What is diabetes?
Diabetes is a chronic disease characterised by high levels of glucose in the blood. Blood sugar levels are controlled by insulin, a hormone produced by the pancreas. Diabetes occurs when the pancreas is unable to produce enough insulin, or the body becomes resistant to insulin, or both. There are three main forms of the disease:
- Type 1 diabetes is an auto-immune disease where the body's immune system attacks the insulin producing cells of the pancreas. People with type 1 diabetes cannot produce insulin and require lifelong insulin injections for survival. The disease can occur at any age, although it mostly occurs in children and young adults. Type 1 diabetes is sometimes referred to as juvenile onset diabetes or insulin dependent diabetes.
- Type 2 diabetes is associated with hereditary factors and lifestyle risk factors including poor diet, insufficient physical activity and overweight or obesity. People with type 2 diabetes may be able to manage their condition through lifestyle changes; however, diabetes medications or insulin injections may also be required to control blood sugar levels. Type 2 diabetes occurs mostly in people aged over 40 years old, however, the disease is also becoming increasingly prevalent in younger age groups.
- Gestational diabetes occurs during pregnancy. The condition usually disappears once the baby is born, however, a history of gestational diabetes increases a woman's risk of developing type 2 diabetes later in life. The condition may be managed through adopting healthy dietary and exercise habits, although diabetes medication, including insulin, may also be required to manage blood sugar levels. Top of page
How common is diabetes?
Diabetes prevalence figures in Australia are primarily estimated from findings arising out of the Australian Health Survey conducted by the Australian Bureau of Statistics.
- There are an estimated 1 million people (aged 2 years and over) with diagnosed diabetes in Australia, but this is likely to be an underestimate, as there is estimated to be 1 adult with undiagnosed diabetes for every 4 adults with diagnosed diabetes (source 1).
- Of those who reported having been diagnosed with diabetes, 85% reported having type 2 diabetes, 12% reported having type 1 diabetes, and 3% did not know which type of diabetes they had (source 2).
- Diabetes prevalence (based on self-reports) doubled between 1989–90 and 2004–05. From 2007–08 to the latest data from 2011-12 the rate has been stable at around 4% (source 2).
- Type 2 diabetes is overrepresented among Aboriginal and Torres Strait Islander persons, with nearly one in nine (11.1%) of adults (aged 18 years and over) returning test results showing that they had the disease in 2012-13 (source 3).
- It is estimated that gestational diabetes impacts on around 1 in every 20 Australian pregnancies (source 4).
What are the risk factors for diabetes?
Diabetes closely co-exists with cardiovascular disease and chronic kidney disease, with these three diseases accounting for around a quarter of the entire disease burden in Australia Accordingly, diabetes shares a number of common risk factors with these other chronic diseases, including: insufficient physical activity, poor diet and failing to maintain a healthy abdominal weight.
Major risk factors associated with type 2 diabetes that cannot be modified include advancing age, genetic predisposition, ethnicity, and family history. Top of page
Treatment or management of diabetes
Diabetes is a chronic condition requiring the use of a variety of health services for its control and for the early diagnosis and treatment of associated complications. People with diabetes use a range of health services to control blood sugar, blood pressure and blood lipid levels to reduce symptoms and the risk of complications, and to enhance their quality of life.
Diabetes is diagnosed when:
- Symptoms are present and a fasting blood test returns a result at, or above, 7.0mmol/L.
- A random fasting blood test returns a result at or above 11.1mmol/L.
- A HbA1c (glycated haemoglobin) blood test returns a result of at, or above, 6.5%.
- There have been no symptoms and two abnormal blood glucose tests are recorded on separate days.
GPs are usually the initial point of contact for people with diabetes and, along with other primary and allied health professionals, will commonly manage diabetes in collaborative care arrangements. This can involve regular monitoring of a patient’s weight levels, blood levels, general health status, and more focused examinations of a patient’s eyes and feet. Where diabetes complications arise, patients will conventionally be referred, as appropriate, to endocrinologists, cardiologists, nephrologists, obstetricians and/or ophthalmologists.
People with diabetes often require medication regimes to control high blood glucose levels. In addition, affected persons may also require medications to reduce high blood pressure and/or cholesterol levels. Persons affected by type 1 diabetes require regular injections of insulin (a protein that removes excess glucose from the blood) in order to regulate their blood glucose levels (and to survive), and some persons with type 2 diabetes also require insulin in cases where their diabetic condition is difficult to control. Top of page
Diabetes programmes and initiatives
Diabetes is addressed at a national level through a range of programs and initiatives to support treatment and management of diabetes-related problems. Significant funding is also provided to ensure that quality clinical research is conducted into diabetes, and to maintain national monitoring and surveillance measures.
Programmes that support management and treatment of diabetes conditions include:
- The Medicare Benefits Schedule, which provides subsidies for patient care and includes Medicare items for the planning and management of chronic and terminal conditions. Eligible patients can also be referred by a GP for up to five Medicare subsidised allied health services that are directly related to the treatment of their chronic condition, including diabetes.
- The Pharmaceutical Benefits Scheme continues to provide subsidies for medicines used in the treatment of diabetes.
- The National Diabetes Services Scheme – managed by Diabetes Australia through an agreement with the Department of Health − provides subsidised products including syringes and needles, blood glucose test strips, urine ketone test strips and insulin pump consumables to persons with diagnosed diabetes who are registered with the Scheme.
- Significant investments in diabetes research through the National Health and Medical Research Council (NHMRC) for research into diabetes conditions. Improving the care of patients with multiple and complex chronic disease, including diabetes, has also been identified by the NHMRC as a major focus in its 2013-15 Strategic Plan.
Additionally, the Australian Institute of Health and Welfare (AIHW) is funded to support national surveillance and monitoring of vascular diseases, which includes diabetes, along with chronic kidney disease and cardiovascular disease.
The Australian Government has developed the new Australian National Diabetes Strategy 2016-2020
to inform how existing resources can be better coordinated and targeted, and to prioritise the national response and existing resources through an emphasis on prevention, early diagnosis and intervention, management and treatment, including the role of primary care. Top of page