Diabetes: a serious matter of life and limb

It is thought that for every four adults with diagnosed diabetes there is another adult living undiagnosed.

If you or someone you know may be an undiagnosed diabetic, have it dealt with as soon as possible: it could cost you a limb — or even your life.

Diabetes is likely to be under-reported, its impact underestimated, yet it is one of the most serious chronic conditions. An estimated 1.2 million Australian adults, or 6 per cent, had diabetes in 2014-15. It is thought that for every four adults with diagnosed diabetes there is another adult living undiagnosed. Without diagnosis the condition cannot be managed. In 2015-16, there were one million hospitalisations associated with diabetes, more common among those living in socio-economic disadvantage or outside a city. There were 16,400 deaths associated with diabetes in 2015, and Australia has one of the highest diabetes-related limb amputation rates. If you or someone you know may be an undiagnosed diabetic, have it dealt with as soon as possible: it could cost you a limb — or even your life.

Midway through the Australian National Diabetes Strategy 2016-20, authorities generally know the starting point for improvement but progress still may be slow. This week the Australian Institute of Health and Welfare has given the baseline data for the 55 indicators on which the goals of the plan will be judged. The first goal is to prevent people developing type 2 diabetes; however, there are still no complete national estimates of incidence, and the trends with risk factors such as obesity and inactivity haven’t been good. Another goal is to reduce the occurrence of diabetes-related complications and to improve quality of life; however, the AIHW has had to rely on dated estimates of management practices. There is more recent data on the scale of the problem, particularly in indigenous communities. The final goal is to focus on strengthening prevention and care through research, evidence and data; however, the AIHW has been unable to identify potential indicators.

A new program will help support about 6000 schoolchildren living with type 1 diabetes. Federal Health Minister Greg Hunt says the program, supported by $6 million in government funding, will provide training and education for teachers to help ensure students’ needs are met. “It will give parents peace of mind that their children with type 1 diabetes are better supported in managing their condition while at school,” Hunt says. “Teachers and school staff will be trained in insulin administration, recognition of hypoglycaemia and normalising diabetes management in schools.”

Intermittent fasting is being considered as a possible alternative to calorie-restricted diets for people with type 2 diabetes. In the journal JAMA, researcher Sharayah Carter from the University of South Australia reported that a clinical trial involving 137 people had shown that fasting on two non-consecutive days, consuming 500 to 600 calories, and eating normally for the five other days not only resulted in weight loss but also improved blood glucose control. While anyone at risk of hypoglycaemia should seek advice before switching to such a diet, UniSA professor of nutrition Peter Clifton says the 5:2 diet warrants consideration. “(Diabetes) is the 21st century’s health epidemic and the biggest challenge confronting Australia’s health system,” he says. “Conventional weight-loss diets with daily energy restrictions are difficult for people to adhere to so we must look for alternative solutions.”

Experts have expressed confidence that the Diabetes-Related Foot Disease Strategy 2018-2022 may be a success. That will have broader benefits, given DFD has mortality rates worse than many cancers. “The new strategy is the first comprehensive national evidence-based DFD plan that describes in detail how health professionals, researchers and governments can implement actionable change now to ensure that all people with DFD have access to care; receive safe, quality, evidence-based care; and benefit from research that continually strives to improve their care,” they write in The Medical Journal of Australia this month. “Australian research has demonstrated that investments in these three priority areas may save 50 per cent of all DFD hospitalisations and amputations, and $2.7 billion to the Australian taxpayer over five years.”