Health service use (AIHW)

Diabetes-related visits to general practitioners (GPs) are increasing

In 2009–10, GPs managed diabetes at a rate of 3.7 per 100 encounters, which is significantly higher than the 2000–01 rate of 2.8 per 100 encounters, suggesting about 1.5 million more occasions where diabetes was managed in 2009–10 than in 2000–01 (AIHW 2010).
According to the 2009–10 Bettering the Evaluation and Care of Health (BEACH) survey, diabetes accounted for 2.4% of all problems managed by GPs that year, making it the fourth most frequently managed chronic condition in general practice.

For more information, see General practice activity in Australia 2009–10.

In 2007–08, there were around 550,000 referrals to health professionals other than general practitioners for people with diabetes

Three-quarters of GP referrals to health professionals for people with diabetes were to diabetes educators (75%). 15% of referrals were to a dietitian/nutritionist, 6% were to a chiropodist/podiatrist, and 4% were to another type of health professional (Figure 1).
Of referrals to diabetes educators (around 406,000), 60% were for males and 40% were for females.

Figure 1: Referrals by general practitioners to other health professionals, 2007–08

Notes:
1. Based on self-reported information.
2. Crude rates are presented.
3. ‘Other’ may include chemist (for advice only), naturopath, nurse, optician/optometrist, osteopath, or other.

Source: AIHW 2012 analysis of ABS 2007–08 National Health Survey data. Table 1.

In 2011, there were almost 7.2 million scripts claimed for diabetes medicines

Of these 7.2 million scripts, 11% (around 816,000 scripts) were for insulin and 89% (around 6.4 million scripts) were for blood glucose-lowering (BGL) medications.
Metformin accounted for over 50% of all blood glucose-lowering drugs dispensed, with around 3.2 million scripts issued in 2011.
Between 1992 and 2011, the rate of scripts claimed through the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) for insulins and analogues, metformin and other blood glucose-lowering medications has gradually increased (Figure 2).

For more information see the Department of Human Services website.

Figure 2: Scripts claimed for diabetes medicines through the PBS and the RPBS, 1992–2011

Service use - scripts for diabetes medications GIF

Note: Data include scripts dispensed under both the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS).

Source: Data extracted by AIHW from the Department of Human Services website. Table 2.

Diabetes accounted for 4.0% of all hospitalisations in 2009–10

Diabetes was the principal diagnosis in around 96,000 hospitalisations in 2009–10 and was an additional diagnosis in approximately 249,000. This accounted for 4.0% of all hospitalisations in that year. These figures are not comparable with previous years due to coding changes.
Of hospitalisations with a principal diagnosis of diabetes, 71% were for Type 2 diabetes, 18% for Type 1 diabetes, 10% for diabetes in pregnancy, 0.5% for other types of diabetes and 0.7% were for unknown type of diabetes.
Of hospitalisations with Type 2 diabetes as a principal diagnosis, almost half (44%) were for eye complications of diabetes, mainly cataracts. Other conditions recorded in Type 2 diabetes hospitalisations were multiple complications (17%), other complications (9%), kidney complications (9%), circulatory complications (7%), poor diabetes control (7%) and hypoglycaemia (5%).
The most common causes of hospitalisations with Type 1 diabetes were acidosis (including ketoacidosis) (28%), diabetes without complication (16%), eye complications (15%), poor diabetes control (14%) and hypoglycaemia (11%) (Figure 3).

Figure 3: Diabetes complications recorded in hospitalisations with a principal diagnosis of Type 1 or Type 2 diabetes, 2009–10

Service use - diabetes complications in hospitalisations GIF

Notes:
1. Includes diabetes hospitalisations with ICD-10 codes of E10 or E11.
2. ‘Other’ includes neurological complications, unspecified complications, and other complications.

Source: AIHW 2011 analysis of the National Hospital Morbidity Database. Table 3.

