Diabetes in Australia: Statistics and prevalence

In the past, type 2 diabetes was considered an elderly disease, but in recent decades, the incidence of adolescents and young adults worldwide has risen sharply due to an increase in obesity rates. The study by the Baker Heart and Diabetes Institute in Australia showed that two people at the same age, who were diagnosed with type 2 diabetes 10 years earlier, had a 50% risk of dying from cardiovascular disease (CVD). This suggest that younger patients with type 2 diabetes have an increased risk of death, mainly due to early cardiovascular disease (Baker IDI Heart and Diabetes Institute 2012). This means that the Australian government should find ways of delaying and controlling the onset of type 2 diabetes in order to reduce death risk and health care spending.

According to the Australia Institute of Health and Welfare (2018), approximately 5% of Australians had type 2 diabetes in 2014–15. As of September 2016, there were 1.3 million people with diabetes in Australia, most of whom were type 2 diabetes.  The prevalence is predicted to be even more because many cases remain unreported, due to survey participants either not knowing or accurately reporting their diabetes status. The British Medical Journal published by the British Medical Association showed that by 2030, Australian patients aged 45 to 64 years of age who are unable to continue working due to diabetes will be from 2015. 8.81 million people rose 18% to 21,400, and government and personal spending will increase significantly (Schofield  & Shrestha, et al 2017). The Sydney Morning Herald quoted the report as saying that Australian health care spending triggered by diabetes will increase from $228 million in 2015 to $257 million in 2030. The increase in the number of people with diabetes, especially type 2 diabetes, has directly led to a surge in health care spending. Statistics show that the growth rate of diabetes-related health care expenditure from 2000 to 2009 was 86%. Relative to direct medical expenditures, the indirect expenditures of individuals and governments caused by diabetes are even more alarming, including personal income and personal labor time reduction, government tax losses and related expenditure increases.

In recent years, Australia has become one of the countries with the highest prevalence of diabetes in the world due to overeating, lack of exercise, high degree of automation and aging. Studies have shown that since 1981, diabetes in Australia has soared by 3% and currently 1 million Australians have diabetes, accounting for about 5% of the country’s population. This ratio has exceeded all Western countries except the United States. Diabetes is not only related to public health, but also jeopardizes government-funded health care systems. As a result, the Australian government has stepped up efforts to prevent diabetes (Olivia, Susan, Sandra and Alan 2017). 

Rising health care spending due to type 2 diabetes

In 1997, the government the government spent a lot of money to fund a study designed to survey the prevalence of diabetes and the impact of the country. The Australian Juvenile Diabetes Fund and the World Diabetes Fund jointly invested $5 million in a five-year study to discover treatments and provide better care. The National Health and Medical Council issued new guidelines to remind diabetics on the need for regular checkup to perform visual acuity examination to prevent retinipathy caused by diabetes (Grace, Clayton & Mcdonald, 2011). In 1998, the Australian government initiated a program designed to prevent and treat diabetes. The details of the program include increased public awareness, monitoring of disease incidence, related complications, and monitoring. In the same year, Health and Family Services issued a National Diabetes Information Toolbox for patients, teachers and students in the school and classroom. In addition, the National Health and Medical Research Council invests more than $1.1 million annually for 14 projects of diabetes research. In 1999, the federal government decided to take action to raise public awareness of the diagnosis of diabetes. Three years later, Australia and the United States jointly invested $1 million to develop vaccines for prevention and treatment of diabetes in children (Australian Institute of Health and Welfare 2013). There are already several in operation in the Northern Territory, such as licensing for sale to the public and improving quality, increasing the availability of fresh food, replacing soft drinks with sugar-free and the campaign “Eat better and move more”,

Prevention at pre-diabetes level

The first consideration concerns prevention of type 2 diabetes at pre-diabetes level. Australia should invest in increasing the diabetes monitoring programs. It is recommended that pre-diabetes patients monitor at least annually for progression to diabetes. This is because having pre-diabetes does not mean that one will automatically develop diabetes , but it is a warning signal. When no change is made, the risk that prediabetes will progress to diabetes is high; However, taking certain measures, such as improving your diet and exercising regularly, can usually make a big difference (Cefalu, Petersen & Ratner 2014). The exact cause of prediabetes is unknown, but excess fat, especially abdominal fat, and inactivity appear to be important factors in the development of prediabetes. Studies have found that eating and exercise are the most effective treatments to combat pre-diabetes and prevent it from moving towards diabetes (Cefalu, Petersen & Ratner 2014). The disadvantage is that not all people would go for checkup when they are still healthy.

