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Sweeping change needed amid ‘diabetes epidemic’: Inquiry

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Diabetes patients are facing a blackhole of information, access, and affordable care when it comes to adequate treatment, according to a new Parliamentary report.
 
The State of Diabetes Mellitus in Australia in 2024 report, released on Wednesday, made 23 recommendations to address the nation’s ‘diabetes epidemic’, following a year-long inquiry and around 500 written submissions.
 
Most relevant to GPs, the report called for longer appointments to be subsidised by the Medicare Benefits Schedule (MBS), greater access to telehealth, bolstered support for rural patients, and the potential of a national screening program.
 
It also recommended:

• food labelling reforms targeting added sugar
• a tax on sugar-sweetened beverages
• regulating marketing and advertising of unhealthy food to children
• exploring a potential national screening program
• a national public health campaign
• further expansion of subsidised access to continuous glucose monitors (CGMs)
• expanding subsidised access to insulin pumps
• securing supplies of GLP-1 RAs for disadvantaged and remote communities
• potentially expanding access to bariatric surgery within the public system.

The inquiry launched in May last year to investigate the causes of type 1, type 2 and gestational diabetes in Australia, evidence-based advances in its prevention, diagnosis and management, and its broader impacts on the health system.
 
The report comes as rates of the condition continue to skyrocket, with the number of people living with diabetes in Australia increasing 2.8-fold, from 460,000 to 1.3 million, in the past two decades.

Additionally, out of all GP appointments, about 12% are for type 2 diabetes alone, 1% are for type 1 diabetes, and 1% for gestational diabetes.
 
Despite this, the report provided evidence that those living outside the major cities are ‘having difficulty accessing support’ from healthcare professionals, including GPs.
 
‘These services should be strengthened to allow more equitable access to support and an integrated model of care instituted with State and Federal Government support made available to all those with diabetes mellitus,’ it said.
 
‘In remote areas there is a significant shortage of Indigenous health workers, and this impacts severely on diabetes management.’
 
It also found that limited access to GPs, especially bulk-billed GPs, was a common barrier, even though primary care plays a key role in helping those living with diabetes to manage the condition.
 
In a bid to address this, several witnesses to the inquiry called for a Medicare overhaul to better represent the realities of general practice.
 
One respondent urged for ‘MBS items to be reintroduced to support the annual cycle of care as this process is time consuming and appropriate remuneration is therefore needed to support GPs’.
 
In response, RACGP Chair Dr Lara Roeske called on the Government to increase patients’ Medicare rebates for standard and longer consultations.
 
‘After decades of underfunding, today’s patient rebates don’t come close to the true cost of providing care across the country,’ she said.
 
‘There should be investment in programs that support GPs to engage at-risk people in their communities.
 
‘Barriers to GPs providing care to patients should be removed, such as allowing GPs to initiate electronic glucose monitoring devices.’
 
The final report referenced several recommendations mentioned in the RACGP’s submission to the inquiry, including its calls for the general population be screened for type 2 diabetes every three years from the age of 40.
 
The college said this should be upped to annually from the age of 18 for Aboriginal and Torres Strait Islander people, who have the highest rates of youth-onset type 2 diabetes in the world, to improve opportunities for early intervention.
 
The Parliamentary report also recommended greater access to subsidised CGMs, including the removal of all access limitations for type 1 diabetes patients, as well as an exploration of expanding subsidised access to insulin pumps.
 
It also called for an expansion of eligibility criteria for GLP-1 RAs for high-risk patients, as well as making efforts to secure their adequate supply.
 
‘The cost of these medications, however, along with the side effects and the fact that we are unsure of the long-term impact of their use are all major concerns,’ the report said.
 
‘In the coming years, there will be an avalanche of these types of medications available for use, and Australia needs to be prepared to manage this change in pharmacotherapy.
 
‘The [Therapeutic Goods Administration] has a critical role to play, as do GPs and pharmacists who need to be well informed about these medications.’
 
Dr Roeske said GPs need more support to help reverse the diabetes epidemic.
 
‘GPs play a central role in diabetes prevention, diagnosis and management, and we know early detection is key for people to turn their health around,’ she said.
 
‘So, it’s critical that general practice care is affordable for everyone in Australia.  
 
‘Diabetes is a complex disease and people often have multiple health issues alongside it. It’s critical that we get health policy and funding right, and investing in preventive care in general practice is key.’
 
In the wake of the report, the investigating committee’s Chair and Labor MP Dr Mike Freelander said access to services are currently inequitable and must change.
 
‘This is particularly true for Indigenous and culturally and linguistically diverse communities,’ he said.
 
‘If we are to reduce the burden of diabetes on the health system, we will require a multipronged approach that focuses on prevention and public health policies across not just health services, but also education, agriculture, construction, social services, communications, transport, and manufacturing.’
 
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diabetes GLP-1RA MBS Medicare Medicare Benefits Schedule

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