Further information

AIHW 2010. General practice activity in Australia 2009–10. Cat. no. GEP 27. Canberra: AIHW.

Definitions

Acidosis: An abnormal condition of reduced alkalinity of the blood and tissues that is marked by sickly sweet breath, headache, nausea and vomiting, and visual disturbances and is usually a result of excessive acid production.
Analogues: Analogue insulin is a type of human insulin. Analogue insulin is made in the laboratory and genetically altered to create either a more rapid acting or more uniformly acting form of the insulin.
Blood glucose-lowering medications: These medications help the body to lower blood glucose levels through a variety of processes, including reducing the amount of stored glucose released by the liver, slowing the absorption of glucose from the intestine, and stimulating the pancreas to produce more insulin.
Chiropodist: See Podiatrist/podiatry.
Hypoglycaemia: Low blood glucose that is a complication of insulin treatment.
Insulin: Insulin is a hormone that helps regulate the movement of glucose from the bloodstream and into the cells. Changes in the production and action of insulin can affect glucose regulation.
Ketoacidosis: Ketoacidosis is a serious condition associated with illness or very high blood glucose levels in Type 1 diabetes. It develops gradually over hours or days. It is a sign of insufficient insulin. Most cases of ketoacidosis occur in people with Type 1 diabetes, it very rarely occurs in people with Type 2.
Metformin: Metformin belongs in the medicines class 'Biguanides' for diabetes management. It helps to lower blood glucose levels by reducing the amount of stored glucose released by the liver, slowing the absorption of glucose from the intestine, and helping the body to become more responsive to insulin.
Pharmaceutical Benefits Scheme: The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of a wide range of prescription medications, providing Australians with access to necessary and cost-effective medicines at an affordable price.
Podiatrist/Podiatry: Podiatry is a field of health care devoted to the study and treatment of disorders of the foot, ankle, and the knee, leg and hip.
Principal diagnosis: For each hospital separation, patients are assigned a principal diagnosis, which describes the chief reason for the patient’s episode of care.

Source data

Table 1: Referrals by GPs to other health professionals, 2007–08
Type of health professional	Proportion of referrals (%)
Diabetes educator	74.6
Dietitian/Nutritionist	15.1
Chiropodist/Podiatrist	5.8
Other	4.5
Total	100.0

Notes:
1. Based on self-reported information.
2. Crude rates are presented.
3. ‘Other’ includes chemist (for advice only), naturopath, nurse, optician/optometrist, or osteopath.

Source: AIHW 2012 analysis of ABS 2007–08 National Health Survey data.

Table 2: Scripts claimed for diabetes medicines through the PBS and the RPBS, 1992-2011
Year	Metformin	Insulins and analogues	Other BGL medications	Total
1992	452,296	308,464	859,660	1,620,420
1993	577,396	327,481	957,859	1,862,736
1994	673,992	336,951	981,434	1,992,377
1995	807,943	353,226	1,039,644	2,200,813
1996	957,087	375,844	1,121,517	2,454,448
1997	1,105,019	396,753	1,198,479	2,700,251
1998	1,258,114	409,001	1,303,460	2,970,575
1999	1,509,055	438,174	1,454,530	3,401,759
2000	1,788,241	469,635	1,582,935	3,840,811
2001	2,019,788	500,398	1,759,053	4,279,239
2002	2,306,309	523,957	1,926,336	4,756,602
2003	2,484,526	537,975	1,960,438	4,982,939
2004	2,621,058	566,445	2,118,494	5,305,997
2005	2,656,120	585,125	2,249,100	5,490,345
2006	2,706,308	607,875	2,364,466	5,678,649
2007	2,823,652	666,640	2,546,912	6,037,204
2008	2,919,179	684,816	2,622,150	6,226,145
2009	3,288,677	762,297	2,910,228	6,961,202
2010	3,312,823	790,590	3,009,357	7,112,770
2011	3,235,936	815,644	3,119,954	7,171,534