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Two recent startling reports have shone a light onto the diabetes epidemic, with experts hoping significant change will follow.
Last week saw the release of a report arising out of the federal parliamentary inquiry into diabetes, with 23 recommendations to strengthen the government’s response to diabetes and obesity.
It comes as Diabetes Australia released their 2024 State of the Nation report in late June, which also highlighted Australia’s diabetes epidemic and that diabetes is particularly increasing in younger people.
The Diabetes Australia report revealed the following:
- In the last decade, Australia has seen a 44% increase in the number of people diagnosed with diabetes between the ages of 21 and 39.
- There has been a 17% increase in diagnosis before the age of 20 in the past 10 years.
- The prevalence of youth-onset type 2 diabetes in people aged 15–24 has doubled in Aboriginal and Torres Strait Islander communities in the past 5 years.
- The total number of people known to be living with all types of diabetes in Australia rose by 32% between 2013 and 2023, from 1.1 million to close to 1.5 million people.
- The number of women diagnosed with gestational diabetes mellitus(GDM) annually has more than doubled in 10 years, making it the fastest growing type of diabetes.
The shared recommendations from both reports
There were several shared recommendations covering treatment, more support for vulnerable communities and greater investment in research.
Some of the shared recommendations include:
- investing in integrated models of care that support a multidisciplinary diabetes care team
- introducing a levy on sugar-sweetened beverages
- increasing funding and support for diabetes educators and specialists to ensure adequate health care workforce
- changes to Medicare Benefits Schedule (MBS) funding to give people more prevention and treatment support.
The Australian Medical Association applauded the inquiry, particularly the recommendation for a tax on sugar-sweetened beverages.
“A sugar tax would have a huge impact on Australia’s health system and the AMA’s modelling suggests a sugar tax could result in government revenue of $4 billion across four years, which could be used to fund further preventative health activities,” AMA President Professor Steve Robson said.
AMA also welcomed the recommendation from the parliamentary inquiry about longer appointment times for health care professionals.
“Doctors, especially GPs, have a vital role to play in terms of helping patients to manage risk factors, providing early intervention and ongoing treatment and we applaud the push for longer appointments subsidised by the MBS,” Professor Robson said.
“This allows our doctors to provide longitudinal care, which will make a difference in the management of the complexities of diabetes and associated conditions,” he continued.
Supply of Ozempic
Both reports discussed the supply of glucagon-like peptide-1 receptor agonist (GLP-1A) medicines in the market and ways to increase it.
Research has shown the efficacy of GLP-1As, like Ozempic, to help people lower their glucose levels and reduce their weight.
However, according to Diabetes Australia Group CEO Justine Cain, the current regulatory and reimbursement systems in Australia are not well placed to efficiently consider and provide access to these new therapies.
“Shortages of medications for the management of diabetes are posing a significant problem for Australians living with type 2 diabetes, and those trying to prevent developing the condition. Diabetes Australia continues to call on doctors and pharmacists to only prescribe and supply medications such as Ozempic to people living with diabetes,” she said.
Disadvantaged communities
The parliamentary inquiry report also highlighted the importance of ensuring supply of these medications for disadvantaged and remote communities, including Aboriginal and Torres Strait Islander communities.
In addition, the Diabetes Australia report recommended workforce strategies to ensure those in Aboriginal and Torres Strait Islander communities have access to multidisciplinary services and culturally appropriate prevention programs. It also recommended more research into understanding what is most effective for Indigenous populations, particularly as they’re generally under-represented in research and clinical trials.
GP and Chair of the RACGP specific interests diabetes group, Dr Gary Deed, said more listening is needed.
“The voice of those particular groups and risks need to be elevated and heard more, because they are the people who suffer from lack of prevention and progress to chronic diseases and diabetes. It becomes a generational, ongoing factor which further embeds disadvantage,” he said.
Calls for a prevention strategy
One key message from both reports was the importance of prevention.
“Investment in access to healthy food; a levy on sugary drinks; and a ban on junk food advertising to children, are all issues we have long been calling for, and we’re pleased that the committee has responded to those calls,” Ms Cain said in response to the parliamentary committee’s report
“Diabetes Australia has been calling for a national prevention plan for years, spanning many governments. Despite a tripling in the number of Australians living with diabetes from 2013 to 2023, there is still no national type 2 diabetes prevention plan,” she told InSight+.
Dr Deed agreed.
“A lot of the time goes towards the treatment of existing identified diseases, but we need to shift the policies towards prevention and diabetes is the ideal disease. Type 2 diabetes is highly preventable,” he said.
There are a number of state-based diabetes and chronic disease prevention programs, including Queensland’s My health for life, New South Wales’s the Get Healthy Service and Tasmania’s The COACH Program delivered in conjunction with Diabetes Australia. Diabetes Victoria also operates the Life! program.
The Diabetes Australia report also highlighted the work of Western Sydney Diabetes, which was established in response to growing levels of diabetes in that community. It is a partnership between community health services, general practice, hospitals, specialists and allied health.
“We can learn a lot from that model to adapt to different models of care around Australia,” Dr Deed said.
“This model exists but there’s no national consistent framework. There’s all this ad hoc, often run by passionate people and interested PHNs [public health networks]. But it’s not a consistent thing. That’s where a national prevention framework would actually make it happen.
“It’s about having vision based around evidence, and then enacting a significant change. We’ve got the evidence. We’ve already got the vision. We have the strategies, but no-one’s got the gall to stand up from a political health policy perspective,” Dr Deed said.
Ms Cain is hopeful that with these two reports, change is imminent.
“We need to act decisively and collectively. The time for bold action is now. We look forward to working with the government as it responds to the committee’s recommendations,” she concluded.
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That is so depressing. Obviously, the provision of services will not help the underlying issues. Tax sugar if you must.
And you would trust the Government to actually spend the four billion dollars on health? While we are at it, should artificial sweeteners in drinks also be taxed given their health sequelae and may be a fat tax while we are at it to reduce CVD! There is no simple solution. If there was, we would have been using it decades ago. Bariatric surgery is often effective but of course does not suit all patients.