ELLAWELL | DIABETES PREVENTION & MANAGEMENT
Geraldine Georgeou & Jon Hemming are the co-founders of EllaWell Diabetes Prevention and Management, a one-stop medical clinic dedicated to the prevention and management of diabetes. Having successfully treated hundreds of patients with their unique approach, they offer an evidence based, structured and supported solution for this pandemic.
The way to deal with the devil of obesity and diabetes is literally one day at a time. – Stephen Furst
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BACKGROUND – DIABETES: THE SILENT PANDEMIC
What is diabetes?
Diabetes is a challenging problem for public health worldwide. It is a chronic disorder in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond adequately to the insulin that is produced. There are two main types of diabetes:
- type 1 diabetes, which is characterised by the autoimmune destruction of the insulin-producing cells in the pancreas
- type 2 diabetes, which is the most common form and is characterised by a reduced production of insulin and an inability of the body tissues to respond fully to insulin.
As there is currently no cure for diabetes, the condition requires lifelong management. In the case of type 1 diabetes, this means keeping blood glucose levels within safe levels through multiple daily insulin injections or a continuous infusion of insulin through an insulin pump. For type 2 diabetes, blood glucose levels are managed through medication, diet, and exercise or a combination of these. People with diabetes frequently also require treatment to lower cholesterol and blood pressure levels. However, despite reaching epidemic levels globally, type 2 diabetes remains under-reported, in part because often people do not realise they have it until they develop complications.
Diabetes in Australia
Approximately 1.7 million Australians have been diagnosed with diabetes. The prevalence of particularly type 2 diabetes, rises with age and is higher in men than in women. The onset of type 1 diabetes is typically at an early age; thus, it is the most common form of childhood diabetes although it can occur at any age. Australia is ranked 7th highest in the world for prevalence of type 1 diabetes in children aged 0-14 years and 6th highest for incidence. Adding to this, there is a growing number of children and adolescents who are now affected by type 2 diabetes.
The impact of diabetes in Australia
Diabetes is associated with a myriad of complications which affect the feet, eyes, kidneys, and cardiovascular health. Nerve damage in the lower limbs affects around 13% of Australians with diabetes, diabetic retinopathy occurs in over 15% of Australians with diabetes, and diabetes is now the leading cause of end-stage kidney disease. In people with diabetes, cardiovascular disease (CVD) is the primary cause of death, with around 65% of all CVD deaths in Australia occurring in people with diabetes or pre-diabetes. Furthermore, 41% of people with diabetes also report poor psychological well-being with reports of anxiety, stress, depression and feeling ‘burned-out’ from coping with their diabetes. Moreover, diabetes is ranked in the top 10 leading causes of death in Australia.
Indigenous Australians are 3 times more likely to have type 2 diabetes compared to non-Indigenous Australians. This number of people with diabetes is even higher for those Indigenous Australians living in remote areas. Indigenous Australians are also at greater risk of complications than non-Indigenous Australians, with a 10-fold higher risk of kidney failure and up to 8-fold higher risk of high blood pressure.
Growth of diabetes
If diabetes continues to rise at the current rates, up to 3 million Australians over the age of 25 years will have diabetes by the year 2025. For type 2, this is likely driven by rising obesity, the ageing population, dietary changes, and sedentary lifestyles. Obesity is a major contributor to type 2 diabetes with estimates showing that eliminating obesity from the population can potentially reduce the incidence of type 2 diabetes by over 40%. The rising incidence of type 1 diabetes is also contributing to the growth of diabetes in Australia, and the prevalence of type 1 diabetes is predicted to increase by 10% between 2008 and 2013.
The financial costs of diabetes
The total annual cost for Australians with type 2 diabetes is up to $6 billion including healthcare costs, the cost of carers and Commonwealth government subsidies. The average annual healthcare cost per person with diabetes is $4,025 if there are no associated complications. However, this can rise to as much as $9,645 in people with both micro- and macrovascular complications. For type 1 diabetes, the total annual cost in Australia is $570 million, with the total average annual cost per person being $4,669. The average total annual cost is $3,468 for people without complications, however this can rise to $16,698 for people with both micro- and macrovascular complications.
Primary prevention is aimed at stopping the development of type 2 diabetes through a healthy diet and lifestyle or medication. Early intervention with intensive lifestyle changes in people with pre-diabetes can reduce the risk of developing diabetes by nearly 60% over a three-year period, and is estimated to produce a lifetime healthcare cost saving of around $1087 per person. Currently, there is no established means of preventing the development of type 1 diabetes.
Secondary prevention aims to stop the development of diabetic complications through lifestyle changes and medication, as well as early detection of type 2 diabetes. Aggressive therapy has been shown to reduce the risks of developing diabetic complications. For example, tight glycaemic control in type 1 diabetes can lead to a 42% reduction in cardiovascular events and a 50% reduction in developing impaired kidney function.
Current diabetes health in Australia
Data from 2010 show that only about half of Australians with diabetes were achieving adequate control of their blood glucose levels. Poor control of blood glucose means a higher risk of developing diabetes complications.
What this means for Australia
Within 20 years, there may be over 3 million Australians with diabetes. This will also mean more people with complications of diabetes. This is even more challenging for Indigenous Australians. Even now, most Indigenous families have at least one person already affected by the complications of diabetes.
As diabetes already costs the Australian economy at least $6 billion annually, investment in prevention for type 2, and research to find a cure for type 1 diabetes, is of great importance.
Australian diabetes policy
Diabetes was declared as a National Health Priority by the Federal government in 1997, and state and federal governments have supported programs to monitor and improve diabetes prevention, detection and management. Nevertheless, diabetes prevalence is still on the rise indicating the need for more to be done.
Call to action
The United Nations and the European Union have both acknowledged the growth of diabetes as a major issue and the importance of preventive measures alongside effective management and care. Whilst Australia has begun to develop strategies for implementation of diabetes prevention programs, much investment and development is still required and, as noted by the UN, the role of government in developing a multi-sectoral approach to prevention is essential. As a first priority, focussed, timely and integrated action must be taken to ensure national diabetes strategies are reviewed and strengthened, as necessary, to re etc the UN Resolution and enable effective implementation.
Diabetes is a huge challenge to our nation’s health and economy. Much more work still needs to be done to continue to improve outcomes and alleviate the burden on individuals, families and the community. Adoption of a healthy lifestyle, which requires both societal support and governmental leadership, is essential for the prevention of type 2 diabetes.
Likewise, increased government funding for research to help find a cure and improved treatments for type 1 diabetes is essential as there is no mechanism for the prevention of this disease. Accurate and up to date information on the burden of disease and successful intervention strategies will also help facilitate better outcomes.