‘Rule of halves’ an avoidable reality for diabetes burden in Australia

Prof Colagiuri

A new report showing that only 37% people with diabetes complete the annual cycle of care confirms the ‘Rule of Halves’ theory for chronic disease is a reality for Australians with diabetes.

The rule of halves framework proposes that only half of people with a chronic disease are diagnosed, of whom half do not receive care, half of those treated do not achieve treatment targets and half of those who reach their targets do not achieve the desired outcomes.

With the exception of diagnosis rates this is the unfortunate reality for the burden of diabetes in Australia, according to a review authored by Professor Stephen Colagiuri and colleagues at the Boden Institute, University of Sydney.

In an analysis based on the most recent peer-reviewed literature and government data on diabetes, the report found:

  • the proportion of people with diagnosed diabetes is 71%
  • the proportion of people with diabetes receiving an annual cycle of care is 37%
  • the proportion of people with diabetes meeting management targets for HbA1c is 53%
  • the proportion of people with diabetes experiencing no complications is less than 50%

On diagnosis, the report noted that the proportion of people found to have undiagnosed diabetes was highest when an oral glucose tolerance test was used.

In terms of care received, approximately 50% of people with diabetes had recent (6-12 months) checks for HbA1c lipids, weight and foot problems, while about 70% had recent eye examinations and blood pressure (BP) measurements.

However, only 38% of people with diabetes achieved their BP and LDL-cholesterol targets and only 21% met the target BMI of less than 25.

Rates of microvascular complications ranged from 19% for diabetic retinopathy to 25% for peripheral sensory neuropathy, while macrovascular complication rates were 13% for both ischaemic heart disease and peripheral artery disease.

“Overall the data indicates that many people with diagnosed diabetes in Australia are not receiving expected standards of diabetes care,” Professor Colaguiri said.

“Consequently, too many people with known diabetes have established micro and macrovascular complications resulting in a significant and potentially avoidable personal, costly and societal burden,” his report notes.

“Australia has the basic infrastructure to deliver evidence-based diabetes best practice to address the significant evidence-practice gaps identified in this review. The challenge is to implement the actions identified in the Australian National Diabetes Strategy 2016-2020 to achieve earlier diagnosis, better access to diabetes care, and better outcomes for people with diabetes,” it concludes.

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