, as well as the Chronic Disease Forum in Darwin the previous year. But the biggest development has involved a change in direction in my podiatry career: in 2010, I moved from the private to public sector, to a role as the podiatry lead and advanced podiatrist in the Townsville Hospital and Health Service. It’s been an exciting time, with more changes afoot. In September, I commence a temporary new role as the Allied Health Team Leader in the Emergency Department, currently the largest in Queensland. Important lessons learned during the study tour? Native language – or first language, namely what a person has learned from birth – is vitally important in connecting people. An important lesson learned is that maintaining and renewing language builds cultural strengths, heals the pain of the past and enables a healthy vision for the future. In Canada, I spent time with the Southern Ontario Aboriginal Diabetes Initiative [http://www.soadi.ca/], which offers an example of First Nations people providing health services for their own peoples. What became apparent is that while in Australia, we have Aboriginal and Torres Strait Islander health worker roles – for example, cultural consultancy and clinical roles in our health services – in Canada and the United States, these types of positions are not as embedded into service delivery. So, it’s good to see that we’re leading in this area. How can health professionals play a greater prevention role and become more actively involved when it comes to diabetes-related foot complications? Education and self-management should be the cornerstone of care provided to every patient, no matter whether newly

diagnosed, with diabetic foot disease complications, a diabetic foot wound or undergoing rehabilitation after an amputation. Working in the area of Indigenous health has taught me to ensure that delivery of education/support (particularly with the focus being on self-management) is culturally acceptable, achievable, able to be easily understood and, importantly, of interest to the person receiving care and not necessarily what the health provider feels is important. Much of this boils down to having a variety of resources and tools at hand to engage with people. These tools don’t have to be sophisticated: for example mirrors prove invaluable in self-management and daily inspection of foot conditions. It’s more about being creative and utilising every-day items that people may have at home. Finally, health literacy is important for all Australians. I currently sit on the Primary Care Committee of the Australian Commission on Safety and Quality in Health Care, and this topic is on our current work agenda. Recently, a consultation paper was released by the Commission, via http://www.safetyandquality.gov.au/our- work/patient-and-consumer-centred-care/health-literacy/ health-literacy-consultation-paper/. I encourage health professionals to follow the progression of this important work to develop a health literacy national strategy. What have you learned from your patients? Everything. I think with Indigenous patients, in particular, I have learned the art of truly listening. Taking the time to communicate and not jumping in when there’s a silence and trying to answer a question for somebody. Of course, in non-Indigenous culture we often refer to awkward silences. So, this has been an important lesson in life, not just my work. As a child, did you think this would be your career path? As a young child, I wanted to be a farmer and grow crops to feed the people of my town. Are thongs ever acceptable? Yes – better than bare feet.

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Diabetes Network – Spring 2013

journal article review

DQ clinicians journal club In this issue, we share a brief overview of an article (as reviewed at a recent Diabetes Queensland journal club) that provides food for thought on the question of whether or not to restrict fruit intake as part of type 2 diabetes management. Title: Effect of fruit restriction on glycemic control in patients with type 2 diabetes – a randomized trial Restricting fruit intake as part of standard medical nutrition therapy (MNT) in overweight adults newly diagnosed with type 2 diabetes is put to a “real life” test in this study coming out of Denmark. In what is believed to be the first trial of its kind, involving 63 men and women split into high and low fruit control groups, researchers came to the conclusion that intake should not be restricted. Their position stems from the fact that no significant benefits resulted from advice provided to participants to eat “no more than two serves of fruit each day” compared to those told to eat “at least two serves of fruit each day” over a 12-week period. A serve of fruit was equal to that which contained approximately 10 grams of carbohydrate. “In spite of a difference in fruit intake of about two pieces daily between the groups, we did not find any effect on HbA1c, body weight or circumference,” the researchers reported. They noted that while most MNT guidelines recommend eating a diet with a high intake of fibre-rich food, including

fruit, “some health professionals have concerns that fruit intake has a negative impact on glycemic control and therefore recommend restricting the fruit intake”. However, as the researchers stated, prior to their “pragmatic trial”, very few intervention studies had tested a variety of fruit over several weeks and none had investigated long-term glycemic control in type 2 patients. Participants in both control groups provided a blood sample and underwent consultations with an experienced registered dietitian at the start and completion of the trial, with weight and waist measurements also taken. Medical nutrition therapy was given on an individual basis, with the only difference between the two groups being advice related to fruit intake. As expected, there was a significant reduction in HbA1c in both groups, but no significant difference between the groups (0.49 ± 0.2 in the high fruit group and 0.29 ± 0.1 in the low fruit group). Similarly, both groups had a significant reduction in body weight and waist circumference, but with no differences recorded between the groups. The researchers did find a tendency towards reduced body weight and waist circumference in the group that ingested most fruit – 0.9 (CI 95%;-0.4 to 2.2) kg and 1.2 (CI 95%; -0.5 to 3.0) cm respectively. They considered the most likely explanation for little variance in outcomes between the two control groups was that “fruit is eaten as a part of a daily diet and therefore when changing the fruit intake, it will lead to other changes in the diet”.

