Prediabetes has a high prevalence, with early detection essential to facilitate optimal management to prevent the development of conditions such as type 2 diabetes and cardiovascular disease. Prediabetes can include impaired fasting glucose, impaired glucose tolerance and elevated HbA1c. This position statement outlines the approaches to screening and management of prediabetes in primary care.There is good evidence to implement intensive, structured lifestyle interventions for individuals with impaired glucose tolerance. The evidence for those with impaired fasting glucose or elevated HbA1c is less clear, but individuals should still be provided with generalised healthy lifestyle strategies. A multidisciplinary approach is recommended to implement healthy lifestyle changes through education, nutrition and physical activity.Individuals should aim to lose weight (5-10% of body mass) using realistic and sustainable dietary approaches supported by an accredited practising dietitian, where possible. Physi-

Maternal and neonatal health outcomes following the implementation of an innovative model of nurse practitioner-led care for diabetes in pregnancy. AbstractAim. To investigate maternal and neonatal outcomes following implementation of a nurse practitioner-led model of care for diabetes in pregnancy. Background. Diabetes in pregnancy increases the risk of adverse health outcomes in mothers and infants. The management of diabetes in pregnancy is crucial to reduce poor outcomes. Design. Uncontrolled before-after intervention study. Methods. International Classification of Diseases codes were used to identify pregnancies suspected of being complicated by diabetes. Demographic, health, diabetes and maternity data were extracted from hospital records. Adverse maternal and neonatal outcomes were compared pre- (2003)(2004)(2005)(2006) and postintervention (2010)(2011). Adjusted relative risks (aRR) were calculated using the glm command in Stata. Results. A total of 261 pregnancies were included: 112 pre-intervention and 149 managed under the nurse practitioner-led model. There were 37 women with preexisting diabetes (26 T1DM, 11 T2DM) and 195 with gestational diabetes. Referrals to dieticians and diabetes educators increased, while referrals to physicians decreased. There was no decrease in the risk of adverse maternal outcomes for all women with DIP or women with GDM. However, there was a 24% decrease in adverse neonatal outcomes overall and a 40% decrease among infants of women with gestational diabetes. Conclusion. The study demonstrated that nurse practitioner-led models of care for diabetes in pregnancy are feasible. The findings suggest that the model reduced adverse neonatal outcomes. By improving information provision, support and care coordination, the model is particularly valuable in rural areas, where access to medical specialists is often restricted.

The role of the Australian Nurse Practitioner (NP) is in its infancy and at a crossroads where extensive research demonstrates effective quality care and yet the role remains underrecognised and underutilised. The translation of practice into “value” is critical for the sustainability of NP roles and requires the practitioner to adopt a systematic method of inquiry. Kim's (1999) “Critical Reflective Inquiry” (CRI) method was adapted by two Australian NPs who specialise in diabetes and chronic disease management. Kim highlights the intent of CRI as understanding the meaning of practice, delivering improvements to practice through self-reflection, and the critique of practice that can lead to practice changes and development of new models of care translated to “products” of value. Based on the thematically analysis of 3 years of CRI application, the authors formed 5 headings that represented the NP's practice as Specialised Care Access, Complications and Diagnostics Interventions, Pharmaceutical Treatment, Vulnerable Populations, and Leadership. The utility of CRI demonstrates how NP practice is integral to a continuous cycle of addressing health care services gaps, and the conversion of “products” into “value” and positions the NP to assimilate the role of the practitioner-researcher.

Consumers access health professionals with varying levels of diabetes-specific knowledge and training, often resulting in conflicting advice. Conflicting health messages lead to consumer disengagement. The study aimed to identify capabilities required by health professionals to deliver diabetes education and care to develop a national consensus capability-based framework to guide their training. A 3-staged modified Delphi technique was used to gain agreement from a purposefully recruited panel of Australian diabetes experts from various disciplines and work settings. The Delphi technique consisted of (Stage I) a semi-structured consultation group and pre-Delphi pilot, (Stage II) a 2-phased online Delphi survey, and (Stage III) a semi-structured focus group and appraisal by health professional regulatory and training organisations. Descriptive statistics and central tendency measures calculated determined quantitative data characteristics and consensus. Content analysis using emergent coding was used for qualitative content. Eighty-four diabetes experts were recruited from nursing and midwifery (n = 60[71%]), allied health (n = 17[20%]), and pharmacy (n = 7[9%]) disciplines. Participant responses identified 7 health professional practice levels requiring differences in diabetes training, 9 capability areas to support care, and 2 to 16 statements attained consensus for each capability—259 in total. Additionally, workforce solutions were identified to expand capacity for diabetes care. The rigorous consultation process led to the design and validation of a Capability Framework for Diabetes Care that addresses workforce enablers identified by the Australian National Diabetes Strategy. It recognises diversity, creating shared understandings of diabetes across health professional disciplines. The findings will inform diabetes policy, practice, education, and research.