Massive obesity and diabetes
The Camden and Concord Metabolic Rehabilitation Programs have a unique cohort of patients with massive obesity and the obesity related co-morbidities of Type 2 Diabetes, Fatty Liver Disease & Obesity Hypoventilation Syndrome. Approximately 50% of participants in the Fatty Liver and Obesity Hypoventilation programs also have diabetes. Participants undergo an intensive rehabilitation programme with a large interdisciplinary team comprised of medical, nursing, dietetics, psychology, physiotherapy and exercise physiology, as well as supervised on-site exercise classes. If insufficient weight loss, publically funded bariatric surgery is considered and offered to suitable participants after 12 months in the programs. Work is underway to evaluate the Metabolic Rehabilitation Programs more formally. Integration between the obesity services, gastroenterology, primary care and public/private lifestyle providers is being evaluated as part of the work. The first joint funding application for investigating the genetics of severe obesity has been made with the molecular biology group at the Garvan Institute and the epigenetics group at Western.
Over the next 5 years, we intend to have: (i) completed a case control study comparing survival and service utilisation among participants and waiting list controls; ii) commenced a RCT comparing the Metabolic Rehabilitation Diabetes Programs to an enhanced diabetes clinic model of care; and (iii) increased the number of family studies to identify possible genetic causes for severe obesity
Type 1 diabetes
Campbelltown is currently a TRIALNET site looking at the natural history of type 1 diabetes (and its prevention). Over the next 5 years, we plan to: (i) commence Oz-DAFNE (structured type 1 diabetes education) locally and then join the Oz-DAFNE research collaborative; (ii) test a new model of care in transition care (ages 18-25) currently under development; and (iii) participate in trials of new technology (CGMS, CSII as they become available.
Type 2 diabetes
Campbelltown is already a DELIGHT site for Astra Zeneca and over the next 5 years, all sites intend to increase participation in pharmaceutical trials as they arise. Management of type 2 diabetes (besides before/in pregnancy, with severe complications or with management difficulties) largely in primary care with whom we intend to work closely in an increasingly integrated fashion (vide infra) over the next 5 years.