Ways to prevent and manage type 2 diabetes in Australia

Blood sugar target

The second consideration is related to blood sugar target. Australia should put up measures to encourage Australians to monitor blood sugar. Patients should be encouraged to perform self-glycemic monitoring (SMBG) until blood glucose is normal and before critical tasks (such as driving). After prescribing SMBG, patients should be assured of continuous guidance, regular assessment of SMBG technology and SMBG results, and their ability to adjust treatment with SMBG data (Cefalu, Petersen & Ratner 2014). For patients who are up to standard (and stable glycemic control), A1C should be tested at least twice a year. Patients with conscious hypoglycemia, although any form of glucose-containing carbohydrates can be used, glucose (15-20g) is the first choice for treatment. After 15 minutes of treatment, if SMBG shows persistent hypoglycemia, treatment should be repeated. Once the SMBG blood glucose returns to normal, the patient should eat or snack to prevent recurrence of hypoglycemia.

Lifestyle intervention

The first way of adopting lifestyle intervention is through education. Patients should receive educational skills when needed after diagnosis or later to increase their knowledge, skills, and diabetes self-management skills (Cefalu, Petersen & Ratner 2014). 

The second way is through nutritional intervention.  It is recommended that all patients with type 1 diabetes and type 2 diabetes receive individualized medical nutritional therapy (MNT) developed by a registered dietitian. For patients who apply a fixed insulin dose daily, maintaining a stable intake of carbohydrates in time and amount can improve glycemic control and reduce the risk of hypoglycemia.

The third way is through energy balance (Schofield, Shrestha, Cunich et al. 2015).  Limited restriction of energy intake through lifestyle changes Moderate weight loss is beneficial for overweight or obese adult type 2 diabetic patients and individuals at risk for diabetes. Recommended lifestyle changes combined with interventions that limit energy intake to moderate weight loss. Many dietary styles are appropriate for managing type 2 diabetes and pre-diabetes, including the Mediterranean diet, DASH diet, and vegetarian diet. It should be recommended that carbohydrates come from whole grains, vegetables, fruits, beans and dairy products, especially those with higher fiber and lower sugar load, rather than other carbohydrate sources, especially those containing sugar (Davis, Knuiman, Hendrie, & Davis 2006).

Physical activity is another way of achieving lifestyle intervention. Physical exercise is one of the basic points in the treatment of diabetes mellitus (Davis, Knuiman, Hendrie, & Davis 2006). Regular practice of physical exercise helps to correctly control blood glucose levels (Schofield, Shrestha, Cunich et al. 2015). Type II diabetes has three fundamental characteristics. One of the characteristics of type II diabetes is its association very frequently, up to 80% of cases, obesity, another feature is that it usually occurs in people over 40 years and the other would be the hereditary component. The benefits in terms of health that exercise could bring us in type II diabetes come as a consequence of the fact that if the patient follows diet and exercise regularly on a regular basis, he can control his diabetes for years without needing medication and therefore delay or never need insulin injection (Schofield, Shrestha, Cunich et al. 2015). The disadvantage is that adhering to physical exercise program is a big challenge to many people.

