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The emerging epidemic of type 2 diabetes, coupled with finite health resources, requires the treatment of hyperglycaemia to be simple and efficiently managed. Type 2 diabetes is a progressive disease and eventually most patients will require insulin at a certain stage to maintain good glycaemic control. The key to when to start insulin is to identify the appropriate glycated haemoglobin (HbA1c) target for an individual patient. If target A1C is not achieved with metformin combined with sulfonylurea, the most commonly used 2nd line oral hypoglycaemic agents, insulin therapy is usually started. In patients on sulfonylureas and metformin who are starting insulin therapy, metformin is usually continued. Part of the rationale for combination oral hypoglycaemic agents and insulin therapy is that by suppressing hepatic glucose production, the patient can retain the convenience of oral agents while minimizing total insulin requirements and, therefore, the degree of hyperinsulinemia. GLP-1 agonists, DPP-4 inhibitors, and sodium-glucose co-transporter 2 (SGLT2) inhibitors can also be continued when insulin is added, however, they are currently not PBS listed for being combined with insulin. There are no clear guidelines as to whether and at what time point SU are to be discontinued or continued when insulin is introduced. Data from the UKPDS and meta-analyses of several randomized placebo-controlled trials report modest but consistent benefits of a combination of sulfonylurea and metformin with insulin therapy compared with insulin monotherapy. However, the combination of sulfonylurea and insulin is less efficacious and results in more weight gain than metformin and insulin. Furthermore, insulin and sulfonylureas have similar effects of increasing circulating insulin levels, and the same glucose-lowering effect can usually be achieved, and at a lower cost and better prediction, with a modestly higher dose of insulin alone. Furthermore, a recent retrospective Danish study has found that patients with a combination with SU and insulin had an increased mortality compared to metformin and insulin. Studies also report increased risks of weight gain and hypoglycaemia when left on SU while starting basal or pre-mixed insulins. Based on this recent literature review, it is a concern that many patients with Type 2 Diabetes are continuing their SU together with their pre-mix insulin, with limited evidence for an added benefit, but a growing evidence of increased risk of hypoglycaemia, weight gain and possibly increased mortality. The outcome of this study will give as important information which could lead to a change in current practice guidelines. The aim of our study is to assess whether SU should be stopped, continued or replaced with a DPP4 Inhibitor once pre-mixed insulin therapy has been started. We hypothesise that SU will not have a significant additive effect on glycaemic control in patients on pre-mix insulin, but contribute significantly to increased risk of hypoglycaemia and weight gain. A similar glycaemic control can be achieved by a dose adjustment of the insulin dose, or by adding a DPP-IV inhibitor without the side effects of SU, such as hypoglycaemia and weight gain. Results of this study could have an important impact on how type 2 diabetes patients are treated safely and effectively. PRIMARY OUTCOMES: To measure the change in glycaemic control when stopping SU or replacing SU with a DPP-4 inhibitor in patients on pre-mix insulin. SECONDARY OUTCOMES To compare the side effects (weight gain) and safety (hypoglycaemia) of stopping SU or replacing SU with a DPP-4 inhibitor in patients with pre-mix insulin. This is a prospective, randomised, open label controlled single centre trial with three arms: a) Patients continue SU b) Patients stop SU c) Patients replace SU with the DPP4 inhibitor Linagliptin (5mg/day) Patient characteristics: Patients with Type 2 Diabetes treated with pre-mix insulin (NovoMix30 or HumalogMix25), at least twice daily for at least 6 months, and also treated with SU since at least 4 years. 99 patients in total (33 patients per arm) will be recruited at St Vincent’s Hospital, Sydney.

The primary objective was to determine the benefits of a pre-surgical exercise programme for prostate cancer patients scheduled for prostatectomy. It was hypothesised that: i) between baseline and pre-surgery, patients would demonstrate – higher physical functional performance, maintain higher levels of muscle strength and endurance, ii) during the weeks following surgery, patients would demonstrate – reduced physical functional performance, reduced muscular strength and endurance iii) between baseline and post-surgery, patients would demonstrate – improved recovery with a higher physical functional performance, maintain higher muscular strength and endurance.

