The State of the Nation: The Diabetes Epidemic in Australia
The State of the Nation, published by Diabetes Australia, is an urgent call to stem the tide of diabetes in Australia. It presents comprehensive information about which Australians are most at risk, the severity of diabetes complications for individuals, as well as the financial cost of diabetes to the economy and the implications for the health system. It also demonstrates the urgent action that needs to be taken on a national level.
With more people being diagnosed with diabetes at an earlier age, it means people are living longer with the condition and that can lead to a greater risk of developing severe complications. This trend is placing an unprecedented burden on individuals, the healthcare system, and the Australian economy.
Credentialled diabetes educator Carolien Koreneff summarises the meaning of this Report for health professionals and explains some of the small steps you can take to make a difference.
Key recommendations
The State of the Nation 2024 report contains 25 key recommendations, covering four main areas of focus:
- Prevention and screening
- Care and treatment
- Vulnerable communities
- Research & national implementation
Impacts of the diabetes epidemic
The impacts of diabetes are broadly divided into three categories:
- Impact on people living with diabetes.
- Impact on the health system
- Economic impacts, both direct and indirect
Impact on people living with diabetes.
Limited access to healthcare, both geographical and financial, means that currently many people living with diabetes are not getting regular health checks, including HbA1c checks, blood pressure checks, cholesterol, kidney, and weight checks. There are also (global) access issues relating to accessing medications, particularly the glucagon-like peptide-1 receptor agonists (GLP-1 RAs, for example Trulicity and Ozempic).
While diabetes mental health challenges are widespread, they are rarely discussed as part of routine diabetes care and are sometimes referred to as a silent diabetes complication. Mental and emotional health challenges can make it more difficult for people living with diabetes to manage the condition. Conversely, appropriate mental health support has been shown to improve diabetes management, reduce the risk of diabetes-related complications and, consequently, lower the cost of healthcare.
Impact on the health system
As diabetes is a complex and challenging condition, inevitably there is a considerable burden on the health system. Complications arising from diabetes represent some of the condition’s most physically debilitating and financially burdensome consequences.
Economic impacts
Diabetes presents a substantial economic burden in Australia, both in direct medical costs and indirect costs resulting from lost productivity, disability, and premature death. These economic impacts are felt at a societal level and at an individual level.
Direct medical costs include costs relating to hospital admissions, pharmaceutical products, outpatient care and the management and treatment of diabetes-related complications such as retinopathy, neuropathy, nephropathy, foot, and cardiovascular disease.
Indirect medical costs include costs relating to reduced productivity, injury from loss of consciousness (for example due to hypoglycaemia), disability (for example due to amputations or loss of vision), informal care (unpaid care provided by family/friends), and premature death.
The prevention of type 2 diabetes is one of the most cost-effective interventions in chronic disease.
Group most affected
The risk of developing type 2 diabetes and gestational diabetes (GDM) is higher in certain demographic groups. These risk factors are genetic and affected by the social determinants of health.
Groups of people most at risk of developing diabetes and related complications include:
- Aboriginal and Torres Strait Islander people
- Culturally and linguistically diverse communities
- Pregnant women
- The elderly
- People living in socio-economically disadvantaged areas
- People living in rural and remote areas
- Children and young people
Some of the challenges for vulnerable and priority groups are that the available information and support around diabetes is provided by a health system that is fragmented and complex. Social inequity and socioeconomic disadvantage can also contribute negatively to health outcomes, it can do so in a number of ways.
Australia’s population is ageing. It is expected that by 2050, almost a quarter of Australians will be aged 65 or over, and the number of Australians over 85 years will double. Given the prevalence of diabetes is also increasing, this means that we can expect significant increases in the number of older Australians living with type 1 and type 2 diabetes in the future – placing a large burden on communities and the overall economy.
It is also important to note that the impact of early-onset type 2 diabetes is serious and becoming more common. The risks of complications is higher, and the response to treatment is often more limited, and of course they will be living with diabetes for a longer time. This means more time at risk of developing serious complications, mental ‘burnout’ and depression associated with long-term diabetes management.
Diabetes stigma
People living with diabetes often report experiencing diabetes stigma which is often driven by misinformation.
Some people report feeling guilty when they are diagnosed with type 2 diabetes. Feeling like they are being blamed for developing type 2 diabetes through poor lifestyle choices is common. In fact, 35% of people were found to have felt ‘blamed’ by healthcare professionals for developing diabetes or not managing their condition well enough if they experienced complications.
