Diabetes epidemic an “emergency”

THE rise of diabetes is a national emergency requiring an appropriately weighty whole-of-government response, says a leading public health advocate.

Dr Lesley Russell, senior research fellow with the Australian Primary Health Care Research Institute at the Australian National University in Canberra, told MJA InSight that the Australian public needed to be made much more fearful of the consequences of obesity and diabetes.

In an MJA editorial, Professor Paul Zimmet, director of the Baker IDI Heart and Diabetes Institute in Melbourne, wrote that the current global diabetes epidemic was the equivalent of the cholera and typhoid epidemics of the 19th century and the HIV/AIDS epidemic of the late 20th century, with 370 million people with diabetes worldwide. (1)

“At least 1.5 million people in Australia now have diabetes and 2 million have prediabetes”, Professor Zimmet wrote. “We have not had a national diabetes strategy and action plan for a decade.”

The latest Australian Diabetes, Obesity and Lifestyle Study (AusDiab) shows that 269 Australian adults aged over 25 years develop diabetes every day. (2)

Australia’s largest population-based longitudinal study, AusDiab examines the incidence of diabetes, prediabetes, heart disease and kidney disease. It has shown that people with diabetes were more likely to have cognitive impairment and physical disability as they age, see their GPs more often and stay in hospital more often than those without diabetes.

Dr Russell said the diabetes epidemic was “a matter of national emergency”.

“We need to have people understand that the primary risk factor for diabetes is obesity, and that this is a very serious illness with very serious consequences”, she said.

“When talking about diabetes, unless you grow up with it in your family, it seems to be an amorphous thing — take a tablet and get on with it. People don’t realise how horrible this disease is.”

Dr Russell said public education campaigns and intervention programs were the key to meaningful change, citing the anti-tobacco campaign as a template.

“Look at how long it has taken us to get where we are now in the anti-smoking campaign”, she said.

“In some ways the smoking issue is easier because every puff will harm you. Obesity is caused by something that is not necessarily harmful.

“Therefore the campaign [against obesity and diabetes] has to be sustained, it has to be reinvented every now and then and it has to have different targets.

“It also has to be of the magnitude that allows it to counter the food lobby”, she said.

Professor Mark Harris, a member of the Royal Australian College of General Practitioners’ National Standing Committee for Quality Care, told MJA InSight that after a flurry of governmental action up until about 2005, there was little attention being paid nationally to diabetes and obesity.

“We’re not seeing this issue being reflected in the election campaign”, Professor Harris said.

“Diabetes and obesity are major drivers of health care costs, and we are falling well short of providing optimal care for people with diabetes.

“It would be wrong to say that there’s been no improvement, but we have not come to grips with prevention, particularly in high-risk groups. What has been done has not been sustained and has had no major effect”, he said.

Australia’s recent improvements in the rates of cardiovascular mortality were in danger of being wiped out by the diabetes epidemic, Professor Harris said.

Dr Russell said a mistake was being made in thinking of diabetes and obesity as simply a health issue.

“This is a whole-of-government issue”, she said.

Professor Zimmet called for a “national diabetes commission” to address the epidemic.

“The delay in establishing such a commission is a national disgrace. Is anyone in Canberra listening?”
 

1. MJA 2013; 199 (4): 225-226
2. Baker IDI Heart & Diabetes Institute 2013; The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)