Australia has fallen behind in our response to diabetes

Here is how we get back on the right path.

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When it comes to the data on diabetes in Australia, the numbers are very telling and very concerning.

According to the National Diabetes Services Scheme (NDSS), there are 1.46 million Australians living with diabetes – 1.27 million with type 2 and 136,000 with type 1. Data from the Australian Institute of Health and Welfare (AIHW) also shows that in 2021, diabetes health-related costs were $3.4 billion – this does not account for the significant indirect costs, including absenteeism, and reduced productivity.

Despite the health and economic burden of diabetes in Australia, we continue to face shortages of medicines that are critical in effective management of the condition and inequitable and unaffordable access to diabetes management technologies. We are now falling behind similar countries, including the UK and Japan, where universal access to continuous glucose monitors is basic standard of care.

The Australian National Diabetes Strategy 2021-2030 is a framework for collaborative efforts by the whole medical system, governments, health systems and the broader community “to reduce the incidence of, and morbidity and mortality from, diabetes and its associated complications”.

However, three years into this excellent roadmap, not one single dollar has been spent towards any of its aims and, most concerningly, there is no implementation plan whatsoever.
This continues a worrying trend in how successive governments see diabetes.

A major symptom of the problems that was highlighted recently is the erosion of diabetes research funding over the past 10 years, decreasing by 35% to $42.3 million in 2022. This for a disease which AIHW data shows has increased in prevalence almost three-fold since the turn of the millennium.

It is because of research that we now have medications that can cause significant weight loss and effectively reduce blood glucose and rates of complications in people with type 2 diabetes. Research has been responsible the exponential advances in diabetes technologies for type 1 diabetes.

Without significant funding of Australian research, we cannot deploy policies and procedures in our health system to support all people living with diabetes.

The current government’s parliamentary Inquiry into Diabetes provides a watershed moment for how we as a nation will set about tackling the growing tsunami of diabetes. Across each of the 467 submissions and in-person hearings, it is clear more must be done.

In addition to the need for improved research support, we must continue to ensure people living with diabetes have access to the right tools, at the right time and are supported to prevent the continuing spiral which leads to worse health outcomes for the patient and the medical system.

We know providing these tools works in reducing the healthcare burden on our society. In 2022, the government provided 136,000 Australians with type 1 diabetes access to subsidised CGM products under the NDSS. This has been an outstanding outcome for people living with type 1 diabetes.

This decision took devices which were only available to those who could afford thousands of dollars a year and made it accessible to all Australians with type 1 diabetes who need it.

It has improved health and economic outcomes as well, with studies of paediatric patients showing the subsidy increased the usage of CGM devices, which in turn increased the likelihood of patients achieving the target HbA1c of <7% by more than twofold from baseline, and the mean HbA1c was reduced by 0.3–0.5% overall.

As someone who is committed to supporting people living with type 1 diabetes, the change the subsidy has made is indescribable. The feedback we have received is that CGM systems have made a huge difference in people’s quality of life as well as their management of type 1 diabetes.

Just like for their type 1 counterparts, living with type 2 diabetes can be challenging. This includes the same burdens of managing blood glucose levels as well as complications, including blindness, foot ulcers and amputations, heart disease and stroke.

Many people living with type 2 diabetes rely on insulin for their glucose management. It is reasonable to suggest that CGM systems would also help people with type 2 diabetes, and lower their risk of developing long-term complications that are costly to the broader healthcare system.

Emerging clinical studies are showing lower blood glucose levels and savings to the health system, with reduced hospitalisations in people with type 2 diabetes using CGM. Furthermore, these benefits were seen whether people with type 2 diabetes were treated with insulin or not.

From an economic and medical standpoint, it makes sense that CGM access is also provided for people with type 2 diabetes. If Australia wants to boast a world-class healthcare system, we need to continue to meet world-best practices, in research and supports.

Senate estimates hearings in 2023 revealed that, of the 136,000 Australians with access to subsidised CGM devices, approximately 50,000 living with type 1 diabetes were not accessing the scheme. This means that funds set aside for this program have not been fully utilised. These funds cannot be handed back – they must be used to expand CGM access to more Australians living with diabetes.

This must include Australians living with insulin-requiring type 2 diabetes or other high-risk communities such as Indigenous Australians, who we know suffer worse health outcomes across the board, but in particular with diabetes.

Australia is regrettably lagging most OECD nations in how we combat diabetes, the least we can do is make sure we provide support for researchers and the appropriate tools for all Australians living with diabetes, like CGM.

Dr Sof Andrikopoulos is currently the CEO of the Australian Diabetes Society and has previously served as President, Treasurer and Chair of the Program Organising Committee of the Society.