Diabetes a “major challenge”

DESPITE initial global apathy towards diabetes and related non-communicable diseases, international action on diabetes is now gaining momentum, say Australian experts.

Writing in the MJA, Associate Professor Ruth Colagiuri, of the University of Sydney’s Menzies Centre for Health Policy, and coauthors said recent activity by the United Nations (UN), the WHO and the global public health community had alerted the world to the threat of non-communicable diseases (NCDS). (1)

“Although diabetes and related NCDs remain disproportionately underfunded, the UN now recognises them as a major challenge to human and economic development”, they wrote, pointing to action-oriented policy and monitoring requirements that were being driven by the UN and WHO.

“The UN, WHO and global public health community were slow to recognise the true magnitude of NCDs. Focused on eradicating infectious diseases and reducing perinatal mortality, they failed to appreciate both the size of the NCD problem and its implications”, they wrote, noting that in 2013 diabetes accounted for 5.1 million deaths.

The authors highlighted Australia’s role in negotiating the NCD global monitoring framework and its efforts in developing a National Diabetes Strategy, which is due for completion in mid 2015.

Professor Glen Maberly, senior medical advisor at the Innovation and Redesign Department, Executive Medical Services, Western Sydney Local Health District, Sydney, told MJA InSight global health organisations could quantify the size of the problem and advocate for change, and were “stepping up to the plate” in these areas. However, he said, the health sector lacked the necessary levers to out that change into effect.

“The tsunami of diabetes that is coming through has to be tackled largely through non-health interventions. We are getting [diabetes] because of our modern lifestyle— the change in food and the lack of physical activity — which are not altered in the health sector”, said Professor Maberly, who is also a senior staff specialist (endocrinology) at Blacktown Mt Druitt Hospital.

He said whole-of-government action was needed. “It’s got more to do with the fact that we’re using cars and we’re not using public transport — our physical activity levels have dropped off — and also the food that we eat”.

Professor Maberly is leading a project in western Sydney to create an alliance of councils, housing development companies and food suppliers to address the factors that have contributed to the area becoming a diabetes “hot-spot”, with twice the prevalence of diabetes as Sydney’s inner city and coastal fringe.

Inner city areas were increasingly becoming more walkable, liveable places that promoted healthier lifestyles, but these changes were yet to filter out to suburban areas.

“There is an equity issue. The greatest burden of diabetes is actually with the lower socioeconomic areas [and] is now emerging with the lower socioeconomic countries”, he said.

Dr Thomas Astell-Burt, senior lecturer in public health at the University of Western Sydney, and colleagues are working with the Chinese Center for Disease Control and Prevention to determine the prevalence and management of diabetes in China.

“What we’re finding is that there is considerable variation and it’s linked to urbanisation and changes in diet, which tend to be more progressively western, and more sedentary [lifestyles]. So what we’re seeing in China is a rapid change in circumstance which is promoting a rapid rise in diabetes”, he said. (2)

Dr Astell-Burt was the lead author on research published earlier this year finding that Australian neighbourhoods with more parks and green spaces that promoted physical activity were associated with a lower prevalence of type 2 diabetes than more built-up areas. (3)

“If we were able to change the types of environments that people were living in to something that we know is more healthy and liveable, that would be a good thing”, he told MJA InSight.

Professor Maberly said turning the diabetes epidemic around in Australia would be a “long haul” initiative, but not impossible.

“It took us more than 15 years to put on [an average of] 4 kg in weight in Australia, which is driving the epidemic”, Professor Maberly said. “So … it will take some time to change it, but the health sector by itself can only highlight the problem.”

1. MJA 2014; Online 10 November
2. Diabetes Care 2014; Online 28 October
3. Diabetes Care 2014; 37: 197-201

(Photo: Ollyy / Shutterstock)