Type 2 Diabetes Prevention. A Three Tiered Health Approach Government Communities Households

Transcription

1 Type 2 Diabetes Prevention A Three Tiered Health Approach Government Communities Households

2 About Diabetes Tasmania Diabetes Tasmania is the peak body for diabetes education, support and prevention in this state representing the 25,000 Tasmanians diagnosed with the disease. Diabetes has become one of the most significant health issues facing our community. Six Tasmanians develop the disease every day and the impact of the disease on our community is overwhelming. Our organisation is working to assist Tasmanians living with diabetes by providing high quality diabetes education, dietetic services for individuals and groups, and workplace programs throughout Tasmania. We follow evidence based guidelines and professional clinicians deliver our health services. Our Board of Governance and our Management Team are all skilled and experienced professionals and provide excellence in their fields of expertise. Our endeavours are ably supported by our professional and skilled staff, augmented by our strong team of volunteers. Our services are effective in managing people s health. For example our telephone health coaching service, The COACH Program has been independently proven to be effective in improving the health and life expectancy of Tasmanians living with type 2 diabetes, and thus reducing the cost of health care for these individuals. Diabetes Tasmania is also the peak body providing support to young people living with type 1 diabetes. Through our suite of child and youth programs we supplement the clinical care offered by specialist doctors, paediatric diabetes educators, and allied health professionals. Our youth programs are aimed at assisting young people to cope with living with a chronic disease. Diabetes Tasmania is a member organisation of Diabetes Australia. We administer the National Diabetes Services Scheme (NDSS) in Tasmania, a Commonwealth funded scheme which provides subsidised diabetes self-management products and education. Fundraising supplements the government contracts we receive to provide quality care to all Tasmanians living with diabetes. Our purpose is to keep Tasmanians healthy, whether they are living with diabetes or not. We promote a healthy lifestyle with regular exercise and a balanced diet as integral to the management of all types of diabetes and in the prevention of type 2 diabetes. i

3 Diabetes Tasmania s Call to Action Type 2 diabetes is at pandemic levels, posing a global threat. In 2011 The International Diabetes Federation stated that it is one of the century s greatest health challenges and remains on a relentlessly upwards trajectory. The global significance of the type 2 diabetes pandemic was recognised by the United Nations with the passing of UN Resolution 61/225. In addition to the UN sanctioning a day to recognise the impact of diabetes, the first for any non-infectious disease, the Resolution also encourages all Member States to develop national policies for the prevention, treatment and care of diabetes in line with sustainable development of their healthcare systems. This document calls on all levels of government to increase their commitment to type 2 diabetes prevention and detection in order to save thousands of Tasmanians from premature death and disabling complications, and our economy from the financial burden associated with diabetes. It also asks our communities and our households to take action, however small, because it is only if we all work together and move forward as one, that any tangible difference will be made to the health and wellbeing of all Tasmanians. The policies of governments, both Federal and State, will determine how Australia copes with the diabetes pandemic. The time for inaction is over and together governments, communities and households must address this critical 21st century challenge. Caroline Wells Chief Executive Officer Diabetes Tasmania ii

4 The State of Tasmania s Diabetes Pandemic Diabetes is a progressive, unrelenting and challenging disease with devastating complications that is misunderstood and has immense human, societal and financial burdens. The size and scale of this pandemic are not in question. Today, 20,819 Tasmanians have diagnosed type 2 diabetes [1], and nearly 17,000 are living with the disease, but remain undiagnosed [6]. By 2025, it is predicted that a staggering 67,500 Tasmanians will develop the disease [2]. Each and every day 6 Tasmanians develop diabetes [3]. Frighteningly, an estimated one third of today s young adults will develop diabetes during their lifetime [4]. Type 2 diabetes is the most common form of diabetes, representing about 85% of all cases in Australia and Tasmania is no exception. It is a chronic disease characterised by high blood glucose levels caused by a reduced production of insulin or the body s inability to properly use the insulin it produces. Type 2 diabetes has a strong familial link which is unmasked by lifestyle factors including obesity and lack of exercise [5]. Typically the disease develops in people aged over 45 years, but sadly it is now being more frequently diagnosed in younger people. One of the significant issues associated with type 2 diabetes is that it is under reported. For every 5 Australians diagnosed, there may be 4 with an undiagnosed case of the disease [6] and in fact, many people may not realise they have the disease until they develop complications. In addition to those with the disease, an estimated 45,000 Tasmanians have pre-diabetes [7]. This means that these people have abnormally high blood glucose levels, but not high enough to be diagnosed as diabetes. Between 2002 and 2012, Tasmania s increase in the prevalence of type 2 diabetes was 88%, an increase significantly less than the national average of 119%. At first glance this statistic may appear positive but in reality as a disadvantaged community, with an ageing population and over-represented in Australian preventable ill-health data, it is reasonable to believe that the prevalence of type 2 diabetes in Tasmania is, in fact, higher. These figures suggest that potentially many Tasmanians have type 2 diabetes but have not been diagnosed with the disease Tasmanians with Type 2 Diabetes Projections

