All levels of government and multiple sectors are urged to take wide-ranging actions to improve diabetes prevention and care under recommendations from a Federal Parliamentary inquiry into diabetes.
The House of Representatives Standing Committee on Health, Aged Care and Sport inquiry highlights widespread inequities in the burden of diabetes, as well as in access to care.
Some people, particularly in outer metropolitan, rural and regional areas, are having difficulty accessing support from diabetes educators, podiatrists, dietitians, general practitioners, endocrinologists, and community outreach services, the Committee chair, Dr Mike Freelander, wrote in the report’s foreword.
In remote areas there is a significant shortage of Indigenous health workers, and this impacts severely on diabetes management, he wrote.
“It is very important that all levels of government work together to address associated issues such as access to potable water, healthy foods, education, and health supports. Once again, it is important that an integrated model of care across all levels of government is seen as the gold standard.”
The highest rates of Type 2 diabetes are found in southwestern Sydney, which includes Freelander’s electorate of Macarthur, followed by western Queensland, Country South Australia, Western NSW and other rural and remote areas. Some areas of the highest incidence include remote Indigenous communities.
The electorates of Chifley, Fowler and McMahon – all in western Sydney – have the highest rates of diabetes (of all types), with regional and rural electorates, such as Spence, Grey and Hunter, close behind.
While Type 2 diabetes clearly affects disadvantaged communities disproportionately, Freelander said it is having a severe impact across all communities and is responsible for enormous pressure on primary care and our hospital system.
The primary aim must be prevention, which will require an all of Government approach involving local, state and federal governments, he said. Prevention and public health policies must focus not only on health services, but also education, agriculture, construction, social services, communications, transport, and manufacturing, he added.
Some of the policy recommendations include improving access to healthy foods, using a reformulation levy to decrease consumption of sugar sweetened beverages, limiting advertising of high sugar and highly processed foods, particularly to children, better urban planning to encourage increased physical activity and improved educational resources for our children about the dangers of diabetes.
Freelander said it was concerning that the marketing of highly processed food products for very young infants “is rampant”.
“Food labelling is opaque, unintelligible to most people without consideration of the long-term consequences,” he said. “Self-regulation by the food industry and the ‘fast food’ industry has not and will not work, and our children are suffering the consequences.”
Freelander said the Committee hoped that the recommendations are taken as a whole, and that early implementation is commenced as “we are truly facing huge health consequences if no action is taken”.
Recommendations
1. The Australian Government should undertake a comprehensive economic analysis of the direct and indirect cost of all forms of diabetes mellitus in Australia.
2. The National Health and Medical Research Council should expedite a review of the Australian Dietary Guidelines, and ensures that the revised guidelines include adequate information for Australians living with diabetes.
3. The Australian Government should implement food labelling reforms targeting added sugar to allow consumers to clearly identify the content of added sugar from front-of-pack labelling. This food labelling initiative should be separate from the information regarding added sugar potentially being included in the Nutrition Information Panel.
4. The Australian Government should implement a levy on sugar-sweetened beverages, such that the price is modelled on international best practice and the anticipated improvement of health outcomes. The levy should be graduated according to the sugar content.
5. The Australian Government should consider regulating the marketing and advertising of unhealthy food to children, and that this regulation should:
- Focus on children defined as those aged 16 and under
- Be applied to television, radio, gaming and online
- Use definition of unhealthy food that has been independently developed.
6. The Australian Government should provide its response to the Australian Food Story: Feeding the Nation and Beyond report and considers a dedicated resource within the Department of Health and Aged Care to support access to healthy food to all Australian communities.
7. The Australian Government, in consultation and cooperation with state and territory governments, should develop a best practice framework to tackle the problem of obesogenic environments, including through better urban planning and the development of physical activity initiatives and supports efforts to increase access to regular exercise in schools and neighbourhoods as a matter of urgency.
8. The Australian Government should explore the potential for effective national screening programs for all forms of diabetes, particularly Type 2 diabetes.
9. The Australian Government should implement a national public health campaign to increase public awareness of the early signs of all forms of diabetes mellitus.
10 The Australian Government should fund the development of education-based obesity screening information and resources.
11. The Australian Government should implement a national public health campaign to increase awareness of the importance of prevention, identification of early signs, and good management of all forms of diabetes mellitus.
12. Equitable access to health care for people living with all forms of diabetes be improved through:
- Access to longer appointments with a health care provider subsidised by the MBS
- Access to case conferencing models of health care, especially in rural and remote areas
- Access to telehealth services
- Increase in the number of item numbers for allied health consultation for those with diabetes for diabetes educators and dieticians and other allied health providers
- Access to diabetes educators, including in high-risk outer metropolitan, rural and remote communities.
13. The Australian Government should review the limits for accessing juvenile mental health and diabetes services, with a view to enabling young people to continue receiving support for longer.
14. The Australian Government should work with the state and territory governments to develop education tools and resources to support all staff across the healthcare system to improve understanding of diabetes, its different forms, the early signs and management. The Diabetes in Schools program should be funded to allow all schools to access it.
15. Subsidised access to Continuous Glucose Monitors (CGMs) should be further expanded. In the first instance, all access limitations in relation to patients with Type 1 diabetes should be removed. Furthermore, individuals with insulin-dependent Type 3c diabetes and patients with gestational diabetes should be made eligible for subsidised CGMs and for those with Type 2 diabetes requiring regular insulin. The Committee recommends prioritising the removal of age limitations on access to subsidised access for Type 1 diabetes patients.
16. The Australian Government should explore expanding subsidised access to insulin pumps for all Australians with Type 1 diabetes. A gradual increase, such as expanding access to those aged 40 and under, would be useful as an initial step.
17. The Australian Government should undertake a review of the price and choice of insulin pumps in Australia.
18. The Australian Government, subject to a positive recommendation from the Pharmaceutical Benefits Advisory Committee, should expands the eligibility criteria for Glucagon-like Peptide-1 (GLP-1) receptor agonists, particularly for high-risk patients.
19. The Australian Government should establishe mechanisms for securing supplies of Glucagon-like Peptide-1 (GLP-1) receptor agonists for disadvantaged and remote communities, including Aboriginal and Torres Strait Island communities.
20. The Australian Government should consider expanding access to bariatric surgery within the public system for eligible patients.
21. The Australian Government should take steps to manage diabetes research efforts through the Australian Centre for Disease Control (CDC) by coordinating with the peak bodies such as JDRF and Diabetes Australia research priorities with an emphasis on equitable access and prevention. The Committee also recommends that the Australian Government considers increased funding for Type 1 diabetes research and clinical trials.
22. The Australian Government should undertake a survey of current diabetes-related data, with a view to developing strategies for establishing new and improving current data sources and for establishing a national diabetes mellitus register within the CDC.
23. The Australian Centre for Evaluation in the Department of Treasury should commit to the ongoing assessment of any actions taken in respect of Committee recommendations made in this report.
A Government response has not yet been lodged.
See Croakey’s extensive archives on health inequalities