1. Christensen, Allan S; Viggers, Lone; Kjeld, Hasselstrom and Gregersen, Sorren. Effect of fruit restriction on glycemic control in patients with type 2 diabetes – a randomized trial. Nutrition Journal 2013, March 5; 12:29.

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Diabetes Network – Spring 2013

Lost in translation no more education

Getting the diabetes message heard can be hard enough at the best of times, without the additional hurdle of language/cultural barriers. In an effort to reach out to Chinese-Australians, who account for more than one third (36%) of the four million Australians who speak languages other than English at home, Diabetes Queensland has developed an education/ support program delivered in Cantonese and Mandarin. Starting as a pilot project prior to full roll-out (February- June 2013), the program, Diabetes: How much do you know? – believed to be the first of its kind in Queensland – targeted communities in Brisbane, the Sunshine Coast and Gold Coast.

The project’s strength turned on use of Diabetes Queensland’s Michelle Tong, an Accredited Practicing Dietitian, fluent in Cantonese and Mandarin, who also developed print resources and social marketing strategies. Pre and post evaluations of the program reflected its value and cultural relevance: the majority of participants found it “very suitable and helpful” and recorded improved knowledge about self-managing type 2 diabetes and accessing health care services. For Michelle, the project was also a personal journey. She shares insights from an ongoing initiative that was selected for presentation at the 2013 Annual Scientific Meeting and Exhibition staged by the Australian Diabetes Society and Australian Diabetes Educators Association in Sydney (28-30 August).

“Having grown up in two different cultures – Chinese and Australian – it was always clear to me that culture plays a big part when it comes to food and related lifestyle choices. As a child, I also experienced first- hand the frustration and challenges posed by language barriers, having emigrated with my family from Hong Kong to Australia at the age of nine. It’s one of the reasons this project became something of a personal journey, enabling me to reach out and help others in a similar situation. Above all, as a dietitian, I wanted to ensure that vital information about healthy lifestyle choices and the importance of a balanced, nutritious diet does not get lost in translation. Prior to commencing the project, it was clear to me that important diabetes management information was indeed getting lost in translation. For example, I was often asked by family and friends if diabetes is reversible, whether eating less rice would help or if medication is all that is required to manage the condition. I feel very privileged to have been given the opportunity of ensuring the Chinese-Australian community

receives trusted and culturally appropriate information. My cultural background certainly made it a lot easier to deliver the program. I wasn’t, however, expecting that the program would also present a major learning curve about barriers other than language in getting the diabetes message out. Language was certainly the vehicle in getting the message out, though not necessarily heard . As I learned, the real success of the program rested on building trust and a strong rapport with participants. This is often because cultural groups tend to stick together, which limits their access to culturally appropriate education and the opportunity for an “outsider” to approach them directly. Each culture also has its own myths, which are important to tackle. In the Chinese-Australian community, for example, common cultural myths include: • People with diabetes should not eat carbohydrate foods • Eating too much sugar will cause diabetes • Taking medication is solely all I need when it comes to managing diabetes • People with diabetes can’t eat fruits that are too sweet

Diabetes Queensland’s – Michelle Tong who is fluent in Cantonese and Mandarin.

• If I’m compliant with what the doctor recommends, such as healthy eating and taking my medication, my condition will stabilise. ” If you would like to know more about this program, please contact Mtong@diabetesqld.org.au

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Diabetes Network – Spring 2013

latest news

Keeping you in the loop

Constant cravings Overeating may not simply boil down to a lack of will power. Scientists from the New Balance Foundation Obesity Prevention Center at Boston’s Children’s Hospital have been studying the effect of high-glycaemic index (GI) foods on food cravings. The study shows that when foods are controlled for energy, macronutrients, and palatability, participants who consumed higher GI foods had significantly higher postprandial blood glucose levels in the subsequent two hours. Plasma glucose was lower and reported hunger was greater after a high-GI meal. What’s more, greater brain activity was elicited in brain regions associated with reward and craving in the late postprandial period, which impacts on eating behaviour at the next meal. The findings support the concept of a food addiction and provide further evidence to support choosing lower GI foods.

Hi-tech health benefits Emerging internet technologies designed to support health care management plans for people with diabetes promise more than reduced paperwork. That’s the news arising from a Monash University study (as published in The Medical Journal of Australia ) that monitored 577 people with diabetes over 14 months. Patients whose care planning was supported by an internet-based care management service showed significant improvements in quality of care and clinical outcomes, with 80 per cent of patients reviewed regularly. When comparing patients’ clinical outcomes before and after use of this technology, significant health-related improvements were observed including HbA1c, total and LDL cholesterol. The technology enables more effective and efficient communication between the GP, other members of the health care team and, importantly, the patient.

