DIABETES
AUSTRALIA
New South Wales
Janice McLay
Liaison Manager
Who is DA-NSW?
The charity
caring for people with diabetes all
of their lives in NSW
Diabetes Australia
Who we are...
• Not for profit organisation
• Peak consumer body in each state
and territory
• Federation of 12 organisations,
including health professionals,
endocrinologists and educators
• Manages the Government’s
National Diabetes Services Scheme
FACT
• 7.2% of the Australian population over age
25 have diabetes whilst only 50% are aware
of their condition
(Ausdiab, 2000)
LEARNING OBJECTIVES
• FUN
• Update information on inequities for ATSI,
socioeconomically disadvantaged, Australian born
overseas
• Trends Diabetes
• Prevalence
• Cost to the community
• Health Care in Australia
• Health promotion
Group Activity - Diabetes
• Divide into 4 teams using the Visual charts please
present information back to the group- 3min
• Team 1- What is Diabetes
• Team 2- What is Type 1 and Type 2 Diabetes
• Team 3- Risk factors of Type 2 diabetes
• Team 4- What can you do to prevent/manage
diabetes?
INEQUITIES
ATSI
• Diabetes in ATSI
–
–
–
–
Diabetes not known in indigenous Australians 1923
Considered exclusive to Europeans
(1 in 10 Torres Strait islanders)
Are found in relatively large numbers in remote & rural
areas( 38% of the central Australian population)
– Almost always type 2
– GDM (gestational diabetes mellitus) very prominent
INEQUITIES
ATSI
• Diabetes ATSI
– Has been associated with a change from a
hunter-gatherer to a “western’ lifestyle
– Is now 3.4 times as common as in nonindigenous groups (10-30% incidence) ABS
2006c)
INEQUITIES
ATSI
Diabetes in ATSI is associated with Lifestyle
factors
• Poor diet
• Sedentary lifestyle
• Obesity
• Alcohol use
All these lead to a socioeconomic disadvantage
• Genetic factors
INEQUITIES
ATSI
BARRIERS TO GOOD
CONTROL
• Access to / cost of
treatment
• S100
• Insulin storage
• Compliance to
treatment
• Lifestyle measures
• Community
programmes
• Access to trained
health care workers
• “passive” management
INEQUITIES
Hospitalisation rates
• Higher than for other Australians
for most diagnosis
• For care involving dialysis x 17
times rate of other Australians
• For diabetes endocrine x 4 times
rate of other Australians
INEQUITIES
ATSI
GENDER
DEATH RATES caused
Mainly by Diabetes
Female
11 x the rate for nonindigenous people
Male
8 x the rate for nonindigenous people
Reference: Australia’s Health 2006
TRENDS IN MORTALITY
Only mortality from disease of the circulatory system showed a
consistently significant decline among Indigenous Australians
INEQUITIESSOCIOECONOMICALLY
DISADVANTAGED
100%
DIABETES DEATH
RATES 2001-2003
82%
0
LEAST
DISADVANTAGED
REFERENCE: (AIHW:DIXON %WEBBIE
2005)-AUSTRALIA’S HEALTH 2006.
DISADVANTAGED
Contrasting figures-diabetes
discriminates Below 3%
Byron
Ku-ring-gai
Pittwater
City of Sydney
Camden
Waverly City
Leichhardt
Manly
Woollahra City
Mosman
INEQUITIES
AUSTRALIANS BORN
OVERSEAS
• 1 in 8 Australians were born in a non English
speaking country
• Diabetes prevalence, hospitalisation and mortality
are higher among people born
– Southern Europe, Eastern Europe, the Pacific Islands,
South-East Asia, China, and the middle Eat and North
Africa
• - approximately 30% of Australians who have
Diabetes were born overseas
Reference: Australia's health 2006
INEQUITIES
AUSTRALIANS BORN
OVERSEAS
•Countries displaying higher rates
hospitalisation for Diabetes Mellitus
are- Greece, Italy , India , Vietnam
•Death rates for diabetes higher among
people born in Germany, Italy, Croatia
,Greece ,Poland and India
INEQUITIES
AUSTRALIANS BORN
OVERSEAS
•Males born in Middle East and North
Africa diabetes prevalence rate 3.6 x of
Australian-born males.
(reference: AIHW:Holdenson et al 2003)
•Females corresponding ratio was 2.4
•Incidence Type 2 among Greek and
Italian immigrants > 3x Australian born
INEQUITIES
AUSTRALIANS BORN
OVERSEAS
•Australian descendents of Pacific Islanders
in QLD diabetes diagnosed in 8%. Increasing
prevalence to 1/5 of persons over 45years.
