- Diabetes and obesity in at-risk cohorts
Overview
8.1‘The impact of poor health,’ as the Department of Health and Aged care emphasised in its submission, ‘is expressed unevenly in Australian communities.’ Throughout the course of this inquiry, it has been repeatedly impressed upon the Committee that people in lower socio-economic groups are at greater risk of poor health. Furthermore, the Department submitted that:
Social, environmental, structural, economic, cultural, biomedical, commercial, and digital determinants of health contribute to health inequity and inequality experienced in Australia.
8.2Indeed, different groups across Australia often have significantly different health needs. In gathering evidence for the inquiry, the Committee travelled across Australia to hear from people about their experiences living with diabetes and obesity. This chapter focuses on cohorts that are acutely impacted by – and often face additional challenges managing – diabetes and obesity. Particular emphasis is placed on Aboriginal and Torres Strait Islander people, with sections covering their access to health care and some of the most common diabetes complications that impact these communities, as well as challenges securing access to healthy food. Equally, members of culturally and linguistically diverse communities, people living with disability, those who reside in rural or remote areas, and older Australians all experience additional barriers to the optimal management of diabetes and obesity.
8.3This chapter places specific emphasis on evidence provided by those living with diabetes and obesity. Throughout the inquiry, the Committee heard from many people across different communities in Australia about their experiences living with these diseases. While this chapter recounts only a fraction of these exchanges, these stories make clear how important it is to respond urgently to the rising tide of diabetes and obesity in Australia.
Aboriginal and Torres Strait Islander communities
8.4In comparison to the Australian population overall, Aboriginal and Torres Strait Islander people are three times more likely to live with diabetes and five times more likely to be hospitalised with diabetes-related complications. Evidence received throughout the inquiry about barriers experienced by Aboriginal and Torres Strait Islander people living with diabetes and obesity focuses in particular on issues related to:
- Seeking medical help and specialised care
- Access to healthy food and
- Social factors.
Access to primary and specialised care
8.5At a public hearing in Darwin, the Committee heard from Dr Hasthi Dissanayake and Professor Beverley-Ann Biggs, along with local elders who are working with the Elcho Island community to establish an Elcho Health and Wellbeing project. This project is evaluating a community developed and led nutrition and lifestyle program aimed at reducing weight and improving metabolic health among the residents of Elcho Island. The project also seeks to determine the effects of the program on diet, physical activity and quality of life as well as to understand Yolŋu perspectives on the program’s benefits and challenges.
8.6Professor Beverley-Ann Biggs explained some of the challenges faced by the Elcho Island communities:
There are two healthcare services on Elcho Island. One is Miwatj Health at Galiwin'ku. The other is Marthakal Homelands, and they do all the homelands. They struggle to get doctors and they struggle to get nurses. They usually come for, at most, 12 weeks at a time. It's better at Miwatj now that we have [inaudible] in charge, but there were periods in the last eight years where there were no doctors on Elcho Island.
8.7Ms Ruth Gulamanda, an elder from Galiwin’ku on Elcho Island and Chief Investigator for the Elcho Health and Wellbeing project, told the Committee about diabetes and heart problems within the community:
People have got higher rates at Galiwin'ku and through east Arnhem. At Galiwin'ku, there are a lot of people who have the sickness of sugar and chronic disease. There are so many that some of them start dying. Sometimes they are ashamed to go to the clinic. Sometimes they make excuses and say, 'I'll go to the clinic later on.' Sometimes the nurses go out to get them for testing and all that, but they say, 'Wait, I'll come around later.' Sometimes they don't get their results back from the doctors or from the workers.
