Issue 31 / 19 August 2013

WOULD it be too hysterical to declare a “diabetes emergency”? Perhaps not.

An estimated 280 people develop diabetes mellitus each day in Australia, adding to the estimated 1.7 million people with the condition. This number is expected to almost double by 2030. One in five people with diabetes do not even know they have it.

Despite the tardiness in acting on diabetes here and globally, which Professor Stephen Leeder details in his MJA editorial, people are now scrambling to turn back the numbers.

In terms of meaningful diagnosis and management, let alone cure, diabetes has long proved recalcitrant for both individuals and communities. Its social and economic cost now threatens to outpace Australia’s health budget for tertiary, secondary and primary prevention of diabetes and its complications.

With an estimated 3.5 million people in Australia now affected by diabetes or prediabetes, Professor Paul Zimmet highlights the urgent need for a response to the “epidemic”. This word is used pointedly — he compares the scale of the problem to that of the typhoid and cholera scourges of the 19th century.

It is an enormous Australian, and global, challenge. There is much to think about and act on when the World Diabetes Congress convenes in Melbourne in December.

Not surprisingly, diabetes features in cutting-edge therapeutics and in research, but also in ethical debates.

The authors of a “Clinical focus” article in the MJA discuss the action and application of glucagon-like peptide-1 receptor agonists in glycaemic control; it remains to be seen what clinical role they will eventually play.

In the MJA ethics series, the authors describe research using cord blood-derived stem cells to attenuate islet cell autoimmunity in type 1 diabetes. However, along with the authors of another article in this series, they also note the complicated ethical considerations in cord blood banking for therapeutic or research purposes.

At the community health level, the factors associated with diabetes go right down to the fundamentals of society and culture. The risks of disease are well known to stratify according to sociodemographic characteristics.

Tackling social determinants, quickly knowing which strategies work and appropriately channelling resources should be central missions of health policy and deserve prominent airing in debates before the upcoming federal election.

In the MJA pre-election series, these important objectives are discussed.

Research investigating the effect of team care and management plans on biochemical measures of diabetes control reinforces the central role of organised and effective primary care.

Any health policy put forward in the election campaign needs to recognise that both societal factors and health care delivery contribute to overall population health.

Clinical and public health research over the past few decades increasingly serves to show how fast health and health care problems develop. Continued health care reform in this context is a necessity.

Professor Christine Bennett outlines reform achievements since the formation of the National Health and Hospitals Reform Commission, as well as current and future challenges to Australian health care and what should be done about them.

“Reform fatigue” may not be an option.

As the competition for the community’s vote nears its end, the MJA offers those who would lead us an opportunity to look beyond slogans to what is likely to make or break Australia’s health.

In the case of diabetes, we ask them not to abrogate their responsibilities to those affected. This is one problem that is amenable to “solutions”.

Like typhoid and cholera two centuries ago, there is real opportunity in Australia, with appropriate public health strategies, to cut the overall burden of disease and the toll that it exacts

Dr Astika Kappagoda is deputy editor of the MJA.

This article is reproduced from the MJA.
 


Poll

Should the increasing number of cases of diabetes in Australia be treated as an emergency?
  • No - but more action needed (47%, 47 Votes)
  • Yes (46%, 46 Votes)
  • No - it's not that bad (6%, 6 Votes)

Total Voters: 99

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