Others experience stigma because of their diabetes. As a result of stigma, as well as the constant need to manage their condition, people with diabetes can feel depressed, frustrated and burnt out.
While more research needed around the lived experience of people with diabetes and the stigma surrounding it, we know that stigma has multiple, serious, consequences.
Helping to prevent diabetes
Large scale, randomised controlled trials of people living with pre-diabetes or at high risk of developing type 2 diabetes have shown that the condition can be prevented or delayed in up to 58% of people through behavioural change programs supporting weight loss, increasing physical activity and enabling healthier eating patterns.
Type 2 diabetes prevention is one of the most cost-effective interventions in chronic disease.
The Australian Government’s National Diabetes Strategy 2021-2030 recommends a community and workplace-based approach for the general population. It includes 12 areas for action including: supporting the development of health-promoting environments that encourage healthy diets, increasing physical activity, preventing unhealthy weight gain, and reducing sedentary behaviour.
Lifestyle programs that support the public to maintain a healthy diet and an active lifestyle have the potential to contribute to overall improvements in other chronic conditions including obesity, heart disease and blood pressure conditions.
What you can do
As a health professional working with people who live with diabetes there are a range of things you can do to assist your clients and reduce the risk of them developing diabetes-related complications.
Firstly, you can emphasise early detection and intervention through routine screenings and focus on effective diabetes self-management to prevent complications.
You can:
- Refer women with pre-existing diabetes who are of childbearing age for pre-pregnancy planning.
- Encourage women to engage with pre-conception and early pregnancy care to achieve a healthy weight to reduce the chances of developing GDM.
- Refer people who live with overweight or obesity to diabetes prevention programs such as the Get Healthy Service in NSW, My Health For Life in Queensland, or The COACH Program in Tasmania.
- Refer people with diabetes to support programs such as the Beat It program, an 8-week fitness program subsidised by the NDSS which is free-of-charge for NDSS participants.
- Refer women who have had gestational diabetes to the Baby Steps program which is designed to empower women to implement lifestyle changes and reduce the risk of developing type 2 diabetes.
Additionally, you can also:
- Pay special attention to young adults with diabetes, who are no longer eligible for support from children’s centres and often become lost in the system as they transition to adult care and become disengaged with their diabetes care and management.
- Provide Telehealth services, which can play an important role in providing access to diabetes care for people living in rural and remote areas.
- Remain educated yourself and adapt public health messages and education about diabetes to different target audiences.
- Provide type 2 diabetes screening to all Australians aged over 40 years, with a particular focus on people with significant risk factors.
- Recognise that there is no one-size-fits-all approach in managing diabetes, particularly for vulnerable groups. Adopting case-conference approaches can be an effective mechanism that include the person living with diabetes, GP, and tertiary specialists (including endocrinologists) in the management of an individual’s diabetes.
Another important consideration is the significance of the words used to talk about diabetes and how they can affect the physical and emotional health of people living with diabetes. There has been some positive change to the words and language used in recent years but there is still room for improvement. People living with diabetes and their families deserve communications that are accurate, respectful, inclusive, and free from judgement and bias.
Looking ahead
Although a range of actions are currently being implemented, it is crucial to identify further solutions that will most effectively combat the diabetes epidemic across future generations. These include:
- Investment in diabetes research
- Solutions for the health system, including preventing hospitalisations, improving care in hospital, and improving access to diabetes technologies and medicines, investing in the workforce, a national kidney screening program, and improving coordination of diabetes care.
These initiatives will require additional investment, but they represent the key steps that will be required in the coming years.
In summary
Investing in timely diagnosis and treatment can not only improve the health outcomes for individuals but also bring about substantial cost savings in healthcare expenditure. By ensuring regular care from a team of health professionals, complications can be prevented or identified and treated early, reducing their impact.
Successful diabetes care and management requires the collaboration and cooperation of health care teams across both primary and secondary care, along with the person living with diabetes. The development of integrated models of care that allow for collaboration around case planning and overall care from an endocrinologist and primary practice can improve the experience and health outcomes of people living with diabetes.
Together we can make a difference.
Source:
The State of the Nation 2024 Report on the Diabetes Epidemic in Australia, by Diabetes Australia, accessed through: https://www.diabetesaustralia.com.au/wp-content/uploads/State-of-the-Nation-2024-Diabetes-Australia.pdf on 17th July 2024.