Issue 31 / 19 August 2013

THE rise of diabetes is a national emergency requiring an appropriately weighty whole-of-government response, says a leading public health advocate.

Dr Lesley Russell, senior research fellow with the Australian Primary Health Care Research Institute at the Australian National University in Canberra, told MJA InSight that the Australian public needed to be made much more fearful of the consequences of obesity and diabetes.

In an MJA editorial, Professor Paul Zimmet, director of the Baker IDI Heart and Diabetes Institute in Melbourne, wrote that the current global diabetes epidemic was the equivalent of the cholera and typhoid epidemics of the 19th century and the HIV/AIDS epidemic of the late 20th century, with 370 million people with diabetes worldwide. (1)

“At least 1.5 million people in Australia now have diabetes and 2 million have prediabetes”, Professor Zimmet wrote. “We have not had a national diabetes strategy and action plan for a decade.”

The latest Australian Diabetes, Obesity and Lifestyle Study (AusDiab) shows that 269 Australian adults aged over 25 years develop diabetes every day. (2)

Australia’s largest population-based longitudinal study, AusDiab examines the incidence of diabetes, prediabetes, heart disease and kidney disease. It has shown that people with diabetes were more likely to have cognitive impairment and physical disability as they age, see their GPs more often and stay in hospital more often than those without diabetes.

Dr Russell said the diabetes epidemic was “a matter of national emergency”.

“We need to have people understand that the primary risk factor for diabetes is obesity, and that this is a very serious illness with very serious consequences”, she said.

“When talking about diabetes, unless you grow up with it in your family, it seems to be an amorphous thing — take a tablet and get on with it. People don’t realise how horrible this disease is.”

Dr Russell said public education campaigns and intervention programs were the key to meaningful change, citing the anti-tobacco campaign as a template.

“Look at how long it has taken us to get where we are now in the anti-smoking campaign”, she said.

“In some ways the smoking issue is easier because every puff will harm you. Obesity is caused by something that is not necessarily harmful.

“Therefore the campaign [against obesity and diabetes] has to be sustained, it has to be reinvented every now and then and it has to have different targets.

“It also has to be of the magnitude that allows it to counter the food lobby”, she said.

Professor Mark Harris, a member of the Royal Australian College of General Practitioners’ National Standing Committee for Quality Care, told MJA InSight that after a flurry of governmental action up until about 2005, there was little attention being paid nationally to diabetes and obesity.

“We’re not seeing this issue being reflected in the election campaign”, Professor Harris said.

“Diabetes and obesity are major drivers of health care costs, and we are falling well short of providing optimal care for people with diabetes.

“It would be wrong to say that there’s been no improvement, but we have not come to grips with prevention, particularly in high-risk groups. What has been done has not been sustained and has had no major effect”, he said.

Australia’s recent improvements in the rates of cardiovascular mortality were in danger of being wiped out by the diabetes epidemic, Professor Harris said.

Dr Russell said a mistake was being made in thinking of diabetes and obesity as simply a health issue.

“This is a whole-of-government issue”, she said.

Professor Zimmet called for a “national diabetes commission” to address the epidemic.

“The delay in establishing such a commission is a national disgrace. Is anyone in Canberra listening?”
 

1. MJA 2013; 199 (4): 225-226
2. Baker IDI Heart & Diabetes Institute 2013; The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)
 


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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3 thoughts on “Diabetes epidemic an “emergency”

  1. Professor John B Dixon says:

    This is an evolving crisis and Canberra is not only stone deaf, but mute and illiterate. There has been no intention to hear or to provide any action that has any chance of making a difference. The obesity-diabetes epidemic and its determinants is the greatest risk to this country’s health, wellbeing and economic development. The silence during this election period id deafening.

  2. David Maconochie says:

    For heavens sake it is no more an epidemic than is smoking. It is a lifestyle choice along with smoking, drinking alcohol and driving fast cars all of which carry similar mortalities.

    The Government stands a snowball’s chance in hell of constructing a policy that will make the slightest difference. All we can do as doctors is quietly plug away at the individuals we see, and treat them and their lifestyle choices with respect even when we do not agree with them.

  3. Therapeutic Goods Admin says:

    I am not sure that obesity/diabetes is a lifestyle choice rather than the result of the changes to the food environment.  The US National Institutes of Health has done regression analysis to show that the obesity epidemic of the past 30 years is mostly due to the over-consumption of foods high in fat, sugar and salt, which are designed and marketed so as to maximise consumption.  The former FDA head and dean of Yale and UCSF medical schools David Kessler explores this theme in some detail in his book, The End of Overeating. 

    The topic is further examined in Fat, Sugar and Salt, by Michael Moss.  Few people make a conscious choice that they want to eat an unhealthy diet.  It is more that an unhealthy diet has become the norm and people need to make a conscious choice to avoid it.  Unfortunately this involves skills and knowledge that many people, especially the less educated, do not possess.

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