Diabetes: Australian facts

Diabetes-related complications are significant factors contributing to morbidity and mortality in Australia and are associated with increases in the costs associated with the treatment and management of diabetes (Lee et al. 2013; Twigg and Wong 2015). Diabetes is associated with both microvascular (small blood vessels such as capillaries and arterioles) and macrovascular (large blood vessels such as arteries and veins) complications, especially in those with out-of-range diabetes management and higher long-term blood glucose levels (Stratton et al. 2000).

Diabetes complications may include:

• microvascular complications to the eye (retinopathy), kidney (nephropathy), and nerves (neuropathy)
• macrovascular complications affecting the circulatory system including ischemic heart disease, peripheral vascular disease and cerebrovascular disease
• an increased risk of other complications developing including foot ulcers (Reardon et al. 2020).

High blood glucose levels can also cause acute hyperglycaemic emergencies (Deed et al. 2018). These emergencies include:

• Ketoacidosis which is a life-threatening complication characterised by hyperglycaemia and high levels of blood acids (ketones) and is mostly found in people with type 1 diabetes.
• Hyperosmolarity which draws water from the body’s organs and is characterised by persistent hyperglycaemia without ketoacidosis and is accompanied by profound dehydration.

Complications in health care

The Australian Diabetes Clinical Quality Registry (ADCQR) Annual Report 2024 includes data collected for around 3,000 adults living with diabetes attending services for diabetes care in 2024. Many of these patients recorded complications related to diabetes.

In the last 12 months, some of the common diabetic complications present in the cohort were:

• sexual dysfunction (6.9%) 
• end-stage kidney disease (6.1%)
• peripheral vascular disease (4.0%)
• lower limb amputation (2.1%)
• myocardial infarction (1.9%)
• congestive cardiac failure (1.3%)
• cerebral stroke (1.2%)
• blindness (1.0%).

The common diabetic complications ever reported in the cohort were:

• sexual dysfunction (14%)
• myocardial infarction (12%)
• peripheral vascular disease (9.0%)
• congestive cardiac failure (6.2%)
• cerebral stroke (5.8%)
• lower limb amputation (5.3%)
• blindness (2.5%).

The most common foot complication reported in the cohort was peripheral neuropathy, which was recorded for 12% of patients in the last 12 months and foot ulceration recoded for 7.4%. 

Kidney complications were common with almost one-third of patients (30%) having moderately increased albuminuria levels and 11% having severely increased levels in the last 12 months. Nearly 3 in 10 patients were classified as having stage 3–5 chronic kidney disease with 6.1% having end-stage kidney disease.

Eye complications were also common with 11% of patients reporting cataracts and 9.0% reporting retinopathy in the last 12 months (ADCQR 2024). 

Pregnancy complications

Diabetes in pregnancy, whether pre-existing (that is, type 1, type 2 or other diabetes type) or arising as a result of the pregnancy (gestational diabetes), is associated with an increased risk of adverse outcomes for both the mother and child during pregnancy, labour and delivery and in the longer term.

Note: The National Hospital Morbidity Database provides national data on pregnancies affected by diabetes, but International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) coding changes and the accuracy of recording diabetes type affect the ability to report on the number of pregnancies affected by and complications from pre-existing diabetes type. Further, in some cases, a definitive diagnosis of diabetes type cannot be made until after the birth of the baby, hence the initial diagnosis of gestational diabetes can include women with other forms of diabetes, detected for the first time in pregnancy (Nankervis et al. 2014).

Short-term outcomes

The complications and adverse outcomes experienced by mothers and their babies during pregnancy and delivery, vary between the types of diabetes (whether pre-existing or gestational diabetes), most likely due to the causes and effects of each diabetes type (AIHW 2019).

In 2023–24, compared to mothers without diabetes, mothers living with pre-existing diabetes (and to a lesser extent, gestational diabetes), were more prone to complications during pregnancy and intervention in childbirth. After adjusting for differences in the age structure of the populations, such complications and interventions include caesarean section, induced labour, preterm birth, maternal care for excessive foetal growth and pre-eclampsia (Figure 1).

Longer-term outcomes

Diabetes in pregnancy is also associated with longer-term adverse outcomes for both mother and baby. For women diagnosed with gestational diabetes this includes an increased risk of recurrence of the condition in subsequent pregnancies with studies showing recurrence rates to vary between 30% and 84% (Kim et al. 2007). They also experience an increased risk for the development of type 2 diabetes, metabolic syndrome and cardiovascular disease.

Babies of mothers living with diabetes in pregnancy are also at an increased risk of childhood metabolic syndrome, obesity, impaired glucose tolerance and type 2 diabetes in later life (Clausen et al. 2007; Kim et al. 2012; Zhao et al. 2016).