5 Many people think diabetes isn t serious... But they re wrong The human suffering and societal burden associated with diabetes is significant, with people with diabetes experiencing increased rates of heart attacks, stroke, end stage renal disease, limb amputations and other major complications. Strokes are 5 times more likely and heart attacks 10 times more likely in people with diabetes than those without the disease[17]. In addition to these human burdens, the financial impacts are substantial. The total Australian annual cost for type 2 diabetes is estimated at $6 billion [9]. Without intervention this figure could quadruple by 2051, crippling our health system [10]. Yet we know that type 2 diabetes is largely preventable with lifestyle changes reducing the risk of developing the disease by up to 60% in people at high risk [11]. 2

6 Priorities for Action We Must Act Now! 1. Prevent Tasmanians from developing diabetes 2. That all Tasmanians know their risk a. Identifying those at high risk b. Diagnosing those undiagnosed 3. Keeping Tasmanians with diabetes well These priorities belong to all of us they are not solely the responsibility of governments, Federal, State or Local, or to the individual, but a collective responsibility where everyone has a role to play. aligned with Diabetes Australia and are our calls to action for all levels of government, our local communities and individuals to make a difference for the health and wellbeing of our state. The strategies outlined in each of these priority areas are the response of Diabetes Tasmania, If we don t make inroads into overcoming what is being called the pandemic of the 21st century it will overcome us Caroline Wells, CEO Diabetes Tasmania 3

7 1. Prevent Tasmanians from developing diabetes Government Adoption of a Health in All Policies approach by the Tasmanian State Government Mandatory Traffic light style nutrition labelling on food and beverages Community Policies which will increase accessiblity and affordablity of fresh produce Abolition of sugar-sweetened carbonated drinks in schools and sporting venues All school canteens accredited with Cool Canteen Accreditation Program (Cool CAP) Household Consider being part of a community garden or better yet start one. Find out what is happening in your local community and get involved Try growing your own fruit and vegetables in your garden or in pots The old adage prevention is better than cure is so true when applied to type 2 diabetes. Overweight and obesity are key contributors to the growing burden of disease from type 2 diabetes. We know that if we eliminate obesity from the population we could potentially reduce its incidence by 38% in men and 47% in women [12]. But we must act NOW because if we don t by 2025, normal weight adults will make up less than one third of our population [13]. Currently a whopping 90% of us don t eat enough vegetables, 50% enough fruit or 72% exercise enough [14]. But how do we change this.. We cannot expect behavioural change on the scale required if people are not supported by a range of societal and legislative changes. It is clearly up to our governments to act to ensure changes are made which support Tasmanians to make a lifestyle change. In addition to Diabetes Tasmania s Priorities for Action, there are many other initiatives that should be pursued including changes to regulate junk food advertising to children, the option of taxing fast foods, and increasing our green spaces in all developments, just to name a few. The current Tasmanian focus on the social determinants of health is critical if lasting change is to be affected, and together the adoption of a Health in all Polices approach is essential. We must address the causes of the causes those factors which influence our health and wellbeing such as our environment, social supports, or lack thereof, societal structure and policies in order to ultimately address those underlying issues of inequity, access and fairness because if we don t we will be unable to achieve effective and sustainable change. 4

8 2. That all Tasmanians know their risk Government Fund a national evidence based type 2 diabetes prevention program AUSDRISK assessments undertaken for hospital inpatients not admitted with diabetes and aged over 40 years All State Government employees are provided with the AUSDRISK questionnaire annually Community Tasmanian employers provide the AUSDRISK questionnaire with their group certificate The use of the AUSDRISK tool is standard practice at all allied health professional visits Household Learn about your family s history of diabetes and talk to your GP about your level of risk Ask every member of your family over the age of 40 to complete the AUSDRISK questionnaire In 2007 the Australian Government funded the development of the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) to identify a person s risk of developing type 2 diabetes. Those with a risk score 12 on the AUSDRISK are considered to be at high risk. This resource means we don t need a blood test or invasive procedure to conduct simple community based screening to identify those who are at greater risk. We have a simple and proven tool to identify those at risk and yet its use is not common place. Detecting those at high risk is critical if we are to slow this pandemic. Again we know that up to 60% of type 2 diabetes can be prevented or delayed by lifestyle intervention and yet we continue to do nothing. This inaction is causing an immense and growing cost in human, societal and economic terms. The priority MUST be detection and early intervention. It can be achieved.we know it s proven..we know its possible and we know it s powerful. If a high risk prevention program was run over 4 years for 50,235* Tasmanian workers, identified at high risk of developing type 2 diabetes and assuming a 50% participation rate** (6,279/year) and assuming 37% of cases will be prevented**, this equates to 9,293 cases of type 2 diabetes delayed or prevented. As part of nationally funded program, to roll out this proven preventative initiative in Tasmania would cost $2.5 million per year # with the reduction in lifetime healthcare costs of $27 million^. *Based on Vic WorkHealth data that 23.3% of workers identified at high risk of developing type 2 diabetes. **Life! Program results. # Based on $400 per person. ^Estimated reduction in lifetime healthcare costs of $1,087 in individuals with pre-diabetes (Palmer et al, 2004). 5