8.8The Committee also spoke to Mr Raymond Sambo at its public hearing in Cairns. Mr Sambo is an Indigenous man who was diagnosed with Type 2 diabetes and recently received ‘…a kidney transplant after 5 long years on the wait list’. Mr Sambo told the Committee about his initial response to being diagnosed with diabetes:
My journey started most probably 20-odd years ago. I was seeing my local doctor at the workshop in the Aboriginal medical centre, and he said to me, 'Keep on going the way you're going, and you'll end up with diabetes.' The unfortunate thing about diabetes is you don't really see any symptoms… I just ignored that advice from the doctor. …I've never really seen an Aboriginal health worker or, if I have, it's been very limited… The biggest thing is I was drinking too much, eating the wrong food, not exercising and all those sorts of things…
When you first start diabetes, the doctor said to me, 'You can control this through changing your lifestyle and cutting back on the grog.' I never smoked, thank goodness, but through exercise and eating properly, he said, 'You can control this.' Again I chose not to listen. I then progressed to medication. You start on the tablets, metformin and so on… I wasn't taking my tablets regularly. Then I progressed to insulin. Once again I never used to take my insulin regularly... I'd make sure to have a beer regularly, but that was, again, my choosing. I didn't see the symptoms of what was occurring to my body.
8.9As the disease progressed, Mr Sambo faced additional complications:
It really struck home to me when they said, 'You're going up to the renal clinic.' When I walked into the renal clinic, that's when it hit me like I'd walked into a brick wall—bang… I've obviously changed my diet, and I'm still recovering a little bit from my transplant. I haven't drunk for over 10 years, but it was 10 years too late. If I'd stopped and made those changes earlier, I mightn't have been in the situation I found myself in.
That's my journey. I was one of the lucky ones, as an Indigenous patient, to get a transplant. It'll be five months tomorrow. As I said, I'm still recovering. Touch wood everything keeps on working. We know it can be rejected.
8.10Ms Tanya Hosch gave evidence at a public hearing on behalf of the South Australian Health and Medical Research Institute (SAHMRI) about her experience living with Type 2 diabetes and associated foot complications. In 2021, Ms Hosch lost her lower-leg to Charcot foot, a complication of diabetes-related neuropathy. She explained:
I'd been living with type 2 diabetes for about a decade and had no concept that Charcot foot was a potential complication... Now that I look back, what I realise is that early experiences with healthcare professionals who were there to help me understand the potential risks to my health were the fork in the road that I think took me down the path of losing my leg. The first endocrinologist I saw privately, and the racism I experienced in her care was so extreme that every time I went to see her my blood pressure would go up. I went back to my GP, who said, 'Maybe see someone in the public system.' The public system was almost impossible to get into. I just gave up on endocrinology.
…while I feel like the care I've had at the acute and tertiary level of the health system has been excellent as a public patient, I shouldn't have been there. The primary health care is where I feel terribly let down, because I never understood the risks that were possible having type 2 diabetes…
8.11Reflecting on the importance of ensuring that patients living with diabetes understand the nature and progression of the disease, Ms Hosch noted:
[When] I was diagnosed with type 2 diabetes... I just thought taking my tablets was all I needed to do. The fact that there was actually no mechanism to make sure I understood the potential problems from diabetes is where I think there was a major failure. Then, of course, Charcot foot proved very difficult to diagnose. The first thing they tell you to do when you are diagnosed is to cease weight-bearing. I was seeing a physio for months before that, doing exercises on my foot, just doing further and further harm. I was very fortunate that someone recommended a GP to me who had worked in Aboriginal communities and took me off to get the right tests. I had three years of complications before I ended up losing my leg, having attempted a foot reconstruction.
8.12Efforts to promote lifestyle changes that can help to reverse the progression of diabetes and obesity in Indigenous communities are also vital. In his submission to the inquiry, Mr Ray Kelly, a Kamilaroi man who is currently completing a PhD at the University of Melbourne School of Medicine, shared his experience about reversal of Type 2 diabetes through lifestyle change by Indigenous people in Australia. Mr Kelly established the Too Deadly for Diabetes program, which has supported Aboriginal people in regional and remote communities across NSW with weight loss and to reduce their HbA1c levels. Mr Kelly submitted:
In 2017 I decided to focus on regional and remote Aboriginal communities. Since then, I have partnered with 16 Indigenous communities across NSW to provide my ‘Too Deadly for Diabetes’ program. This has seen patients lose a total weight loss of over 5,800kg, at an average weight loss of 7% of their starting weight. The average reduction in HbA1c has been 1.6%. Many participants also reduce or eliminate medications for type 2 diabetes and hypertension. These results are impressive when compared to the whole Australian population, however it must be stated that these communities have many challenges and would be considered some of the most difficult locations in NSW to provide a lifestyle program. In addition, the program is provided within the primary care setting by nurses and Aboriginal Health Workers/Practitioners. We have been able to show that even in the most challenging environments, Aboriginal people will achieve great health outcomes if provided with the right information and support.
