Growth in diabetes to cut life expectancy

Diabetes Australia has called for annual screenings for the disease to be introduced for all Australians over 40. Linda Belardi reports.

The next generation of adults may be the first in centuries to have shorter life expectancies than their parents if the growth in diabetes continues unchecked, according to the latest evidence.

The Baker IDI Heart and Diabetes Institute said an estimated 3 million Australians over the age of 25 would have diabetes by 2025.

This rate of growth would have the effect of erasing decades of health gains from anti-smoking campaigns and better management of heart attack and stroke.

“The last few decades have seen a steady decline in deaths from cardiovascular disease. However, the rising prevalence of diabetes and obesity may reverse these trends,” said the report launched by a coalition of diabetes researchers and consumer advocacy groups last month.

Whilst most of the growth is due to type 2 diabetes, the prevalence of type 1 diabetes in Australian children is also rising, placing Australia among the top rated 10 countries. For type 2 diabetes,

Australia ranks amongst the highest in the developed world, ahead of nearly all Western European countries but below the US.

Lewis Kaplan, CEO of Diabetes Australia called for a national plan of action in line with the current UN resolution on diabetes.

“We need a substantial and a sustained commitment by the federal government and all state and territory governments to both primary and secondary prevention of diabetes,” he told Nursing Review.

Kaplan said prevention campaigns had to tackle growing rates of obesity and encourage broad lifestyle change within the population. Strategies targeting individuals alone were unlikely to work

and more far-reaching strategies were needed.
He advocated for more stringent government controls on junk food advertising and improved nutrition education in school curriculums.

Workplace incentives were also recommended to encourage physical activity to help counter declining participation in exercise, and universal health screening for diabetes for everyone over 40. This would involve lowering the recommended age for an annual health check from 50 to 40 and require everyone in this age group who is admitted to hospital to have a diabetes blood test.

Evidence showed this strategy was a cost effective method of detecting those at risk before they developed serious complications of diabetes, Kaplan said.

Currently 680,000 people are living with type 2 diabetes undiagnosed and 2 million Australians are currently pre-diabetic and have a very high risk of developing diabetes in the next five years.
Research has found that early intensive lifestyle changes in people with pre-diabetes can reduce the risk of developing diabetes by nearly 60 per cent over a three-year period, he said.

Baker IDI Heart and Diabetes Institute, Diabetes Australia and the Juvenile Diabetes Research Foundation teamed up to deliver the latest snapshot for federal politicians and to lobby for a stronger commitment from government.

Federal Liberal MP Judi Moylan, who is a founding member of the Parliamentary Diabetes Group, attended the event as a representative for the Minister for Health.

To raise awareness of these statistics, consumer advocates have dubbed the next generation of Australians, “Generation D”. The report said an estimated one third of today’s young adults will develop diabetes during their lifetime.

“There is a lot more that could be done. But the problem is we live in an environment where there is a push back from people who say ‘we don’t want a nanny state’,” said Kaplan. However, he said, neglecting the ongoing childhood obesity epidemic “could be construed as child abuse.”

The report card for indigenous Australians was also alarming. The report said amongst older adults in many indigenous communities, type 2 diabetes has become the norm, and many families have at least one person on dialysis due to diabetes-related kidney disease.

Indigenous Australians are more than three times more likely to report having the condition, but in some parts of Australia the prevalence amongst adults can reach as high as 33 per cent - amongst the highest in the world.

To date, Kaplan said government strategies have been poorly implemented and evaluated. Last year the government dumped its own $2 million lifestyle management program without proper evaluation. “Our view was the program needed to be strongly reviewed about why it had a low uptake. It actually needed to be boosted up not cut out, because we know we have 2 million Australians with pre-diabetes.”

Kaplan said the program needed to target a broader range of people than the 40-49 subset, and pointed to the Diabetes Australia Victoria “Life!” program as a successful example of what can work.

“It’s signing people up in significant numbers and producing some very strong data showing its effectiveness. The NSW Health Department has expressed an interest in the program and we are very keen to secure funding to roll this program out nationally,” he said.

The diabetes sector also suffered a further setback recently when the government’s $450 million program for co-ordinated care, announced in the 2010-2011 budget, was scaled back significantly due to opposition from the AMA. It is now a $30 million, four-year pilot that is about to be rolled out in Queensland, Victoria and South Australia.

But Kaplan said the pilot won’t reveal anything we don’t already know. “We know that co-ordinated care works. It’s just now a political process of approving it and getting the doctors’ organisations on board, and bringing them to a point where they can’t knock it back. Unfortunately, that’s going to take a bit of time.”

Professor Jonathan Shaw, associate director of Baker IDI, who authored the report, said diabetes was reaching epidemic levels. Globally, the highest prevalence of diabetes is found in North Africa, the Middle East and Asia, and in indigenous communities.

“In Australia around 8 to 9 per cent of adults have diabetes, compared with 5-8 per cent in Western European countries. In the Middle East it ranges from 10-25 per cent and we see the same or similar levels amongst Middle Eastern populations when they live elsewhere such as Australia,” he said.

Shaw said this ethnic component could be linked to the rapid speed of modernisation experienced by these cultures. He said current interventions were patchy and more needed to be done to improve the co-ordination of care for people with diabetes.

The report, Diabetes: the silent epidemic and its impact on Australia is available to download from the Baker IDI website. Visit: www.bakeridi.edu.au

Number crunch

• 1.5 million Australians currently have diabetes
• Prevalence in 1980 was 300,000 people. For 2033 it is estimated to be 3.5 million.
• Australia has the 7th highest prevalence and 6th highest incidence of type 1 diabetes in the world amongst children.
• One in two people with diabetes do not have their blood glucose levels under control.
• 32 per cent of avoidable hospitalisations are diabetes related.
• The total annual cost for Australians with type 2 diabetes is $6 billion.

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