It’s about time for a different approach to reduce the diabetes burden
Written by Amy Peirce
National Diabetes Week kicks off 14th of July 2019 and this year Diabetes Australia is saying “it’s about time” for us to take action on diabetes with early detection and treatment.1
Australia’s National Diabetes Strategy released in 2015 was described as “a once in a decade opportunity to strengthen the fight against the nation’s biggest health threat”.2 The strategy articulates seven key goals and potential areas for action to reduce the social, human and economic impact of diabetes in Australia. However, implementing this strategy and in a systematic way remains a challenge.
Adding to this challenge is a perceived lack of unawareness among people of the significance in preventing and managing diabetes. For example, ask an Australian adult to list the diseases they most fear being diagnosed with and they would probably name cancer, heart disease, stroke and dementia. Few are likely to include diabetes on such a list. Most would also be surprised to learn that diabetes was an underlying and/or associated cause of one in ten Australian deaths totalling 16,400 in 2015.3,4
Since 2008, diabetes has ranked seventh in the leading causes of death in Australia and, unlike heart disease, bowel cancer, or cerebrovascular disease, the number of deaths from diabetes is increasing.5
Diabetes is the fastest growing chronic condition in Australia, with more than 100,000 new cases diagnosed in the past year.6 In 2017-18, one in twenty Australians (4.9% or 1.2 million people) had diabetes of any type.7 Many Australians with diabetes have a family member or carer supporting them, meaning an estimated 2.4 million Australians are affected by diabetes every day in some way.6 In addition, another estimated 500,000 Australians have “silent” undiagnosed diabetes.6
Disease and cost burden
Of the three main forms of diabetes – type 1 (T1), type 2 (T2) and gestational diabetes – T2 represents 85-90% of all cases and is generally a progressive condition of older adulthood, whereby the body gradually becomes resistant to, and/or unable to produce enough insulin.8
If left untreated or poorly managed, T2 diabetes can become a gateway to many life-ending medical events, not least of which are heart attack, stroke and kidney failure.9 Cardiovascular disease is the primary cause of death, with around 65% of all cardiovascular deaths in Australia occurring in people with diabetes or pre-diabetes.10
Other major complications include nerve damage, limb amputation, depression, anxiety and blindness, all of which have a significantly detrimental impact to quality of life and productivity.9,10 Unlike T1 diabetes which is an autoimmune condition, T2 is generally associated with obesity, high blood pressure and low levels of physical activity, yet may be largely preventable by maintaining a healthy lifestyle.9,10
Not to mention the cost. While there are no estimates of the current diabetes cost burden in Australia, the total annual cost of diabetes among Australians aged 30 years and over in 2005 was estimated at $10.6 billion, which in 2018 equated to $20.2 billion.11,12 This includes direct healthcare and non-healthcare costs, as well as government subsidises, yet excludes lost productivity. As the diabetes burden continues to escalate, the $1.2 billion per year loss in lost gross domestic product from this disease in 2015 is expected to climb to $2.9 billion by 2030 due to its impact on lost work productivity.13
A different approach
Maybe T2 diabetes has an image problem? As a disease which can initially be managed with lifestyle (e.g. food changes, exercise) changes, T2 diabetes may be unlikely to inspire much fear compared with a diagnosis of cancer.10 Indeed, it may not impact the psyche of many Australians who are still ignoring the signs that they may be at risk of developing diabetes.
Perhaps community initiatives such as “The Community Health Challenge” started by one forward thinking pharmacy in Queensland is the key to helping people understand their diabetes risk and the adverse consequences of the condition if not properly managed or even diagnosed.
The “Community Health Challenge” allowed people to donate to charity in return for a complete health check including a blood glucose check. The initiative enabled participants with elevated blood glucose to be referred to their GP for further testing, thereby potentially uncovering cases of silent diabetes that otherwise could have remained undiagnosed for a long time and potentially leading to serious health consequences.14
Given the substantial and increasing cost burden of diabetes in Australia, we can no longer afford to ignore the importance of diabetes and its devastating impact.1
So what can be done differently?
Based on “The Community Health Challenge” experience, it can be argued that it’s about time to develop further such initiatives involving communities to enhance individual awareness, engagement and self-management to truly resonate with Australians at risk of developing diabetes, as well as those with the condition needing additional support. These ideally should be implemented under the framework of a national diabetes strategy supported with the appropriate resources and infrastructure needed to deliver improved health outcomes and arrest the increasing burden of diabetes. It really is about time.
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- Diabetes Australia: National Diabetes Week Campaign. 2019. https://www.itsabouttime.org.au/
- New National Diabetes Strategy a “once in a decade” chance to refocus Australia’s efforts to fight the biggest threat to our health and productivity. 2015. https://bit.ly/1NtY601
- Australian Institute of Health and Welfare: Diabetes. 2019. https://bit.ly/2XLyEUi
- Australian Institute of Health and Welfare: Diabetes snapshot. 2018. https://bit.ly/2TdppuC
- Australian Bureau of Statistics, Causes of Death, Australia, 2017. https://bit.ly/2VPuwOo
- Diabetes Australia: Diabetes in Australia. 2018. https://www.diabetesaustralia.com.au/diabetes-in-australia
- National Health Survey: First Results, 2017-18. https://bit.ly/2LyNHdz
- Diabetes Australia: What is diabetes https://www.diabetesaustralia.com.au/what-is-diabetes
- Diabetes Australia: Type 2. https://www.diabetesaustralia.com.au/type-2-diabetes
- Diabetes: the silent pandemic and its impact on Australia (2012). Baker Heart & Diabetes Institute https://www.baker.edu.au/impact/advocacy/the-silent-pandemic
- Lee CM et al. The cost of diabetes in adults in Australia. Diabetes Res Clin Pract 2013; 99(3):385-90
- Carter H. The Economic Consequences of Diabetes: More Than Just a Health Issue. ADEA-QLD Conference 21 April 2018 Presentation. https://www.adea.com.au/wp-content/uploads/2018/04/Hannah-Carter-presentation.pdf
- Schofield D et al. The Costs of Diabetes Among Australians Aged 45-64 years from 2015 to 2030: Projections of Lost Productive Life Years (PLYs), Lost Personal Income, Lost Taxation Revenue, Extra Welfare Payments And Lost Gross Domestic Product From Health&WealthMOD2030. BMJ Open 2017; 7:e013158.doi:10.1136/bmjopen-2016-013158 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223630/pdf/bmjopen-2016-013158.pdf
- Challenge uncovers hidden elevated glucose. Australian Journal of Pharmacy. 2019. https://bit.ly/2LA7GbL