2.3 Diabetes complications

Around 6% of adults in Australia had diabetes in 2017–18. This prevalence has nearly doubled since 2001.

Long-term complications of diabetes include:

• Stroke
• Heart disease
• Kidney disease
• Eye disease
• Nerve problems
• Foot ulcers
• Foot amputations.

In Australia in 2017–18, diabetes complications accounted for:

• 276,965 hospital bed days
• 7% of all potentially preventable hospitalisations.

In 2017–18:

• There were 50,273 hospitalisations for diabetes complications, representing 184 hospitalisations per 100,000 people of all ages (the Australian rate)
• The number of hospitalisations for diabetes complications across 325 local areas ranged from 64 to 782 per 100,000 people
• The rate of hospitalisation was 12.2 times as high in the area with the highest rate compared with the area with the lowest rate
• The rate for Aboriginal and Torres Strait Islander people was 3.7 times as high as the rate for other Australians
• The rate of hospitalisation was much higher in remote areas than in other areas
• Rates of hospitalisation increased with socioeconomic disadvantage in major cities, outer regional areas and remote areas.

Between 2014–15 and 2017–18:

• The rate of hospitalisation for diabetes complications nationally increased by 7%
• For Aboriginal and Torres Strait Islander people, the rate of hospitalisation for diabetes complications increased by 8%.

Rates are standardised to remove age and sex differences between populations.

Variation in rates of hospitalisation for diabetes complications is likely to be due to differences in:

• Prevalence of diabetes and risk factors – some population groups have higher prevalence of diabetes, risk factors for diabetes and risk factors for complications
• Access to services – non-hospital models of care may be less available outside major cities. Diabetes educators and allied health care to manage complications are not easily accessible in all areas. Aboriginal and Torres Strait Islander people may not have good access to culturally appropriate care
• Patient factors – people who have diabetes should be empowered to self-manage their condition. They need access to healthy food and some need refrigeration for insulin. They need support for physical and mental health issues that may impair their ability to self-manage
• Clinical factors – this includes variability in clinicians’ use of guidelines, systems for referral and follow-up of people with diabetes, and resourcing of primary care services.

Support self-management for people with diabetes. Education for people with type 2 diabetes can reduce their risk factors for complications; for example, about dietary habits, foot care and smoking.

Improve models of integrated care. All people with diabetes should have access to a team of clinicians for diabetes care. This team includes GPs, medical specialists, nurses and allied health professionals. The team should communicate with each other, and between hospital and community settings.

Improve prevention, early diagnosis and management of diabetes and its complications. This may include long-term interventions to address the social determinants of health.

Provide care for Aboriginal and Torres Strait Islander people that is culturally safe, holistic and multidisciplinary.

The Commission consulted widely, but is solely responsible for making the recommendations; as such, the recommendations may not reflect the views of all contributors to the Atlas.

2a. Consistent with the commitments made under the National Health Reform Agreement and building on the activities set out in the 2017 Bilateral Agreement on Coordinated Care, Local Hospital Networks, Primary Health Networks and the Aboriginal Community Controlled Health Service sector to implement the following principles in developing chronic disease management programs consistent with the National Strategic Framework for Chronic Conditions:



i. Patients, families and carers as partners in care, where patients are activated to maximise their knowledge, skills and confidence to manage their health, aided by technology and with the support of a healthcare team



ii. A risk stratification approach that supports identification of patients with high coordination and multiple provider needs, to ensure personalisation of service provision 



iii. Flexible service delivery and team-based care that supports integrated patient care across the continuum of the health system through shared information and care planning



iv. A commitment to care that is of high quality and safe, including care planning and clinical decisions that are guided by evidence-based patient healthcare pathways, appropriate to the patient’s needs v. Data collection and sharing by patients and their healthcare teams to measure patient health outcomes and improve performance

v. Data collection and sharing by patients and their healthcare teams to measure patient health outcomes and improve performance.

2b. The Commission, the Independent Hospital Pricing Authority and the Administrator of the National Health Funding Pool to identify and develop alternative approaches to funding for chronic disease and infection that could be applied to the National Health Reform Agreement Pricing and Funding model so that pricing and funding are aligned with best-practice guidelines. The alternative models could include bundled payments, capitation payments or regionally coordinated service responses.

Diabetes

2e. Local Hospital Networks, Primary Health Networks and the Aboriginal Community Controlled Health Service sector to promote appropriate care for the management of people with diabetes aligned with:

i. The Management of Type 2 Diabetes: A handbook for general practice (2020)

ii. The Australian National Diabetes Strategy 2016–2020

Download the diabetes complications section of the Atlas below, to read more about the context, data, key findings, interpretation, and addressing of variation for this clinical item:

Contents:

Context

• Risk factors for type 2 diabetes
• Preventing complications

About the data

What do the data show?

• Magnitude of variation
• Analysis by remoteness and socioeconomic status
• Analysis by Aboriginal and Torres Strait Islander status
• Trends over time

Interpretation

• Socioeconomic and demographic factors
• Variation in health care and self-care
• Change in New South Wales coding

Reducing hospitalisations for people with diabetes

• Integrated care models
• Telehealth
• Consumer enablement
• Advances in medical treatment
• Preventing diabetic eye and kidney disease
• Earlier diagnosis of diabetes
• Improving care for inpatients with diabetes
• Preventing type 2 diabetes
• Improving care for Aboriginal and Torres Strait Islander people

Resources

Australian initiatives

References