9 3. Keeping Tasmanians with diabetes well Government Medicare funding for video consults by allied health practitioners Increasing the number of annual Medicare funded allied health visits from 5 to 12 Continued funding for evidence-based secondary prevention programs Community Support people with type 2 diabetes so they feel comfortable in letting you know they have the disease If you know someone with diabetes is unwell, advise them to visit their GP Household Ensure you have your regular diabetes health checks Make sure you are registered on the National Diabetes Services Scheme and that you access it regularly The complications of diabetes are the major driver of diabetes-related health care costs and a major cause of human suffering. The statistics are alarming.. Cardiovascular disease is 2.5 times more prevalent among people with diabetes than the general population [16]. Strokes are 5 times more likely and heart attacks 10 times more likely in people with diabetes than those without the disease [17]. Diabetes is also the most common cause of nontraumatic limb amputations and the leading cause of blindness in working age Australians [18]. Diabetes is responsible for 42% of all new cases of chronic kidney disease [19]. Although diabetes is a progressive disease these horrendous and largely preventable complications are the leading cause of avoidable hospitalisations, representing about 1 in 3 avoidable hospital admissions [20]. 41.6% of adult Australians with diabetes report medium, high or very high levels of psychological distress [21]. Only 68% of Tasmanians [22] registered on the NDSS access the scheme regularly, so consequently may not be managing their diabetes as effectively as possible. Economically the burden is enormous. The annual cost for people with type 2 diabetes in Australia is estimated at $6 billion, with the average annual cost per person increasing greatly with the presence of complications from $4,025 per person without complications to $9,645 per person with micro and macro vascular complications [15]. But we know that effective treatment can reduce diabetes complications by approximately 50% [23] so reducing this financial and human burden is achievable. Inaction is unacceptable. 6

10 References [1] National Diabetes Services Scheme, accessed 19 June [2] Magliano et al., 2009 cited in diabetes: the silent pandemic and its impact on Australia, [3] Magliano D J, Peeters A, Vos T, Sicree R, Shaw J, Sindall C, Haby M, Beggs S J, Zimmett P Z, Projecting the burden of diabetes in Australia: What is the size of the matter? Australia and New Zealand Journal of Public Health, 33(6): et al., 2009 cited in diabetes: the silent pandemic and its impact on Australia, [4] Magliano et al., 2008 cited in diabetes: the silent pandemic and its impact on Australia, [5] Shaw J (ed), Tanamas S (ed), diabetes: the silent pandemic and its impact on Australia. [6] Australian Institute of Health and welfare (AIHW), The national system for monitoring diabetes. Cat. No. AUS 122. Canberra: AIHW [7] Dunstan D et al., 2001, cited in Diabetes Australia: Type 2 Diabetes the 21st Century Pandemic, [8] National Diabetes Services Scheme, accessed 2 May [9] Colagiuri et al., 2003, Colagiuri et al, 2009, cited in diabetes: the silent pandemic and its impact on Australia, [10] Davis WA, Knuiman, MW, Hendrie DV, Davis TME, The obesity-driven rising costs of type 2 diabetes in Australia: projections from the Fremantle Diabetes Study. Internal Medicine Journal, 36(3): [11] Diabetes Australia, Diabetes National Election Agenda , Type 2 Diabetes: the 21st Century Pandemic. [12] Cameron et al., 2009 cited in diabetes: the silent pandemic and its impact on Australia, [13] Magliano et al., 2008 cited in diabetes: the silent pandemic and its impact on Australia, [14] AIHW, [15] Colagiuri et al., 2003, Colagiuri et al, 2009, cited in diabetes: the silent pandemic and its impact on Australia, [16] AIHW, [17] AIHW, 2010, Australia s Health [18] Tapp RJ, Shaw JE, Harper CA, decourtan MP, Balkau B, McCarty DJ et al. The prevalence of and factors associated with diabetes retinopathy in the Australian population. Diabetes Care Jun; 26(6): [19] AIHW, 2010, Australia s Health [20] A National Health and Hospitals Network: Further Investments in Australia s Health: internet/yourhealth/publishing.nsf/content/nnhn2-report2-toc~nhhn2-report2-chapt2 [21] AIHW, 2011Diabetes and poor mental health and wellbeing: an exploratory analysis. Diabetes series No 16. Cat. No. CVD 55. Canberra: AIHW. [22] [National Diabetes Services Scheme, accessed 4 June [23] United Kingdom Prospective Diabetes Study; Steno-2, Gaede et al., cited in diabetes: the silent pandemic and its impact on Australia,

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12 Diabetes Tasmania 88 Bathurst Street Hobart Tas Cameron Street Launceston Tas 7250 Ph facebook.com/diabetestasmania July 2012