The campaign against diabetes is gaining momentum under the new National Diabetes Strategy, but the sector is still in need of solid epidemiological study, says pioneering diabetologist Professor Paul Zimmet.

The new strategy for 2021-2030, released last week, is a truer reflection of the recommendations of the expert group advising the government than the first iteration covering 2016-2020.  It also recognises the coronavirus as a particular threat to people with diabetes.

Professor Zimmet, who co-chairs the panel with former federal MP Judi Moylan, said Health Minister Greg Hunt accepted in full the group’s recommendation report.

“By an incredible coincidence one of the meetings we had with him was around the time the Covid pandemic was declared in March 2020.  We were discussing areas that we thought had not been adequately addressed in the original strategy,” he said.

“He was very receptive.  We proposed then that there should be a review of the 2016-2020 strategy and pointed out areas that we were concerned about. He was very positive and accepted holus bolus the recommendations for change that we sent him.

“These included the need to address the Covid pandemic and what needed to be done because diabetes is considered one of the highest risk conditions for Covid infection.”

It was “a nice situation” to move forward within the new strategy to ensure it took into account the fact that thousands of people with diabetes were in the high-priority group for vaccination and other prevention measures, he said.

The executive advisory group which assisted the Department of Health to revise the 2016-2020 strategy focused mostly on intensifying commitments to existing targets, such as:

• More emphasis on prevention of T2D
• Earlier detection of T1D and T2D to be prioritised
• Much more emphasis on reducing diabetes complications
• Preparation of living guidelines for health professional for managing diabetes
• Very strong emphasis on diabetes in indigenous communities
• Management of diabetes in older adults
• Prevention of intergenerational diabetes
• Upgrading of the availability and capability of the diabetes workforce

However, the existence of the strategy is already proving valuable in terms of improved focus and cooperation.  “Without it, diabetes care could be in a big mess,” Professor Zimmet said.

“There is a lot of activity, and we also have the benefit of seeing various groups involved with diabetes work much more closely together – Diabetes Australia, the Australian Diabetes Society, the Australian Diabetes Educators Society,  the Australian Paediatric Diabetes group, etcetera.”

Professor Zimmet said he was pleased to see progress in T2D prevention programs, after a slow start, as well as work to raise awareness of the importance of early T1D diagnosis in children and prevention of diabetes complications.

“The extension of the continuous blood glucose monitoring program for pregnant women and other people has received a lot of support through the National Diabetes Supply Service.  Glucose monitoring technology is becoming much more available to high-risk groups, particularly people with T2D,” he added.

“The implementation of the Diabetes in Schools program is now moving, and in indigenous communities there are a number of programs which have raised the care and management of diabetes and addressing complications.”

But more needed to be done on the upskilling of medical and allied health workers on diabetes, he said.

“One excellent program funded by the National Medical Future Fund – educating Indigenous health workers – will soon become widely available through the Indigenous community.  It’s a really focused, top initiative and (would be) pretty good actually for the general community as well.”

Another world-standard program on intergenerational diabetes covering the entire Northern Territory population is not only breaking new ground in research but also bringing improved care and management, he added.

Funds have also become more plentiful for Diabetes Australia’s work to run the NDSS, supporting 1.5 million Australians with diabetes advice and products, the KeepSight blindness prevention program, and the Foot Forward amputation prevention scheme.

Political support

Asked last year to support the amputation prevention scheme, Minister Hunt jumped on board saying, “I’ll fund it if you make indigenous communities one of the priorities.”

“Of course, we’d like to see more action, but there has been action and it has become really focused since we put the (strategy review) to Greg Hunt,” Professor Zimmet said.

“We have to say, though he’s been sidetracked by Covid and vaccines, he has remained keenly observant of chronic disease in Australia.

“The other thing about the evolving of the national strategy is that it alerts the government where health funds should go. Diabetes is not the only major health issue in Australia but it is certainly one of the biggest issues.”

In addition, the drive and political smarts of Ms Moylan, a former Liberal senator, has played a major role in advancing the cause of the diabetes community, he said.

The minister’s implementation advisory group will be continuing to push for a rigorous national epidemiological program for diabetes and obesity that would undertake surveys every five years.

This was proposed among recommendations for the 2016-2020 plan, along with a coordinated national research program for diabetes, to show where the strategy was having an effect.

Professor Zimmet led the first such diabetes survey, dubbed AusDiab, in the year 2000.  In its wake came a 2011 study by the Australian Bureau of Statistics, which is believed to have under-reported the prevalence of the condition.

“The ABS to our mind did not do a good job.  It did not follow standardised methodologies used throughout the world or previously in Australia so you could compare the data, and it underestimated diabetes in the Indigenous community in particular, but also we believe in the general community,” he said.

The Monash University professor has teamed with colleagues at Kings College in London to track whether the coronavirus pandemic gives rise to more new diabetes cases, in step with historic links between other viral infections and new diabetes.

He is also concerned about so-called “long Covid” showing up in damage to major organs in diabetic patients who become infected.  Even if they don’t have a bad case of the virus at the time, the damage could become apparent years later.

“That’s one of the reasons we made a very strong play to have Covid issues within the new strategy.  And it’s quite clear that diabetes and obesity put people in the highest risk category for Covid.  That’s an issue in terms of funding.  Governments have to start being aware.”