8.13The Diabetes across the Lifecourse Partnership at the Menzies School of Health Research recommended greater support for the primary health care sector to promote routine health checks and screening for Type 2 diabetes, and to provide education to Aboriginal and Torres Strait Islander communities about preventing, detecting and managing diabetes.
Kidney disease
8.14Aboriginal and Torres Strait Islander people living with diabetes are disproportionately affected by diabetes-related kidney disease and kidney failure. As Diabetes Australia highlighted, ‘The fact that there are more than 30 dialysis clinics in regional and remote communities across Australia highlights the impact of diabetes-related kidney disease.’
8.15The National Aboriginal Community Controlled Health Organisation stated:
The burden of diabetes and associated complications in Aboriginal and Torres Strait Islander populations looks set to worsen. Diabetes accounts for more than 70% of new cases of kidney failure, and Aboriginal and Torres Strait Islander people with diabetes are five times more likely to report kidney disease than people without diabetes. Regardless of locality, Aboriginal and Torres Strait Islander people are five times more likely than non-Indigenous Australians to develop kidney disease, and four times more likely to die from kidney disease. Incidence of kidney failure is up to 20 times higher than non-Indigenous Australians in remote areas.
8.16Miwatj Health told the Committee that people living with diabetes and chronic kidney disease are ‘more vulnerable to diabetic retinopathy and foot complications requiring close monitoring and comprehensive care plans.’ This cohort is also more prone to other health issues such as anaemia, metabolic bone disease and infections resulting in acute complications and hospitalisations.
8.17The Australian Medical Association (AMA) observed that Aboriginal and Torres Strait Islander people ‘with kidney failure are less likely to be wait-listed for transplantation than non-Indigenous Australians’ due to a range of barriers, such as lack of ‘service availability and likelihood of referral for transplant evaluation, cultural bias and individual patient factors such as co-morbidities which affect the acceptability of a kidney transplant.’ As such, the AMA recommended the Australian Government invest in addressing systemic healthcare inequality, and improve diabetes prevention and early detection of diabetes for Aboriginal and Torres Strait Islander people.
8.18Mr Sambo explained that there are significant social, emotional and wellbeing impacts for Aboriginal and Torres Strait Islander people who need to relocate away from their communities for dialysis:
They have to relocate from the outer islands to TI [Thursday Island] if, again, there are fortunately enough chairs there for dialysis. Otherwise, they have to come to Cairns. Now, when they come to Cairns, you've got to imagine it: they're uprooted from their community and they're uprooted from their family, connection to culture and connection to community—all things that contribute to our wellbeing. Again, looking at the medical side of it, we really need to start, as they said, looking at the holistic side of it. This is the other part of the holistic side—looking at those things that affect Aboriginal and Torres Strait Islander people, which is that soul removal from community.
Then, for Queensland Health, I know there's a limited budget, but look at some of the accommodation that they're putting patients in here in Cairns. …if you've got family coming from the Aboriginal communities or the Torres Strait—if they're a husband and wife with six kids or eight kids—some women are living in… two-bedroom old motels... They are old motels that really should be bulldozed, but, because they're getting subsidised by Queensland Health, they know they're going to have a full room. Their vacancy rate will be zero, because, again, they're getting fully subsidised by Queensland Health. Again, you talk about diet and things like that, but, when you're living in some of these accommodations, you haven't even got proper cooking facilities—a full-sized fridge. These are some of the things that really need to be looked at as far as accommodation when you bring your patients down.
8.19Diabetes Australia recommended funding for an Aboriginal and Torres Strait Islander focused Diabetes-related Kidney Disease Screening Program to support early detection and intervention.
Foot complications
8.20Aboriginal and Torres Strait Islander people are more likely to be hospitalised for lower limb amputation. According to SAHMRI, hospitalisation rates are 11 times higher for females and five times higher for males compared to Australia’s non-Indigenous population.