Prevention of type 2 diabetes at pre-diabetes level

Psychological therapies. The diabetes policy should consider improving psychotherapic interventions (Bergmame & Shaw, 2018, p.11). Many people eat inadequately because of anxiety or depression , lack of time or lack of knowledge about proper nutrition. Medical workers should consider using a patient-approved, standardized tool for assessing diabetes anxiety, depression, anxiety, eating disorders, and cognitive abilities at the time of initial visit, and then periodically assessing changes in condition, treatment, and living environment (Smits et al 2018 p. 9),. Should be evaluated. The proposed assessment includes caregivers and family members. The advantage of this proposal is that it helps those patients with mental challenges. The disadvantage is that it may increase the health care costs (Mulligan et al 2017, p. 1021).

Patient-centered treatments

It is important also to optimize patient health outcomes and health-related quality of life by using active listening, eliciting patient preferences and beliefs, and assessing patient-centered communication methods such as literacy, numeracy, and potential treatment disorders. The advantage of this intervention is that it ensures facilitate comprehensive care. The disadvantage is that it is time consuming. 

The first recommendation for the improvement of current Australian diabetes strategy is the improvement of screening and treatment of pre-diabetes. When detected before advancing to mellitus stage, diabetes can be addressed easily and cheaply (Muilwijk et al 2018). The diagnosis of prediabetes means that the blood glucose levels are above the values ??of a healthy person but not so high as to have diabetes. Australian government should ensure that the Australian Diabetes Strategy policy support screening and treatment. This can be achieved by increasing the funds for this areas.

The second recommendation is lifestyle invention (diet and exercise). Lifestyle interventions mainly limit total dietary calories, limit alcohol, quit smoking, eat more vegetables and high-fiber foods, and increase exercise (Davis, Knuiman, Hendrie, & Davis 2006). It turns out that long-term life intervention is positive and effective (Schofield, Shrestha, Cunich et al. 2015). Evidence suggests that exercise and weight loss can prevent diabetes and lower blood glucose levels better than diabetes medications. These interventions are better than the medical intervention.

The third recommendation is the adoption of comprehensive primary care (Rosa et al 2018 p. 15). John Boffa, representing the Aboriginal Congress of Central Australia, stressed the importance of comprehensive primary health care, including various aspects of social and health care, especially improving health and development during early childhood. Grace, Clayton & Mcdonald, (2011). highlighted the importance of a population approach in the primary prevention of diabetes and chronic diseases in Central Australia based on the experiences of New Zealand. This implies an approach that includes the whole community and that is for the whole life and the whole family, as well as sustainable, focused on the ethnic groups and that includes collaborations of the communities. 

Blood sugar target: encouraging Australians to monitor blood sugar

The forth recommendation is the adoption of ecological health promotion program. Tan, Wang & Mitchell (2008) highlighted an “ecological” health promotion program that was implemented by indigenous communities in the State of Victoria in order to improve physical activity and nutrition using a wide range of environments, objectives and strategies. The program’s successes were underpinned by community leadership and participation, adaptation of the program to community values, local knowledge, structures and social organizations.

The fifth recommendation is by focusing on historical, cultural, socioeconomic and political dimensions. Michael Kyrios, of the Swinburne University of Technology, explained the influence of the prehistoric, historical, cultural, socioeconomic and political dimensions of the health of indigenous Australians, influences not fully taken into account in conventional theories about obstacles that hinder behavioral change. Programs for indigenous people need to include behavioral changes related to personal health, as well as multifaceted approaches that include these external influences (Cohen & Shaw, 2007, p. 385).

Lastly, the Australian government need to increase specialists. Neale Cohen, Baker IDI endocrinologist, highlighted the role of specialists as important components of a multidisciplinary team. He stressed that although diabetes in most people can be controlled in primary care, some develop more complex problems. People who need to be referred to the specialist are those who have kidney or visual disease, neuropathy, people who are starting an insulin regimen, those who use pumps or who have psychological needs, as well as women with diabetes. 

Cohen, N, & Shaw, J 2007, ‘Diabetes: advances in treatment’, Internal Medicine Journal, 37, 6, pp. 383-388, Academic Search Premier, EBSCOhost, viewed 27 August 2018.
 The article emphasizes the effectiveness of insulin infusion pumps. The article is crucial in this study because it give a hint about some of the measures which Australia can do.