•Migrants changes in diet and physical
activity have been implicated in their
increased risk
BARRIERS TO ACCESSING HEALTH CARE
SERVICES FOR THEIR DIABETES THAT THEY
ENCOUNTER DUE TO LANGUAGE AND
CULTURE
28% diabetes
population
Polynesians - Blacktown/Campbelltown
SE Asians - Auburn/Fairfield
Middle East - Bankstown/Fairfield
Aboriginal communities - Far West
Definitions for ‘prevalence’
and ‘incidence’
Prevalence – the proportion of people within a
population who have a certain disease or condition at a
particular time
Incidence – number of new cases of a disease or
condition arising in a population over a period of time
INCREASING INCIDENCE
OF DIABETES-Why?
•
•
•
•
•
Increases in Obesity
Physically inactive lifestyle
Ageing population
Rising awareness
Improved detection
Diabetes Facts
Australia
1200
Thousands
1000
800
600
400
200
0
1982
Source: Aus
AusDiab
Diab
1990
1994
2001
2010
INCREASING INCIDENCE
OF DIABETES-Why?
• 2.5 Million adults obese in 2004-05
– 1 in 5 males 18yrs > and 1 in 6 females (1)
• 4.9 million estimated to be overweight (1)
• 2004 half of Australians did not undertake
leisure-time physical activity at levels
recommended for health benefits
(1)
Reference1. Australia’s Health 2006
INCREASING INCIDENCE
OF DIABETES?
• Type 1 -2004 – annual incidence of 24.6% per
100,000 population < 15yrs (1 in 4000)
• 2004-05 AusDiab estimated every yr 8 person in
every 1000 will get Diabetes
• 2004-05 NHS -699,600 self reported diabetes.
– 13% Type1
– 83% Type 2 + (4% did not know type)
Reference: Australia's Health 2006
Atlas shows Prevalence rates
1995 -2006
530,000
70%
increase in
5 years
People
have
diabetes
Diabetes epicentre in Sydney
6%
Projected rates 2006 - 2012
If trend continues
1.5m. in NSW
4m.- Australia
HEALTH OUTCOMES OF
DIABETES
• 20% of people with diabetes reported
having 1 or more types of ‘heart, stroke or
vascular diseases’ compared with 4%
general population.
• Kidney replacement therapy due to Diabetes
accounted for 30% of all new cases for
Kidney registry.
Retinopathy
Normal vision
Same scene viewed by a
person with diabetic
retinopathy
HEALTH OUTCOMES OF
DIABETES
• Diabetes is the most frequent cause of lower
limb amputation (not associated with an
accident).794 hospital admissions NSW
2004-05
• 30-50% of men with Diabetes suffer from
impotence
HEALTH OUTCOMES OF
DIABETES
•
•
•
•
Type 2 accounts for approx 85-90%
68% of all hospitalisations due to Type 2
Type1 accounts for approx 23%
Gestational around 7%
NSW GOV’T 2006
MORTALITY DIABETES
• Diabetes is the 6th highest cause of death in
Australia
• Diabetes is the underlying or associated cause of
death in approx 8% of deaths in Australia.
• Diabetes was listed as the only cause in < 2% of
deaths, which reflects the fact that people die from
the complications of diabetes, not the disease
itself.
COST BURDEN FOR TYPE 2
DIABETES
• Diagnosed Type 2 diabetes is estimated at $3
billion a year
• Average cost per person $5,360 +$5,540 in
benefits = $10,900
• Cost per person increases with onset of
complications
– $4,020 without complications
– $9,625 with both micro and macro vascular
complications (2.8 times higher)
Note: These costs do not include lost productivity
from days lost through illness and premature death.
COST BURDEN FOR TYPE 2
DIABETES
• Direct health costs were hospitalisation due
to
– Complications (32 %)
– Use of medicines to treat complications (4%)
• Each person received an average $5,540 in
form of
– Government subsidies such as pensions
– Sickness benefits
Reference: DIABCOST
HEALTH CARE IN AUSTRALIA
• Diabetes National Health priority 1996
• Acute and short term focus
• Public health -2004-05 1.7% of total
recurrent health expenditure
• Major chronic diseases account for approx
70% of total health expenditure
HEALTH CARE IN AUSTRALIA
What is the Australian government doing
for Diabetes?
• 2007-08 budget-Prevention
– $103.4M over 4yrs to develop Risk assessment
‘tick test’
– $10.6M over 4yrs to develop national nutrition
and physical activity survey
– $11.7M one off grants over 4yrs for physical
activity projects
Budget Review 2007-08
Health
HEALTH CARE IN AUSTRALIA
What is the Australian government
doing for Diabetes?
