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Gestational diabetes through a systems science lens

Project title: Simulation modelling to support decision making in gestational diabetes care

Start date: April 2015

Estimated end date: 2018

What is the issue?

This PhD project tackles the growing problem of gestational diabetes against the backdrop of increasing interest in systems science methods to examine complex problems.
Health systems are under continual pressure to provide accessible and effective health services with limited budgets. In this context, decisions regarding the best investment of health funds need to be well informed, reviewed regularly and aimed at achieving the greatest health gain for the investment.

The development and testing of methods and tools to inform decision making processes is critical. The application of systems science and simulation modelling to the decision-making process is an innovative area with great potential value for those responsible for allocating resources.

Gestational diabetes is a type of diabetes that develops, or is first diagnosed, during pregnancy. It can lead to adverse short- and long-term outcomes for both infant and mother. Infants born to women with gestational diabetes are at short-term risk of high birthweight, birth complications and hypoglycaemia and at long-term risk of sustained impaired glucose tolerance. Women who have gestational diabetes are at higher risk of developing type II diabetes later in life.

The prevalence of gestational diabetes in Australia is increasing and research is needed to better understand how to effectively target resources and services.

How is the project addressing the issue?

This project will apply systems science and simulation modelling to the problem of gestational diabetes in the ACT as a case study.

Systems science is emerging as an effective way to examine both complex health problems and their context. It can be used to synthesise evidence, examine and compare the potential outcomes of interventions and guide the best use of limited resources through methods such as simulation modelling.

The project will use case study methodology to illustrate the strengths and weaknesses of simulation modelling as a tool to inform policy and program decision making.

It will be informed by a multidisciplinary stakeholder group model-building process involving clinicians, service managers and researchers. This provides an opportunity to ensure the model reflects the shared understanding of the causal pathways and potential intervention points in the system.

Simulation modelling will then be used to explore strategies for gestational diabetes diagnosis, early intervention and management. The modelling will include interaction between risk factors, the short-and long-term outcomes for mother and baby, and potential modes and timing of intervention.

Involving key decision-makers and experts in the model development and validation process increases the validity of the model for the local context. The model is therefore more likely to be useful to inform decisions about priority interventions and policies.

What are the expected outcomes?

The project will:

  • Produce a model that will be a functioning simulation tool to explore possible scenarios and the likely impact over time of each scenario on health outcomes for the mother and baby as well as service impacts for the health system
  • Produce a joint commitment for policy action and program decisions through engagement with the stakeholder group
  • Evaluate the use of simulation modelling to inform decision making.

Updated April 2016

Project lead

Louise Freebairn, PhD Candidate, Prevention Centre, ACT Health

Project team

The project will produce two key outcomes of interest to policy and practice.

  • Evaluate the effectiveness of participatory simulation modelling as a process to inform program and policy decision making
  • Result in a simulation model for gestational diabetes to map the interactions between risk factors, and explore potential points of intervention and service implications.
  • Internationally recognised experts in obstetrics, diabetes, obesity, population health interventions, health economics and simulation modelling participated in a group model building process that started in May 2016.
  • A series of workshops have been planned to expose participants to dynamic simulation modelling. Participants’ expert knowledge will be used to map the problem in all its complexity, to direct us to relevant literature and data sources, and to help us quantify and verify the model (May to December 2016).



  • Freebairn L. Gestational diabetes through a systems science lens. Centre for Health Stewardship Research Group. Australian National University. 19 November 2015. Canberra.
  • Freebairn L. Simulation modelling: A systems approach to optimising the use of evidence to inform decision making in gestational diabetes care MODISM – 21st International Congress on Modelling and Simulation. 29 November 2015. Gold Coast.
  • Freebairn L. Simulation modelling as a tool for knowledge translation in health policy settings: a case study protocol. School of Medicine, University of Notre Dame, Research Conference 2016. 23 March 2016. Sydney.