8.21SAHMRI recommended a national scheme to subsidise medical grade custom footwear, orthoses, foot protective devices, offloading and wound care products for Aboriginal and Torres Strait Islander people at risk, or living with, diabetes-related foot complications.
Access to healthy food
8.22The Committee received a substantial amount of evidence regarding the lack of access to healthy food in many Aboriginal and Torres Strait Islander communities. For example, Ms Gulamanda told the Committee about the lack of affordable healthy food on Elcho Island:
Sometimes at the shop, it's very expensive. We don't have enough money to buy the right groceries, like vegetables and greens, and the prices keep rising at the store. When we buy from there, we can't get a lot of healthy foods because of the prices. Some of us are still being paid by Services Australia, and we have to get money out of our own pockets. For instance, in Darwin for $100 I can get four plastic bags, whereas in Elcho you only get half a brown paper bag.
We try to give advice to the community to stop eating takeaway food there and to instead cook their own meals. Sometimes we see adults walking around. They go to the takeaway store to buy breakfast. Coke is their favourite thing on the menu. Sometimes they eat chicken and chips for breakfast. We'd like to change that, and to support them to start eating healthily again. We've got to help each other by providing good food for everybody, so we can come together and talk about this disease.
8.23Dr Dissanayake explained that the challenge of buying healthy food in store on Elcho Island was exacerbated by the fact that many households do not have equipment to cook food, such as pots, pans and knives. Professor Biggs explained that a similar issue existed in relation to access to cold drinks:
Not everyone has a fridge on Elcho Island... There are no cold drinks. It's very hot, as you know and as I'm sure you're experiencing, so people go to the store to buy something cold to drink. There are no water fountains. On the one hand, I think it's addictive—both the sugar and the caffeine. On the other hand, there aren't any easy alternatives to get cold drinks. Most people are dehydrated.
8.24Ms Jacinda Roberts told the Committee about the situation in town camps with poor access to healthy food around Alice Springs:
…look at where our town camps are, and many of them are actually placed opposite where there are fast food delis. I think about one of the supermarkets, which is well placed in the gap, where the cost of fruit and veg is at least eight times what it would cost in Coles and Woolworths, but you can't walk to Coles and Woolworths. You can only walk there. So of course you're going to go next door and grab some fast food. I've seen a food truck go into a town camp at six o'clock at night. Once again, it's that exploitation. In a town camp, you're very limited. People don't necessarily have the means to cook and prepare food, so you have a food truck which is selling hot dogs and Slurpees going in at dinner time to effectively the most vulnerable people to sell their food. You can educate as much as you can, but when your settings aren't conducive to health it makes no difference.
8.25Alice Springs Town Council Mayor, Matt Paterson, also told the Committee that the Alice Springs KFC is ‘…the busiest KFC in the country. It sold more chicken than any other postcode in the country. Our takeaway, our fast food, is very popular.’
8.26During the inquiry, the Committee travelled to Yarrabah in Far North Queensland to speak to Dr Jason King, Director of Clinical Services at Gurriny Yealamucka Health Service Aboriginal Corporation. Dr King said that poor water supply and quality was a common issue in many remote communities:
One of the first instructions I got from local people when I came here was not to drink the locally supplied water. Often it's unpalatable, and that's due to the high iron content in the water from piping, for example. In March this year it was discovered that several of the outlets had raised levels of certain metals such as copper and lead, and arsenic was found in some of the water outlets. Subsequent testing showed that most of that was from first-flush samples due to water stasis and the hyperchlorination of the water supply. But historically, water supply has been a problem. If we're giving people advice not to drink sugary drinks and they can't drink local tap water, they're then faced with the choice of trying to purchase their water. The commodification of an essential human right to water is major issue internationally, and Australia is no different with a bottle of water costing more than a bottle of coke in a community like Yarrabah.
8.27Dr King also emphasised the need to examine the transportation of essential products to remote locations like Yarrabah, and to look at how businesses can support transportation more effectively. Dr King elaborated:
Where you can go in and pay $10 for a head of lettuce, for example, while a Coke is cheaper than water—that is a problem. Those decisions are made on a financial basis, but the impacts to health are direct. A very quick turnaround can see changes in lifestyle and organ damage from diabetes, for example, within a generation. I think we could see significant changes if real choices were available for patients.