Bergmame, L, & Shaw, S 2018, ‘Psychoeducational interventions to improve adolescents’ medical management of diabetes: A comprehensive review’, Health Psychology Report, 6, 1, pp. 10-39, Academic Search Premier, EBSCOhost, viewed 27 August 2018.

The article stresses the importance of psychoeducational intervention in management and prevention of type 2 diabetes. This means that including psychoeducational intervention in diabetes policy is of great importance.

Olivia K., Susan N., Sandra G. and Alan B. (2017) ‘Diabetes educator role boundaries in Australia: a documentary analysis’, Journal of Foot and Ankle Research. 201710:28

The article focuses on need for comprehensive management. The article maintains that both the management of insulin as well as treatment of related conditions such as wounds are crucial in diabetes strategy.

Lifestyle interventions for diabetes prevention and management

Diabetes Australia (2018). Peak Health Groups Welcome Government Funding for New National Diabetes Eye Screening Program to Prevent Blindness. Available from: https://www.diabetesaustralia.com.au/news/15522?type=articles [Accessed 31 August 2018].

The article focuses on diabetes and eye diseases in Australia. It underscore the significance of having many eye check services to help in management of eye conditions related to diabetes. The article reveals that people should be encouraged to have timely eye checks to assist with early detection of problems and enable early treatment to save sight.

Diabetes Australia (2018) Diabetes healthcare needs improvement. Available from https://www.diabetesaustralia.com.au/news/15523?type=articles [Accessed 31 August 2018].

Citing the observation by Professor Stephen Colagiuri, the article revealed that Australian diabetes healthcare services are not adequate. The article calls upon the concerned institution to step up the diabetes healthcare services.

Mulligan, K, McBain, H, Lamontagne-Godwin, F, Chapman, J, Haddad, M, Jones, J, Flood, C, Thomas, D, & Simpson, A 2017, ‘Barriers and enablers of type 2 diabetes self-management in people with severe mental illness’, Health Expectations, vol. 20, no. 5, pp. 1020-1030. Available from: 10.1111/hex.12543. [31 August 2018].

The article focuses on psychotherapy in management of diabetes. The article revealed that mental conditions may hinder self-management of diabetes and hence the need for psychotherapy is very important.

Al Slamah, T, Nicholl, BI, Alslail, FY, & Melville, CA 2017, ‘Self-management of type 2 diabetes in gulf cooperation council countries: A systematic review’, PLoS ONE, vol. 12, no. 12, pp. 1-16. Available from: 10.1371/journal.pone.0189160. [31 August 2018].

The article reveals concepts related to self-management. The article underscores the significance of physical exercise, proper dietary intake and insulin management processes that are crucial to patients with type 2 diabetes.

Schofield, D. & Shrestha, R. N. et al (2017), ‘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, 7(1): e013158. [31 August 2018].

The article focuses on economic consequences of type 2 diabetes. The article showed that by 2030, Australian patients aged 45 to 64 years of age who are unable to continue working due to diabetes will be from 2015. 8.81 million people rose 18% to 21,400, and government and personal spending will increase significantl

Al Slamah, T, Nicholl, BI, Alslail, FY, & Melville, CA 2017, ‘Self-management of type 2 diabetes in gulf cooperation council countries: A systematic review’, PLoS ONE, vol. 12, no. 12, pp. 1-16. Available from: 10.1371/journal.pone.0189160. [31 August 2018].

Physical activity for diabetes management

Australia Institute of Health and Welfare (2018) Diabetes snapshot. Retrieved from: https://www.aihw.gov.au/reports/diabetes/diabetes-snapshot/contents/how-many-australians-have-diabetes/type-2-diabetes

Australian Institute of Health and Welfare (2013) Diabetes expenditure in Australia 2008–09, Cat. no. CVD 62. Canberra: AIHW.

