Fears for future of young diabetes patients

New evidence has emerged that the growing incidence of Type 2 diabetes in children is a nationwide trend.

Liverpool Hospital in southwest Sydney is in the ‘diabetes epicentre’ of NSW
Picture: Jonathan Ng

New evidence has emerged that the growing incidence of type 2 diabetes in children is a nationwide trend, with pediatric endocrinologists in western Sydney revealing they are also treating children with the disease and speaking of their fears of the devastating complications that lie ahead for their patients.

Doctors in northern Australia this week issued an urgent plea for national intervention to stem the rising tide of type 2 diabetes diagnoses in children and young people, warning patients are suffering heart attacks as young as 25 and some are expected to reach end-stage renal failure by the age of 30.

Doctors at Campbelltown Hospital in western Sydney have revealed they are also treating numerous patients with type 2 diabetes aged under the age of 18, and that pediatric clinics are not funded or resourced adequately.

It is a similar story with adult clinics, with a severe lack of public multidisciplinary services for people living with obesity and diabetes who are unable to access pharmacotherapies and have very limited access to publicly funded bariatric surgery.

The medics have called for a national database to be established to help determine the true proportions of the rising trend of type 2 diabetes.

Lisa Amato, a pediatric endocrinologist at Campbelltown Hospital, told a federal parliamentary committee inquiry into diabetes on Monday that patients under 18 were increasingly being diagnosed with type 2 diabetes in western Sydney.

It comes on the back of evidence presented by clinicians in the Northern Territory and Western Australia of an “exponential trend” of increase in the disease in young people on a scale never been seen before anywhere in the world.

Pediatric endocrinologists in Darwin have reported their list of patients with type 2 diabetes has increased 20-fold in the past five years to over 100 children, with children as young as four years old being diagnosed.

The increasing prevalence is being driven in particular by high rates of gestational diabetes. Dr Amato said western Sydney was also seeing such a trend.

“We’re seeing increasing incidence of diagnoses at a younger age,” she told the diabetes inquiry hearing. “We’re probably not screening appropriately so there’s probably a lot of young people who we are not picking up early.

“Complications of type 2 diabetes on average will occur 15 to 20 years after diagnosis. So we’re talking about a 15-year-old who might be needing dialysis when they’re in their early 30s.”

Western and southwestern Sydney are among diabetes epicentres in NSW, with very high rates of diabetes incidence and complications. Yet there is a severe shortage of multidisciplinary care services for people with obesity, which is one of the major causes of type 2 diabetes.

Endocrinologist Kathryn Williams, the clinical lead and manager for the Nepean Family Metabolic Health Service, one of the only such multidisciplinary public tertiary services, told the hearing that healthcare for people with obesity was essentially a “user pays” system.

Despite many of the clinic’s patients being housebound with BMIs of 50 and even as high as 80, or struggling to walk 20m down the corridor at the hospital, only 15 public bariatric procedures a year were available. And access to GLP-1 agonists such as Ozempic was extremely limited even for severely obese patients, despite wealthier populations accessing it fairly readily.

“I have only 14 patients approved for (pharmacotherapy) treatment currently,” Dr Williams said. “We’re desperately waiting for the medications to be available for our patients on the PBS. This group of patients is sick and have a very low quality of life.

“Increasingly effective therapies for obesity become available on a ‘user pays’ basis, with the most at risk for obesity and its complications having the least access.”

Type 2 diabetes affects 1.5 million Australians and is strongly related to high rates of overweight and obesity. One in three adults in the NT now has type 2 diabetes.

The disease contributes to around one in 10 hospital admissions nationally, and far more in diabetes hotspots.