8.28Mr Sambo described addiction to sugary drinks as being similar to an addiction to smoking or alcohol:
I think they were talking about diabetes last night on the news and they said, 'Let's up the cost of soft drink.' One thing, in the communities, is the water is at least a dollar, so the soft drink is still higher. Again, as I said, I was watching the news, and there was a non-Indigenous lady living in a major centre, and they said, 'Would this work for you if we upped the price of soft drink?' She said: 'Most probably not. It wouldn't make any difference.' So that's the thinking. It's the same in Aboriginal communities. Unfortunately, Coke is a bit of an addiction, as is smoking and alcohol. That's a really hard one to break—getting people to go off that soft drink and to drink water. I have that same problem with my own kids at home. I say, 'Look, you've got to drink more water.' I'm just trying to drum that message into them, and I'm even struggling at home with my own kids.
8.29Ms Edwina Murphy, a young Jawoyn woman living with Type 2 diabetes in the Northern Territory, said that ‘[p]roviding food and transport to go in town to get medication and food’ would help to improve access to healthy food.
8.30Ms Laura Baddeley, Nutrition Manager at the Arnhem Land Progress Aboriginal Corporation described ‘…reliable access to food and essentials as a basic human right.’ Ms Baddeley recommended access to healthy food could be improved through:
…freight subsidies across the board. There's really good evidence that people will buy more healthy foods if there is a freight subsidy and if we can reduce the price of healthy products. If it's affordable, people can buy what they need. The other thing would be around the starting cost of products. Like we talked about earlier, our buying power is very small, and we can't negotiate with big food like big retailers in Australia.
8.31Professor Julie Brimblecombe, who gave evidence at a public hearing in Darwin, told the Committee about the work being undertaken across many remote stores to improve access to healthy food:
Many remote stores are doing what they can to address food affordability and the high cost of food. For example, they provide subsidies for fruit and vegetables. They work with suppliers to try to reduce the cost of different types of foods. But you can see from that figure too, from what was reported by these 29 stores, that costs of repairs and maintenance to stores, cost of freight and cost of break-ins are barriers reported by stores. What's really required to bring down the cost of food, to have viable stores and to address food affordability is a subsidy. What this subsidy looks like requires quite a lot of work that different inquiries have recommended. The national food security inquiry has just recommended a subsidy for remote stores to address food affordability.
Social factors
8.32Throughout the inquiry, the Committee heard about a range of complex social factors preventing people from managing their diabetes and obesity, such as a lack of access to adequate housing and economic disadvantage. For example, Dr King told the Committee that there are 414 houses for 4200 people in Yarrabah. There are thus on average ten people living in each house, with up to 20 people living in three-bedroom houses. Many houses in Yarrabah also are not connected to electricity, which makes refrigeration difficult and creates serious problems for storing certain types of insulin that need to be temperature stabilised. Dr King explained: ‘That can place increased stress on people's confidence in the quality and safety of their medication.’
8.33Mr Sambo pointed out the limited social housing available in the Torres Strait:
We talk about housing in the Torres Strait. There's limited social housing. A lot of the housing is subsidised by government. Those workers flying in get the houses. Private real estate can up the price of those because they know they'll get the rent. They can charge whatever, and the rent is subsidised by their employer. All the other private houses are out of reach for the local population, because how can you afford $600 a week if you're on unemployment benefits? That's the problem. How do people, as I said, get private rentals? They might be working, but even still the cost of private accommodation is so expensive that it cuts out the locals for that sort of stuff. Accommodation probably isn't as bad in Aboriginal communities, but we still have overcrowding in Aboriginal communities. If you have 10 mob in a house, how do you maintain a good diet when you have that many people in the house? As they spoke about, there's always a shortage of food. With overcrowding come hygiene issues. All those things lead to poor health.
8.34SAHMRI recommended funding to address the social determinants of health contributing to inequitable burden of diabetes, such as ‘income, environment, housing, education, food security […]’.
