Doctors call for diabetes action plan

Hospitals are facing a rising tide of diabetes-related complications in patients as the numbers of Australians living with the disease explodes.

A diabetes sufferer checks his blood sugar level. Picture: Shutterstock

Hospitals are facing a rising tide of diabetes-related complications in patients as the numbers of Australians living with the disease explodes, prompting top doctors to call for the urgent implementation of a national action plan.

In a report that for the first time maps the scale of the growing crisis, Diabetes Australia estimates that more than three million Australians will be living with diabetes by 2050, at a massive cost to the health system.

Incidence of the disease has almost tripled in the past 20 years – a growth rate six times that of the population – with 1.47 million Australians now affected, most of them suffering type 2 diabetes which is heavily associated with being overweight and lack of exercise as well as genetic factors.

“The diabetes epidemic will affect every Australian, either directly by developing the condition or caring for someone who has or indirectly through its impact on the health system,” the report predicts. “It is a leading cause of blindness, dementia, stroke, mental and emotional health challenges, heart and kidney disease, preventable blindness and severe Covid-19. It is a major contributor to hospitalisations and is associated with around 10.5 per cent of all deaths. The number of diabetes-related deaths increased by 72.5 per cent from 2000 to 2020.”

Type 2 diabetes is by far the most prevalent type of the disease, in which the body becomes resistant to the normal effects of insulin and gradually loses the capacity to produce enough of the hormone in the pancreas. The condition can be managed with medication and modified or even reversed with diet changes and exercise. The current rapid increase of gestational diabetes, which can lead to type 2 diabetes later in life, is also worrying doctors, with 400,000 women diagnosed over the past decade. Australian Indigenous communities have the highest rates of diabetes in the world, and an increasing incidence of type 2 diabetes in children and young people is sparking fears that hospitals will soon begin to see a greater incidence and array of serious complications from the disease. Diabetes already contributes to around one in 10 hospital admissions.

“A range of newly documented complications, including dementia, cellulitis, iron deficient anaemia and mental health conditions, are increasing the burden on the health system,” the report says.

Joseph Kizama is 58 and was diagnosed with type 2 diabetes at age 27. He had a family history of the disease and was significantly overweight. Although he was prescribed medication to manage the condition and advised to exercise, he did not stick to the advice.

“I was young and I was strong and thought I could run through a brick wall,” Mr Kizama says. “I didn’t really take it that seriously.”

Six years after his diagnosis, Mr Kizama was admitted to hospital with heart complications. “Then things got worse,” he says. “There was damage to the kidneys, my eyesight started to play up. Then it got to a point where about 17 years ago a doctor in emergency said to me, ‘If you maintain this lifestyle, with your current medical history I will give you no more than five years before you die.’

“So, that was a wake-up call for me. I started to do things a little bit better. But unfortunately the disease had set in so much that you can’t reverse damage to the organs.”

Although Mr Kizama improved his lifestyle and stuck to his medication regimen, he developed terrible problems including a leg infection that would not heal and sent him to hospital for 300 days. In January this year, due to poor circulation, he had to have his right foot amputated.

Suffering kidney failure, he now needs dialysis three times a week to stay alive. He will not be able to have a kidney transplant due to his very poor heart function – he has 13 stents in his arteries – and expects to face death in his mid-60s.

“What I want to say to people is this is a serious business; diabetes doesn't muck around,” Mr Kizama says. “You don’t want to see the results of uncontrolled diabetes. It can really be disastrous.”

Australia developed a 10-year national strategy on diabetes in 2021 and professor of metabolic health and Director of The Boden Institute at the University of Sydney Stephen Colagiuri said work on the implementation of the plan needed to progress quickly in the face of the crisis.

“Diabetes is a serious condition and its seriousness is often underestimated and not appreciated,” said Professor Colagiuri.

“It’s not doom and gloom in terms of what can be done about it. The national strategy is a very good guide, but the strategy needs to be implemented to make a difference.”