Diabetes, along with closely linked heart disease, is responsible for the deaths of more New Zealanders each year than any other condition.
My mother died of diabetes complications. She struggled with this disease for years. She took insulin orally at first, as her condition worsened she had to go to the hospital for injections. She was hospitalised many times and finally became another casualty of diabetes. She took her medicine faithfully, lifestyle changes- probably not.
John’s story is probably typical for a diabetic and highlights challenges faced in tackling the disease. “The word is relentless because that’s how it feels. My first response to being diagnosed with Type 2 diabetes in 2009 was one of frustration and resentment. I didn’t want to be diabetic. I was frustrated that it meant changing my lifestyle, which at the time, I hadn’t prepared to do. I did nothing.
My wife and I were with my daughter up in Ripon one day in 2017, and I remember waking up Friday morning and being very, very breathless. They rushed an ambulance to me. Looking into the eyes of my wife and daughter and thinking ‘I’m not ready to die’. Self-inflicted and I’ve done this to them; a result of my non-engagement.
I vowed then if I got through it, then I would start to make some changes to the way I lived. I would take this seriously”.
6% of our total population have diabetes (another 2% have diabetes without being aware of it). Incidence of diabetes has nearly doubled over the last 12 years, population increase, aging of the population and rising obesity, being the contributing factors. People of Māori, Pacific and South-Asian ethnicity, and the socioeconomically disadvantaged; bear a disproportionate burden of obesity and type 2 diabetes.
The prevalence rate for Maori/Pacific is three times that of European. The mortality rate for Maori/Pacific is even higher, nearly five times that of European/Other. Prevalence of diabetes among people aged 65 and over is 15 to 20% of the population. The aging population and rising obesity mean that the number of diabetics is likely to increase further.
The age at which we get diabetes is also getting younger. Those who get diabetes below the age of 40 have a much higher rate of developing other complications like heart disease and early mortality. Incidence of diabetes for the age group 30-39, while still low, has doubled over the last 12 years.
New Zealand has a diabetes problem, fuelled in part by high rates of obesity. It is the largest and fastest-growing health issue we face in New Zealand. Our pacific island neighbours have some of the highest incidences of diabetes in the world. While the Ministry of Health doesn’t have an estimate of the budget spent on Diabetes, NHS in the UK estimates they spend a whopping 10% of their total budget on diabetes.
What is diabetes?
Diabetes is a disease where your body cannot control its blood sugar levels properly due to a lack of insulin. Or your cells have become resistant to insulin. There are two types of diabetes. About 10% of people with diabetes have Diabetes1, which is more likely to be hereditary and not preventable. The vast majority have Diabetes 2, which is closely linked to obesity. There is no cure for diabetes, but it can be prevented and controlled.
What is pre-diabetic?
Pre-diabetics have a high sugar level, but below the threshold considered diabetic. 16% of the population aged 45 and younger is pre-diabetic. An estimated 40% of Maori, Pacific and Indian population aged 35-39 in Auckland are pre-diabetic.
Diabetes Prevention
For most of us, diabetes can be prevented by eating healthy and exercising. It can also be detected at the pre-diabetic stage with a simple blood test, with a good chance of preventing from progressing to full-blown diabetes.
Living with diabetes
In theory, this is an easily solvable problem, Screen and blood test everyone at high risk. Prevent or control with medication and lifestyle changes. Unfortunately, this is easier said than done, numbers are on the rise in almost every part of the world. One of the most challenging issues is changing lifelong habits of diet and sedentary lifestyle.
Diabetes Initiatives – New Zealand
‘Living well with diabetes 2015-2015’ project launched by the Ministry of Health is the main initiative to reduce diabetes. This plan targeted a 20 to 30 per cent reduction in the rate of new cases by 2020 as well as targets for reducing deaths, life expectancy and reducing complications. The broad action areas targeted by the plan are sound, and it aims to reduce diabetes using a mixture of awareness, information, screening and intervention. There is a lack of detail on which parts of the plan are complete, and the ministry has no status update (it is currently gathering this data from the DHBs). The program has not achieved ambitious goals set; however, the increase in the prevalence of diabetes appears to have slowed down.
There are broad-based initiatives which will reduce diabetes. ‘Healthy families NZ’ promotes the diet and an active lifestyle. Health star rating a voluntary code for food labelling.
Diabetes New Zealand is a non-profit aiming to provide information and support, also an advocacy group for people with diabetes and those at high risk.
International Initiatives
International Diabetes Federation has done a comprehensive analysis of over 70 trial programs carried out all over the world to come up with some of the success factors in tackling diabetes. Many of their recommendations have come from studies done in Australia,
Some of these ideas are
- Diabetes screening- Using an online risk assessment tool.
- Blood testing for those identified as high risk.
- Comprehensive lifestyle intervention programs, through group counselling sessions, telephone or webchat. Currently, all states in Australia run these programs.
- Medication where appropriate
- Public Health initiatives- A sugar tax, promotion of healthy diets in schools and kindergartens, prominent food labelling and regulation of food/soft drink marketing.
Is there value in screening the whole population say over the age of 45? Probably, this is not something current practised. Is it worthwhile running public awareness campaigns, similar to drink driving or dangerous driving? Possibly.
Challenges
Getting people identified as diabetic, pre-diabetic or high risk to get tested and make the diet and lifestyle changes required has been challenging. Changing a lifestyle and diet, bedded in over many decades, is not easy. Psychological support is very much an essential part of treatment and long-term care.
Keeping safe- what can you do?
- Healthy diet and exercise would be a perfect place to start.
- If you don’t have diabetes or unsure, use ‘Are you at risk’ online monitoring tool from diabetes NZ, https://www.diabetes.org.nz/are-you-at-risk.
- If you are high risk, arrange for a blood test, with your GP.
- If you already have diabetes, nothing is important as following your GP’s advice and making those lifestyle changes stick!
- Diabetes NZ recommends an annual diabetes check-up and has a range of resources to help you. Their Facebook page has an online community for support, and there are also several other Facebook groups.
Diabetes by Numbers
- 6% of the total population has diabetes
- 2% of the total population have diabetes without being aware of it
- 15-20% of the population aged over 65 have diabetes
- 85% increase in diabetic patients since 2005
- 5-10% of our health spending is on diabetes
- Three times – the prevalence of diabetes amongst Maori, compared to non- Maori
- Five times – the mortality rate of Maori vs Non -Maori
- 16% of population below 45 are pre-diabetic
- 40% prevalence of pre-diabetes among Maori, Pacific, Indian aged 35-39
Acknowledgements
- Diabetes NZ- https://www.diabetes.org.nz/
- Diabetes UK -https://https://diabetes.org.uk/
- International Diabetes Federation – https://www.idf.org/
- Ministry of Health, NZ – https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/diabetes-data-and-stats
- Diabetes Australia – https://www.diabetesaustralia.com.au/risk-calculator
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