Culturally and linguistically diverse communities
8.35In Australia, people belonging to some culturally and linguistically diverse communities tend to be at higher risk of developing Type 2 diabetes. According to Diabetes Australia, this includes people from the Pacific Islands, the Middle East, South Asia and Africa. In addition to facing language barriers and other cultural challenges, these cohorts may also experience difficulties navigating the health system. To manage these challenges, Diabetes Australia submitted that diabetes resources and education should be available in culturally appropriate formats in key languages.
8.36During the inquiry, the Committee heard about diabetes prevention programs implemented within Pacific Islands communities. For example, NSW Health told the Committee about the Pasifika Preventing Diabetes Program, which ‘is a church based, community owned lifestyle program aiming to improve detection, prevention and management of diabetes and its risk factors.’ NSW Health elaborated on this program:
The program is being conducted across 48 churches attended by a high proportion of people of Pasifika origin to reduce the risk of developing of type 2 diabetes and to improve self-management among those with type 2 diabetes.
The project is funded by a National Health and Medical Research Council… Partnership Grant, with an additional funding contributed from 13 partner organisations.38 This includes NSW Ministry of Health, NSW Pathology and four metropolitan Sydney LHDs [local health districts].
The programme seeks to empower participants and their communities by providing a framework to help the community build their own sustainable lifestyle changes. Trained, peer support facilitators deliver formal and informal sessions related to healthy eating, physical activity, and diabetes. Participants are consented for participation as family groups and attend interactive activities such as walking and cooking groups. Participant resources are developed in consultation with peer facilitators and translated into relevant languages. A total of 480 participants have been recruited so far.
8.37The Committee also heard about the Maridulu Budyari Gumal (SPHERE) Le Taeao Afua (LTA) project, that was implemented across four South Western Sydney Samoan Churches for a six-month period. The project was led by a Samoan community reference group, and expanded to include representation from other Pacific communities across Sydney. Maridulu Budyari Gumal (SPHERE) submitted:
The LTA intervention had a train-the-trainer approach, using Peer Support Facilitators (PSFs) to deliver support to the wider community. A Community Activator (CA) trained and supported the PSFs. GP attendance was promoted in parallel to the community approach through referral letters for those who received abnormal results.
The LTA program confirmed that recruitment and delivery of the intervention via churches is feasible. During the 12-month period, over 110 intervention activities were delivered across the three churches. Churches are well attended by Pacific communities in Australia. Pre-post evaluation showed an overall reduction in HbA1c and diastolic blood pressure, with near doubling of self- reported total physical activity, and an increase in low fat choices (such as removing fat from chicken during food preparation). The program greatly benefited the local Samoan community of South Western Sydney. The Pacific Reference Group who manages the program would like to extend the program across GWS. Through an NHMRC [National Health and Medical Research Council] Partnership Grant the project is current being expanded across the Sydney Pasifika Community to include 48 more churches.
8.38Maridulu Budyari Gumal (SPHERE) recommended support to enable intervention programs like LTA to be implemented in other culturally and linguistically diverse communities.
People with disability
8.39Just over ten per cent of people living with a disability also live with diabetes. Diabetes Australia suggested that disability support workers would benefit from training to support people with diabetes, ‘particularly people who are unable to self-administer insulin or appropriately monitor their diabetes themselves.’
8.40The submission from Diabetes WA explained that people with disability living with diabetes can access funding from the National Disability Insurance Scheme (NDIS) for a disability-related diabetes management plan:
Enabling people living with a disability and diabetes to access support workers to assist with insulin administration is essential for ensuring cost is not a prohibitive factor in receiving quality, best practice diabetes care plans. For some diabetes management supports, the NDIS can fund a registered nurse to train and delegate key tasks to a support worker or enrolled nurse. This includes insulin administration and use of new diabetes technologies for the delivery of insulin and measurement of blood glucose levels. There has been confusion in WA regarding the interpretation of the legislation with regards to this delegation of care, resulting in inconsistencies. Diabetes WA is also unaware of any national quality standards, competencies, or accreditation of training for support workers involved in delegated diabetes care.
People living in rural and remote areas
8.41People living in rural and remote areas are almost three times more likely to be hospitalised for diabetes, and mortality is twice as high compared to people living in major cities. Diabetes Australia’s National Community Consultation Survey found that 40 per cent of people living in regional areas reported difficulties accessing doctors’ appointments or appointments with other health professionals. As a result, people in rural and remote areas have poorer access to medicines and diabetes management.