The purpose of this study is to investigate the efficacy of a cognitive behavioural treatment (CBT-A-A-SRP) for comorbid anxiety and sleep-related problems in adolescents. The study will also include concurrent parent sessions (CBT-P-A-SRP). It is hypothesised that adolescents who received the CBT-A-A-SRP intervention will demonstrate a significantly larger reduction in anxiety symptoms and sleep-related problems compared to adolescents in the waitlist condition.

The aim of the study is to examine the impact on dental health of being recalled for a dental check-up at a specified interval.

The aim of the Falls After Stroke Trial (FAST) is to test the effect of home-based, tailored intervention to reduce falls. A sample of community-dwelling stroke survivors who have finished formal rehabilitation, and therefore are at a high risk of falling again will be randomly assigned to one of two groups: an experimental group (habit-forming exercise and safety training), or a control group (usual care which is no active intervention). The primary hypothesis is that the home-based, tailored intervention will be effective in reducing both the proportion of people falling and rate of falls over a one-year period in stroke survivors living in the community. The secondary hypotheses are: 2. That home-based, tailored intervention will also be effective in improving: balance, self-efficacy, mobility, physical activity, community participation, and health-related quality of life. 3. That home-based, tailored intervention will reduce healthcare utilisation and be cost-effective.

The primary purpose of this study is to examine the safety and potential effectiveness of a drug molecule called 64Cu-SARTATE as a potential new way to detect neuroendocrine cancers. Who is it for? You may be eligible to join this study if you are aged 18 years or over, have a life expectancy of 8 weeks or more and Low and Intermediate Grade (Ki-67 index <20%) neuroendocrine tumors (NET). Study details: All participants in this study will be injected with a single dose of 64Cu-SARTATE (a drug molecule). The study lasts for one week and the patient is administered 1 dose of the drug followed by whole body PET scans at 30mins, 1hr, 4hrs, & 24hrs. Complete safety evaluations will occur during visit 2 (day 2) & visit 3 (day 8). These scans will be compared to the current PET imaging standard called 68Ga-DOTATATE which you will have recently received as a standard procedure. It is hoped that this research will help to develop a product which is more accurate for the diagnosis of neuroendocrine tumours in patients.

This study is investigating the feasibility of providing a direct measure of lung tumour motion during radiotherapy treatment, using existing standard treatment equipment. Who is it for? You may be eligible to join this study if you are aged 18 years or above, have been diagnosed with lung cancer and are a Patient with non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC). Study details All patients in this study undergoing radiotherapy will have markers implanted into and around lung tumours using an airway ultrasound technique known as Endoscopic Bronchial Ultrasound (EBUS). The procedure has a duration of about 45 minutes. Then patients wait 2 weeks before continuing to routine radiotherapy simulation and planning. Treatment planning typically takes 2-3 weeks and then treatment will commence. The inserted markers are visualised and tracked using x-ray images, during the radiotherapy treatment sessions, once a week. This study aims to validate a method to record real-time tumour motion due to respiration, during lung cancer radiotherapy treatment. Identifying the motion in real-time will help to implement treatments that can track tumours, resulting in safer and more effective treatments.

This trial will aim to determine if smartphone based Motivational Interviewing supplemented with Motivational Interviewing provided during usual physiotherapy care can increase activity in patients with sub-acute low back pain.

Non-invasive brain stimulation is emerging as a therapeutic tool for many brain related conditions. There are numerous non-invasive brain stimulation techniques that apply electrical or electromagnetic stimulation to the brain in different ways to alter neural activity. The most researched, and consequently best developed, of these are transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Both TMS and tDCS has been shown to have varying degrees of therapeutic efficacy for major depression. Research efforts are currently focused on identifying factors that modulate individual differences in the way the brain response to TMS which could lead to development of optimised protocols for stimulation delivery. There is evidence that sex hormones may modulate the effect of TMS and tDCS. However very few studies have investigated this and none have focused on the dorsolateral prefrontal cortex, the site that both methods are most often applied in a clinical context. The current project is an investigation of the impact of gender, and within female gender of menstrual phases associated with high and low estrogen, on the effect of TMS and tDCS to the dorsolateral prefrontal cortex.

The purpose of this study is to investigate whether our standard practice of injecting local anaesthetic into the knee joint for total knee replacements impacts knee range of motion at 6 weeks post operation for total knee replacement. We hypothesize that local infiltration analgesia during operation in total knee replacements negatively impacts the knee range of motion.