Disability and diabetes The results of a new systematic review and meta-analysis published in The Lancet Diabetes & Endocrinology journal show that people with diabetes aged over 65 are at least 50 per cent more likely to have a physical disability than their peers without diabetes. The increase in impaired mobility and functional disability isn’t entirely clear, but thought to be related to both the complications associated with diabetes and possibly chronic muscle inflammation due to high blood glucose concentrations. This research highlights potential health and economic implications, especially considering the increase in diabetes diagnosis among middle- aged Australians. Further information across the age spectrum is required to fully assess the impact this may have.

For more information on all stories visit www.diabetesqld.org.au

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Diabetes Network – Spring 2013

what’s on

Calendar Dates For a full list of our upcoming programs please visit www.diabetesqld.org.au or phone 1300 136 588.

Development and training for health professionals Carbohydrate Counting: A full-day workshop for dietitians and diabetes educators to develop the skills and confidence to better support clients’ ability to accurately count carbohydrates. Understanding Diabetes: A three-hour workshop that aims to provide best practice education for care workers supporting clients in disability services, aged care, community clinics, rural settings and hospitals. The program offers an interactive learning environment to assist care workers to support self-management in clients and patients with diabetes. Eat It facilitator training: The 'train the trainer' course that enables fitness and other health professionals to deliver a six-week nutrition education program. The program dispels myths around healthy eating and provides participants with knowledge and skills to better support their clients. Diabetes – What Now? facilitator training: A training package for metropolitan and regional diabetes educators and dietitians to deliver the ‘Diabetes – What Now?’ self-management education program for people with type 2 diabetes. The Diabetes Queensland package includes facilitator training, assessment, program collateral and promotional and health professional support. Ongoing management for people living with diabetes Diabetes – What Now? This diabetes self management program is for people with type 2 diabetes who are newly diagnosed or who have not had any diabetes education. Diabetes – What Now? is typically run over two weeks with a two-hour session each week. It is currently run in North and South Brisbane and in the Cairns, Warwick, Roma and Hervey Bay Regions. EXPOsing diabetes: The educational program for people with type 1 and/or 2 diabetes is delivered as a consumer expo throughout metropolitan and regional Queensland. The expo provides the opportunity for people with diabetes to hear from experts and get practical tips to help in self-management. Virtual Shopping Tour: This two-hour classroom based session provides practical information on how to make healthier choices at the supermarket. Delivered by a dietitian, it covers topics such as healthy eating for diabetes, interpreting ingredients lists, nutrition claims and reading food labels.

16 Oct

Virtual supermarket tour Chermside 9.30am-11.30am

23 Oct

Virtual supermarket tour Noosa 2.00pm-4.00pm

What’s on Right side of page:

9 Nov EXPOsing diabetes Ipswich 8.00am-3.00pm Understanding Diabetes: Diabetes Education for Care Workers - is a three hour workshop for personal care workers, assistants in nursing and other unregulated care providers. The aim of the program is to provide best practice education for care workers supporting clients in disability services, aged care, community clinics, rural settings and hospitals. Understanding Diabetes offers an interactive learning environment to assist care workers to support self-management in clients and patients with diabetes. The workshop includes: Virtual Supermarket Tour The Virtual Shopping Tour for people with diabetes and their carers, is a free two hour classroom based session. The tour provides people with practical information on how to make healthier choices at the supermarket. Delivered by a Dietitian, it covers topics such as: • Healthy eating for diabetes • Interpreting ingredients lists • Nutrition claims • Reading labels 25 Oct Carbohydrate Counting Ship Inn, Southbank 8.30am-3.30pm

Understanding diabetes Diabetes education for care workers Milton 1.00pm-4.00pm

22 Nov

What is diabetes?

• • • •

How is diabetes managed?

Healthy eating and physical activity

Blood glucose monitoring

• Managing high and low blood glucose levels • The diabetes health care team.

28 Nov Virtual supermarket tour Milton 5.30pm-7.30pm Understanding Diabetes is endorsed by the Royal College of Nursing and offers 2.5 Continuing Nursing Education (CNE) points.

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Venue:

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To register: go to the “Health Professionals – services and programs” on the DQ website [www.diabetesqld.org.au] or phone 1300 136 588 Date: Friday, 25th October, 2013 Time: 8:30am - 3:30pm Venue: Ship Inn, Stanley Street, South Brisbane QLD

* Registration closes Monday, 18th October

To register: go to the “Health Professionals – services and programs” on the Diabetes Queensland website [ www.diabetesqld.org.au ] or phone 1300 136 588

* Registration closes Monday, 18th October

Diabetes Network – Spring 2013 Diab tes Queensland

1300 136 588

www.diabetesqld.org.au

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