- + Key points: Diabetes
Latest available information
Latest available data for adults in NSW
• 8.7% of adults aged 16 years and over (9.9% of men and 7.5% of women) had diabetes or high blood glucose as estimated from the 2015 NSW Adult Population Health Survey (self-reported using Computer Assisted Telephone Interviewing or CATI). It is likely that there are many people with diabetes in NSW who are unaware they have it.
• Prevalence estimates have been increasing over time.
• Diabetes prevalence increases with age and socioeconomic disadvantage and diabetes is more prevalent among Aboriginal people.
• Hospitalisations for which diabetes was recorded as a principal diagnosis increased by around 70% between 2001-02 and 2009-10. In July 2010 the Australian Coding Standard for diabetes was changed which resulted in around a 60% decrease in the number and rate of hospitalisation for diabetes as a principal diagnosis in NSW between 2009-10 and 2010-11. The rate of hospitalisation for diabetes as a principal diagnosis was 148 per 100,000 population in NSW in 2014-15.
• While Type 2 diabetes accounts for up to 90% of all diabetes cases in the community, it accounted for just over 60% of all hospitalisations for diabetes in 2014-15. Type 1 diabetes accounted for around 34% of hospitalisations and gestational diabetes for 4.6%.
• While diabetes was the principal (underlying) cause of just over 2% of all deaths in NSW in 2013 (1,289 deaths), around 10% of all deaths in that year were related to diabetes (5,081 deaths). Cardiovascular disease was the most common cause of death among people with diabetes.
Latest available data for adults in Australia
As estimated from the 2011/12 Australian Health Survey: National Health Measures Survey (face-to-face interviewer-conducted survey, followed by collection and analysis of specific biomarkers in blood and urine sample for adults and urine sample for children aged 5-12, and self-reported information on medication and supplements):
• 5.1% of adults aged 18 years and over (6.3% of men and 3.9% of women) had diabetes.
- + Background: Diabetes
Diabetes definition and burden of disease
Diabetes mellitus is a group of closely related chronic conditions characterised by high blood sugar (glucose) levels. In uncontrolled diabetes, glucose builds up in the bloodstream and leads to a range of short- and long-term problems, including damage to vital organs.
Diabetes and its associated complications contribute significantly, both directly and indirectly, to mortality, morbidity, poor quality of life of sufferers and carers and the cost of health care. Experts agree that diabetes now represents one of the most challenging public health problems of the 21st century worldwide (Tanamas et al. 2013). Diabetes and cardiovascular conditions together are the causes of about one-third of all years of life lost due to premature death and about one-fifth of all years lost to premature death or years lived with a disability in NSW. The contribution of diabetes to the total disease burden in Australia in 2011 was 2.3% (AIHW 2016).
Types of diabetes
There are three main forms of diabetes mellitus: Type 1 diabetes, Type 2 diabetes and gestational diabetes. Type 1 diabetes is estimated to be present in 10-15% of people with diabetes and is caused by a combination of genetic and environmental factors, but there are no known modifiable risk factors for this form of diabetes. Type 2 diabetes accounts for about 85-90% of all diabetes cases and primarily affects people older than 40 years. Several modifiable risk factors play a role in the onset of Type 2 diabetes, including obesity, physical inactivity and poor nutrition, as does genetic predisposition and ageing. Gestational diabetes mellitus occurs during pregnancy in about 3-8% of females not previously known to have diabetes. It is a temporary form of diabetes and usually resolves after the baby is born (Beers et al. 1999). The fourth, minor group, includes diabetes secondary to other conditions, for example diseases of the pancreas or drug-induced or chemical-induced diabetes.
Complications of diabetes
Diabetes can lead to acute and chronic complications. Acute metabolic disturbances can lead to coma. Chronic high blood glucose levels (hyperglycaemia) are associated with long-term damage, dysfunction and failure of virtually every body organ, especially the heart and blood vessels, eyes, kidneys and nerves. Consequently, diabetes predisposes those suffering from it to many severe conditions, including cardiovascular disease, as well as visual loss, amputations and renal failure.
Management of diabetes
Sustained, individualised management substantially reduces the risk of complications in people with diabetes. A combination of diet, exercise and medication (including insulin injections) is used in combination with very frequent monitoring of blood glucose levels and other risk factors (for example blood lipids and blood pressure) and regular screening for complications.
Explanations of nomenclature
In the past, Type 1 diabetes was called 'insulin-dependent diabetes mellitus' (IDDM) or 'juvenile-onset' and Type 2 diabetes was called 'non-insulin-dependent diabetes mellitus' (NIDDM). However, as insulin is often used to treat patients with Type 2 diabetes, the old terminology has been discouraged by the WHO since 2000 (NCCH Volume 5 2000).
Diabetes mellitus and diabetes insipidus are completely different conditions. Diabetes insipidus (DI, Central diabetes insipidus) is a temporary or chronic disorder that causes sufferers to excrete excessive quantities of otherwise normal urine and excessive thirst. Excessive urination and thirst are the features in common with diabetes mellitus , hence a Greek word for syphon (diabetes) is used in the name of both conditions. Diabetes insipidus is caused by deficiency of hormone called vasopressin (ADH) and is much less common than diabetes mellitus (Beers MH et al. 1999). This topic and data in the Report refer to diabetes mellitus.
Tanamas SK et al. The Australian diabetes, obesity and lifestyle study (AusDiab). Baker IDI Heart and Diabetes Institute, 2013.
Beers MH, Berkow R. The Merck manual of diagnosis and therapy. West Point: Merck & Co, 1999.
