World Diabetes Day 14 November 2012
Posted on Thursday, 15 November 2012
THE DIABETES DILEMMA
It is chilling when former UN Secretary General Kofi Annan, a man who has seen many of the world’s conflicts, pandemics and crises, reminds us that diabetes kills more people worldwide annually than HIV/Aids, tuberculosis and malaria combined.
Even more sobering is that Australia is on the front line. One study has found that if the rise in diabetes continues, up to 17% of Australians will have Diabetes by 2025. Unbelievably, we are on track to beat that prediction.
The message from the European Leadership Forum in Copenhagen earlier this year was clear: Governments need to act. Australia must too.
A global perspective
Well before this century reaches its half term, the global affliction of diabetes will have seriously challenged the budgets of all nations.
It will have wrought incalculable harm to the quality of life of individuals with consequences for the social fabric and productivity of nations. For richer nations the consequences will be drastic – for poorer, catastrophic.
All over the globe diabetes is an insidious blight to income, productivity and to life-expectancy. The World Health Organisation (WHO) estimates that 347 million people worldwide have diabetes and that without intervention the number will double by 2030. There are currently 2.9 million deaths each year, directly caused by diabetes.
The global challenge of diabetes in the 21st Century was the trigger for the United Nations Resolution passed unanimously in 2006, which declared November 14 World Diabetes Day.
But with Diabetes rates growing worldwide six years after the Resolution there is little room for self-congratulation. It should serve to stiffen our resolve as a community to do better. Diabetes must be a national health priority with an emphasis on prevention, diagnosis, treatment and research.
We continue to be confronted by escalating health costs and fiscal constraints exacerbated by the deadly political inertia of a hung parliament. Amid all this we need to retrieve the crucial mantra that NOTHING SUCCEEDS LIKE PREVENTION. Prevention is both the best medicine and the best politics. It is also the cheapest.
Undiagnosed, untreated or inadequately treated, diabetes can lead to death preceded by multiple health conditions. Diabetes is a major cause of limb amputation, blindness, cardio vascular and kidney disease.
Diabetes in Australia
It is estimated that 1.7 million Australians (out of a population of 23 million) have diabetes; 280 new cases are being diagnosed every day. Over 2 million people have pre-diabetes - a condition where the blood sugar level is irregular, placing an individual at a high risk of developing type 2 diabetes. Without diagnosis and appropriate intervention, more than 30% of people with pre-diabetes go on to develop type 2 diabetes within 10 years.
The stark reality of the prevalence and cost of diabetes in Australia was outlined earlier this year in a research paper by Baker IDI titled Diabetes: the Silent Pandemic and its Impact on Australia.  It projects a diabetic population of 3 million over the age of 25 years by 2025.
Type 2 diabetes was once called late onset diabetes as it mostly affected people over the age of 60. Today, children, particularly in the Indigenous and Pacific Island populations, are being regularly diagnosed with the condition and condemned to a future of complex and expensive care.
The Organisation for Economic Co-operation and Development (OECD) has warned that obesity is a major contributor to the diabetes pandemic. In the Betterlife Index of the last 20 years, Australia is identified as having one of the fastest growing obesity rates on the planet. It reveals that about 60 per cent of Australian’s are now overweight or obese.
Baker IDI estimates that the total annual cost for Australians with type 2 diabetes is up to $6.57 billion per annum. This figure includes healthcare costs, the cost of carers and the Commonwealth Government subsidies.
The latest statistics in the Australian Institute of Health and Welfare overview of kidney transplant and dialysis in Australia show that the rate of new cases of End Stage Kidney Disease (EKSD) has increased by 80 per cent and is largely diabetes related. Indeed over the preceding 18 years kidney replacement therapy for ESKD almost tripled as did the number of people on kidney dialysis.
There is a wealth of grim documentation pointing to the catastrophic cost of failing to diagnose early. The peak body Diabetes Australia estimates that there is a 12-fold differential in the cost of managing advanced diabetes compared with early diagnosis and intervention.
The dilemma for government therefore is whether to invest in prevention and relatively inexpensive treatment modalities, or continue to withdraw programmes with an inevitable budgetary explosion affecting current and future generations.
Australia’s Approach to Diabetes Management
Tragically, Australia today is without a coherent strategy for managing diabetes and has been without a national diabetes action plan since 2007.
In an impassioned speech to the Parliament in May this year, Federal Member for Moore, Dr Mal Washer MP reported concerns expressed by leading professionals including a warning by Sydney University Professor Stephen Colagiuri, that the cost of diabetes will exceed $23 billion within 20 years and a prediction by Baker IDI Professor Paul Zimmet, that diabetes will become the fastest growing non-infectious disease epidemic in human history.
The government’s decision to cut a $200 million four year programme aimed at prevention of type 2 diabetes has set alarm bells ringing throughout the health sector.
Dr Washer was critical of spending cuts imposed upon the renal dialysis programmes in Alice Springs which has the largest kidney dialysis unit in the Southern Hemisphere. He was scathing of the notion that cutting the programme by $12.3 million was effective policy. “Compare that with the $23 billion he [Treasurer Wayne Swan] would have to find in 20 years…..” Dr Washer warned.
There are two forthcoming opportunities for government to recommit to a National Diabetes Plan. The first will be ‘Kids in the House’ an event at the end of November, when 100 children with type 1 diabetes will visit Parliament to explain to Members and Senators what it is like to self-administer complex and invasive procedures several times a day just to stay alive.
The other will be the International Diabetes Federation conference to be held in Melbourne next December which will bring international diabetes experts and parliamentarians to Australia.
The impetus provided by such colloquia might well re-awaken our legislators to the harsh realities of the diabetes dilemma.
It is little short of astounding that so ravenous a scourge as type 2 diabetes should be spreading amongst us with so little perturbation in the community.
Added to this is clear indifference to the plight of type 1 diabetes sufferers for whom access to the best treatment remains subject to financial caveat.
We can and must do better.
The Hon Judi Moylan MP
12 November 2012
The Hon Judi Moylan MP is a former Minister for Community Services, Minister assisting the Prime Minister on the Status of Women and has been the Chair of the Parliamentary Diabetes Support Group for 12 years. She is the 2012 recipient of the Sir Kempson Maddox Award for her contribution to diabetes prevention.
 The Baker IDI Heart and Diabetes Institute
 The Baker IDI Heart and Diabetes Institute
 Australian Health Institute of Health and Welfare, Dialysis and Kidney Transplantation in Australia 1991 – 2010 page vii
Diabetes Australia, Diabetes National Election Agenda 2013 – 2015 page 2