• 2007-08 budget- Chronic disease
– $291.3M over 4yrs for Medicare items for
longer care sessions
– $337.6M over 4yrs for Medicare to help people
with chronic conditions made worse by poor
oral health-Diabetes is part of this
– $57M over 4 yrs on other measures
– Ongoing support of NDSS
Budget Review 2007-08
Health
HEALTH CARE IN AUSTRALIA
What is the Australian government doing
for Diabetes?
• Comments
– Indigenous health $121M well short of the
$460M called by the AMA
– RDAA say it did not provide sufficient
measures to increase the numbers of rural
practitioners
Budget Review 2007-08
Health
HEALTH CARE IN AUSTRALIA
What is the NSW government doing for
Diabetes?
• $5.2 M program to tackle diabetes in
Sydney’s south west
–
–
–
–
Diabetes Prevention program
Identifying those at high risk
Over 3yrs
30,000 people, 40-64yrs
• Pay gap for diabetes supplies-pens/needles
Health NSW government
news 2007
Diabetes Australia
A Health Promotion Perspective
Target Groups...
• Whole community
• High risk groups eg. pre-diabetes,
indigenous Australians, family members
• People with diabetes –Type 1,Type 2,GDM
Diabetes Australia
A Health Promotion Perspective
Health Promotion
• The process of enabling people to
increase control over their health
• Health promotion at Diabetes Australia
two distinct purposes:
• Prevention of diabetes
• Management of diabetes
Diabetes Australia
A Health Promotion Perspective
A partnership approach...
• Diabetes Australia adopts a partnership
approach to health promotion
• Key partners include:
• Community groups
• NSW Health & Area Health Services (clinical and
health promotion)
• Divisions of General Practice & GPs
•ADS ,ADEA
• Other non-government organisations
• Universities & colleges
• Other government agencies - DVA / DET
Classification of abdominal obesity
by waist circumference
Waist circumference (cm)
Males
Females
Normal
Overweight
Obese
< 94.0
< 80.0
94.0 – 101.9
80.0 – 87.9
≥ 102.0
≥ 88.0
Diabetes Australia
A Health Promotion Perspective
Links to health promotion strategies…
Diabetes Australia strategies for promoting
health are aligned with national & state
health priorities:
• Go for 2 and 5NSW - promoting healthy weight,
fruit and vegetable consumption
• Physical Activity Strategies eg. Active Australia,
promotion of National PA guidelines,
• Diabetes Australia is represented on NSW
physical activity / nutrition networks DAA aligned
Diabetes Australia
A Health Promotion Perspective
Activities linking with the 5 key action
areas of Ottawa Charter...
Build healthy public policy
• Provision of free needles, syringes and blood
testing strips via the NDSS
• Health care card
• Advocacy
• Community Sharps Disposal
• Lobbying government for funding and services
• Working with industry groups
Diabetes Australia
A Health Promotion Perspective
Activities linking with the 5 key action
areas of Ottawa Charter...
Create supportive environments
• Education for employers and advocacy on behalf
of people with diabetes
• Support for children and adolescents in school
environment
• Work with partner organisations in prevention &
awareness – ADEA/ADS past work AFL / DVA
• Workplace awareness and prevention programs
Diabetes Australia
A Health Promotion Perspective
Activities linking with the 5 key action
areas of Ottawa Charter...
Strengthen community action
• Branches and support groups
• Community based programs - Tai Chi, DVA, Buzz
Day, Great Australian Bite
• Capacity building within communities to support
initiatives – Councils, Train The Trainer (CALD)
Diabetes Australia
A Health Promotion Perspective
Activities linking with the 5 key action
areas of Ottawa Charter...
Develop personal skills
• Providing information and education about
prevention and management of diabetes including:
• printed resource material,
• websites
• customer care line
• school visits
• community lectures / media
• Lifestyle programs - DVA / VITALITY/
Diabetes Australia
A Health Promotion Perspective
Activities linking with the 5 key action
areas of Ottawa Charter...
Reorient health services
• Promotion of the value of the contribution of a
multidiciplinary team approach to caring for people
with diabetes
• Provision of support to health professionals eg.
Printed resources, customer care line, update and
education day for health professionals
• Support health services in conducting diabetes
awareness & prevention programs
RESOURCES
•
•
•
•
•
•
www.diabetesnsw.com.au
www.kidsandteens.com.au
Diabetes in New South Wales Atlas 2007
Type 2 diabetes risk reduction book
www.eatlas.idf.org
DiabCost Australia-Assessing the Burden of Type
2 Diabetes
• National Priorities for turning around the Diabetes
Epidemic- www.diabetesaustralia.com.au
Diabetes Awareness Week July 8-14
Type 2 diabetes can be prevented –
‘GET TO KNOW YOUR RISK FACTORS’
OTHER DA NSW ACTIVITIES
INTERNATIONAL
DIABETES DAY-14TH
November