Baker IDI Heart and Diabetes Institute (2012) Diabetes: the silent pandemic and its impact on Australia. Retrieved from: https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/e7282521-472b-4313-b18e-be84c3d5d907.pdf

Bergmame, L, & Shaw, S 2018, ‘Psychoeducational interventions to improve adolescents’ medical management of diabetes: A comprehensive review’, Health Psychology Report, 6, 1, pp. 10-39, Academic Search Premier, EBSCOhost, viewed 27 August 2018.

Cefalu WT, Petersen PM, Ratner RE (2014), ‘The alarming and rising costs of diabetes and prediabetes: a call for action!’, Diabetes Care 37:3137–8. doi:10.2337/dc14-2329

Cohen, N, & Shaw, J 2007, ‘Diabetes: advances in treatment’, Internal Medicine Journal, 37, 6, pp. 383-388, Academic Search Premier, EBSCOhost, viewed 27 August 2018

Davis WA, Knuiman MW, Hendrie D, & Davis TM (2006), ‘The obesity-driven rising costs of type 2 diabetes in Australia: projections from the Fremantle Diabetes Study’, Intern Med J. 36(3):155-61

Diabetes Australia (2018) Diabetes healthcare needs improvement. Available from https://www.diabetesaustralia.com.au/news/15523?type=articles [Accessed 31 August 2018].

Diabetes Australia (2018) Peak Health Groups Welcome Government Funding for New National Diabetes Eye Screening Program to Prevent Blindness. Available from: https://www.diabetesaustralia.com.au/news/15522?type=articles [Accessed 31 August 2018].

Duncan, AD, Goff, LM, & Peters, BS 2018, ‘Type 2 diabetes prevalence and its risk factors in HIV: A cross-sectional study’, PLoS ONE, vol. 13, no. 3, pp. 1-11. Available from: 10.1371/journal.pone.0194199. [31 August 2018].

Grace BS, Clayton, P & Mcdonald, SP (2011), ‘Increases in renal replacement therapy in Australia and New Zealand – understanding trends in diabetic nephropathy’, Nephrology (Carlton)

Muilwijk, M, Nicolaou, M, Qureshi, SA, Celis-Morales, C, Gill, JR, Sheikh, A, Sattar, N, Beune, E, Jenum, AK, Stronks, K, & van Valkengoed, IM (2018), ‘Dietary and physical activity recommendations to prevent type 2 diabetes in South Asian adults: A systematic review’, PLoS ONE, vol. 13, no. 7, pp. 1-22. Available from: 10.1371/journal.pone.0200681. [31 August 2018].

Olivia K., Susan N., Sandra G. and Alan B. (2017) ‘Diabetes educator role boundaries in Australia: a documentary analysis’, Journal of Foot and Ankle Research. 201710:28

Rosa, Cd, Campos, Jd, Natali, MM, Sá Nakanishi, Ad, Comar, JF, Martins, IP, Mathias, PF, Pedrosa, MD, & Godoi, Vd (2018), ‘Food restriction promotes damage reduction in rat models of type 2 diabetes mellitus’, PLoS ONE, vol. 13, no. 6, pp. 1-22. Available from: 10.1371/journal.pone.0199479. [31 August 2018].

Schofield DJ, Shrestha RN, Cunich M et al. (2015), ‘Lost productive life years caused by chronic conditions in Australians aged 45–64 years, 2010–2030’, Med J Aust 203:260.e1–6. doi:10.5694/mja15.00132

Schofield, D. & Shrestha, R. N. et al (2017), ‘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, 7(1): e013158.

Smits, KJ, Sidorenkov, G, Kleefstra, N, Hendriks, SH, Bouma, M, Meulepas, M, Navis, G, Bilo, HG, & Denig, P (2018), ‘Is guideline-adherent prescribing associated with quality of life in patients with type 2 diabetes?’, PLoS ONE, vol. 13, no. 8, pp. 1-13. Available from: 10.1371/journal.pone.0202319. [31 August 2018].

Tan, JS, Wang, JJ. & Mitchell, P (2008), ‘Influence of diabetes and cardiovascular disease on the long-term incidence of cataract: The Blue Mountains eye study’, Ophthalmic Epidemiol, 15, 317-27