Australian Institute of Health and Welfare. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. BOD 4. Canberra: AIHW, 2016.
National Centre for Classification in Health. The International statistical classification of diseases and related health problems, 10th Revision, Australian Modification (ICD-10-AM). Volume 5. Sydney: NCCH, 2000.
- + Interventions: Diabetes
The best way to reduce the harm caused by diabetes is by preventing the onset of Type 2 diabetes. Diabetes shares many modifiable risk factors with other lifestyle-related chronic diseases such as cardiovascular diseases. These include smoking, physical inactivity, poor diet, too much alcohol and being overweight. This means that strategies related to the prevention, early detection and optimal management of these risk factors will lead to better health outcomes for people with Type 2 diabetes and other lifestyle-related chronic diseases.
NSW Health provides support for the prevention and optimal management of Type 2 diabetes through a broad range of programs:
Healthy Eating Active Living
The NSW Healthy Eating and Active Living (HEAL) Strategy 2013-2018 provides a whole of government framework to promote and support healthy eating and active living in NSW and to reduce the impact of lifestyle-related chronic disease. Further information on the NSW HEAL strategy is available from http://www.health.nsw.gov.au/heal/Pages/default.aspx.
Get Healthy at Work
Get Healthy at Work is a new NSW Government initiative that aims to improve the health of working adults. It focuses on healthy weight, physical activity, healthy eating, active travel, smoking and harmful alcohol consumption. Further information on the NSW Get Healthy at Work initiative is available from http://www.health.nsw.gov.au/healthyworkers/pages/default.aspx
Get Healthy Information and Coaching Service
This free, confidential telephone-based coaching service supports NSW adults to make sustained improvements in healthy eating, physical activity, and achieving and maintaining a healthy weight. Further information on the Get Healthy Information and Coaching Service is available from http://www.gethealthynsw.com.au
Find Your Ideal Figure
This initiative is intended to support informed, healthier food choices in NSW. As of 1 February 2012, major food retailing outlets with 20 or more stores in NSW and more than 50 stores nationally are required to include information about the kilojoule (kj) content of standard products on their menu boards. The 8700 Find Your Ideal Figure website provides information, links, tips, online calculators and tools, including a mobile phone application. Further information is available from www.8700.com.au.
Healthy Built Environments Program
The built environment can play an important role in promoting and supporting healthy behaviours. Research demonstrates the link between the modern epidemic of lifestyle-related chronic diseases such as cardiovascular diseases and Type 2 diabetes, and the way we live in the built environment. Car-dominated transport, coupled with a lack of active transport options (walking, cycling and public transport), reduce opportunities for physical activity. Sprawling low-density residential developments with poor access to amenities including healthy, fresh food and poor connectivity can negatively impact on both mental and physical health.
The Healthy Built Environments Program, funded by the Centre for Population Health and located within the University of New South Wales's City Futures Research Centre, aims to address the environmental determinants of health through research, leadership and advocacy, and education and workforce development. Further information on the Healthy Built Environment Program is available from http://www.be.unsw.edu.au/programmes/healthy-built-environments-program/about
NSW Agency for Clinical Innovation’s Endocrine Network
The NSW Agency for Clinical Innovation established the Endocrine Network in 2007 to assist clinicians working with patients who have diabetes or obesity to develop best practice guidelines for treatment and to provide direction for diabetes and obesity research, education and management. The Endocrine Network has a number of priority areas including the development of the NSW Model of Care for Diabetes Mellitus covering the identification, treatment and management of people with Type 1 and 2 diabetes, gestational diabetes and diabetes in pregnancy. Further information on the Endocrine Network is available from http://www.aci.health.nsw.gov.au/networks/endocrine
NSW Chronic Disease Management Program (Connecting Care in the Community)
The NSW Chronic Disease Management Program (CDMP) aims to deliver an integrated, patient focused, whole person approach to effective health management to improve the quality of life of people with chronic and complex conditions, their carers and families and to prevent unplanned and avoidable hospital admissions. It achieves this by coordinating a statewide chronic disease management approach. The CDMP focuses on the five major chronic diseases recognised as having a major impact on the burden of disease in NSW: diabetes, chronic obstructive pulmonary disease (mainly emphysema and chronic bronchitis), coronary artery disease (also known as coronary or ischaemic heart disease), hypertension (high blood pressure), and congestive heart failure. It is overseen by the Chronic Disease Management Office. Further information on the NSW Chronic Disease Management Program (Connecting Care in the Community) is available from http://www.health.nsw.gov.au/cdm/pages/default.aspx
NSW Chronic Care for Aboriginal People Program
The NSW Chronic Care for Aboriginal People (CCAP) Program is managed by the NSW Agency for Clinical Innovation. The aim of the CCAP is to prevent and manage conditions including diabetes, heart disease, stroke, hypertension and kidney disease among Aboriginal people. These conditions share common risk factors, and common approaches are needed to address them in Aboriginal communities. Further information on the NSW Chronic Care for Aboriginal People Program is available from http://www.aci.health.nsw.gov.au/resources/aboriginal-health/chronic_care_for_aboriginal_people/ccap
- + For more information: Diabetes
Useful websites include:
NSW Ministry of Health at www.health.nsw.gov.au
Diabetes Australia at http://www.diabetesaustralia.com.au/
Australian Bureau of Statistics at http://www.abs.gov.au
Australian Institute of Health and Welfare and its National Centre for Monitoring Diabetes at http://www.aihw.gov.au
Australian Diabetes Society and its National Association of Diabetes Centres at http://www.diabetessociety.com.au/nadc.asp
healthdirect at http://www.healthdirect.gov.au