‘A major public health crisis’: Diabetes policy under scrutiny

A GP specialising in diabetes has said he hopes a Parliamentary Inquiry will help flesh out crucial details to inform policymakers looking to reduce the burden of the disease.
 
Dr Gary Deed, Chair of RACGP Specific Interests Diabetes, told newsGP he is interested to see if current gaps in understanding of the disease can be addressed. He describes existing information as mostly ‘high level population-based data’, with little granular detail on individuals and how general practices manage the condition.
 
‘PHNs provide some feedback but there is not any major incentive to collect other data on numbers of hospitalisation from particular practice locations, for instance,’ he said.
 
Dr Deed also gives the example of knowing how many high-risk complex diabetes patients a practice manages compared to average, or how many nursing home patients have the condition in a particular area, as details that could make a difference to management of the disease.
 
‘This sort of data could help understand and inform models of care that challenge current paradigms,’ he said.
 
‘How do we make policy decisions based on data gaps? In the US … data collection drives policy.’
 
According to Dr Deed, the new Diabetes In Australia inquiry is ‘a timely reminder that diabetes remains a major public health crisis’.
 
As well as considering the impacts of diabetes on the health system and economy, the committee members are looking into the disease’s causes and risk factors.
 
They will also consider recent advances in its prevention, diagnosis and management, as well as the links between diabetes and obesity.
 
The effectiveness of current Federal Government policy will also be under scrutiny.
 
The committee’s Chair Dr Mike Freelander, a former paediatrician now representing the NSW electorate of Macarthur, said the inquiry’s scope is ‘very broad’.
 
‘It’s going to be a long-term inquiry and we want to get as much information as we can so we can get a plan for the future,’ he said.
 
Dr Freelander specified that the social factors in type 2 diabetes (T2D) will be explored with a view to trying to reduce its ‘very high incidence’.
 
The Deputy Chair of the Committee, Melissa McIntosh, said she has learned first-hand about the ‘significant impacts’ of the disease due to her son developing type 1 diabetes after contracting COVID-19.
 
Professor Monique Ryan, a former paediatric neurologist and now the Member for Kooyong, is another committee member, and said in her former role she had been aware of some shifting trends in the disease.
 
‘In the last decade or two, as paediatricians, we have been seeing a really concerning increase in the incidence of type 2 diabetes in Australian children,’ she said.
 
Professor Ryan said the inquiry will also delve into gestational diabetes, which she said is particularly on the rise in Aboriginal and Torres Strait Islander communities.
 
According to Dr Deed, educating GPs about diabetes should remain a priority, and he said funding to support the use of guidelines in clinical care is ‘desperately needed’.
 
‘The RACGP has many great resources, including in diabetes,’ he said. ‘However, to embed these into the workflow of each GP requires nationally coordinated support.’
 
He suggests the inquiry could also help address modifiable risks of women diagnosed with gestational diabetes, as well as their children, with both groups more likely to develop T2D.
 
Dr Deed would like to see a nationally coordinated primary care plan to address overweight and obesity, and clearer referral pathways from GPs to programs promoting behavioural changes.
 
‘Diabetes has a timeline that starts before the diagnosis is established right to the end-of-life care that may be needed,’ he said.
 
‘All through these journeys GPs and their care teams are part of the essential support network that people turn to [for] help and health.
 
‘Hopefully this review will seek to discover some of the key times in the journey of the person with diabetes, where GPs need extra support to step up care and coordination.’
 
Around one in 20 Australians were estimated to be living with diabetes in 2020, according to the Australian Institute of Health and Welfare (AIHW) – with that figure excluding those diagnosed with gestational diabetes.
 
Disease prevalence increases significantly with age, with almost 20% of those aged 80–84 believed to be living with diabetes.
 
The AIHW also states that the official figures are likely to be an underestimate of the true prevalence, citing studies that suggest many cases go undiagnosed.
 
Prevalence rates rose from 2.4% in 2000 to 4.3% in 2020, with the rate peaking in 2016 and remaining stable after that.
 
The disease was cited as the underlying cause of around 5100 deaths in Australia in 2020, with estimates that it contributed to around 17,500 further mortalities. The majority of those were linked to T2D.
 
The diabetes and obesity inquiry was referred to the House of Representatives committee by Federal Health and Aged Care Minister Mark Butler last month.
 
For more details on the inquiry, see the Parliament of Australia website. Written submissions are open until 31 August.
 
The RACGP’s clinical guidelines for managing T2D are available on its website.
 
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