8.42Diabetes Australia recommended case conferencing arrangements be improved to ensure people in rural and remote general practices have access to proper diabetes care by an endocrinologist and a credentialled diabetes educator.
Older people
8.43Older people are disproportionately affected by diabetes. According to statistics provided by Diabetes Australia, one million (67.5 per cent) of people living with diabetes are aged over 60, and more than 250,000 people are aged over 80.
8.44Diabetes Australia submitted that one in five people and one in four First Nations people currently living in residential care live with diabetes. Many require assistance with special dietary requirements, their glucose monitoring and insulin administration. In many cases, Diabetes Australia noted, these needs are unmet, which in turn:
…can lead to very poor quality of life, unnecessary complications, avoidable hospitalisations, and premature death.
8.45Diabetes Australia also discussed the situation in aged care and submitted:
There is often a lack of awareness among aged care staff about the contribution of diabetes to other problems such as unexplained falls and urinary tract infections. This results in potentially avoidable transfers to hospital.
Additionally, Standard 3, Personal care and clinical care of the Aged Care Quality Standards, requires that all people in residential aged care can access safe and effective, best practice clinical care that is tailored to their needs and optimises their health and wellbeing, Sadly, when it comes to diabetes this Standard is rarely met.
A new national Diabetes In Aged Care training program for all aged care workers would improve the capability of aged care workers and service providers. A tiered training program, with training appropriately aligned to the level of care and support staff provide to people living with diabetes, is the most cost-effective way to upskill Australia’s aged care light.
8.46Diabetes Australia highlighted that longer life expectancy over the next 40 years ‘will drive a significant increase in the number of people living with diabetes in aged care.’
8.47As part of its investigation into new diabetes technologies, the Committee heard evidence pertaining of the advantage that devices such as continuous glucose monitors and insulin pumps have in these contexts, as they allow for nearly automated administration of medications. Professor Alicia Jenkins, Head of Clinical Research Domain and Lab Head at the Baker Heart and Diabetes Institute told the Committee that:
…with this newer technology, even with the commercial version which is short of the closed-loop that you've heard about, patients with mild to moderate cognitive impairment are actually able to keep really good control, stay on their pumps and not need a lot of support from their healthcare professionals or their families.
8.48Professor Jenkins further emphasised the results of survey conducted by the Institute, which indicated that Australians living with Type 1 diabetes are especially concerned about diabetes management in older age. As she explained:
A survey that we've done showed us that there is a concern for Australians living with type 1 diabetes of, 'I'm fine now; what happens as I age?'
Patients in assisted living or residential care, she noted, should have access to current technology, and support from staff who are trained in diabetes management.
Committee comment
8.49The Committee acknowledges the significant challenges and hardship experienced by people living with diabetes and obesity. The Committee also recognises that diabetes and obesity affect people differently.
8.50The Committee believes more can be done to increase awareness about diabetes and obesity among at-risk cohorts. There is evidence, however, that improving awareness can only be successful if people have the access to the resources they need, such as the right medical help, access to healthy food and social support.
8.51As the Committee noted earlier in this report, the Aboriginal Healthcare workforce remains a priority for Indigenous communities.
8.52The Committee notes that the House of Representatives Standing Committee on Agriculture tabled a report entitled Australian Food Story: Feeding the Nation and Beyond tabled in November 2023. The Government response to this report remains outstanding.
8.53The Committee recognises food security as a priority issue that must be addressed. The Committee therefore urges the Australian Government to consider the recommendations made in the Australian Food Story report as outlined in Chapter 3.
8.54The Committee recommends that the Australian Centre for Evaluation in the Department of Treasury commits to the ongoing assessment of any actions taken in respect of Committee recommendations made in this report.
8.55The Committee acknowledges that this report includes several complex recommendations that, if accepted, will require coordinated effort across multiple levels of government to be implemented successfully. Ongoing assessment and evaluation is important for ensuing that actions taken in respect to any recommendations are effective, particularly over the long term.
Dr Mike Freelander MP
Chair