Goal 1: Prevent people developing type 2 diabetes

Goal 1 indicators relate to the incidence and prevalence of type 2 diabetes in the population, as well as modifiable risk factors in the general population.

Eight indicators were identified to measure progress against Goal 1:

Indicator 1.1: Incidence of type 2 diabetes

There are currently no complete, national estimates of the incidence of type 2 diabetes in Australia. Part of the picture is available from the National (insulin-treated) Diabetes Register (NDR) which provides information regarding the incidence of insulin treated type 2 diabetes. However, many people with type 2 diabetes do not require insulin treatment, so the NDR data provide a substantial underestimate of the total type 2 diabetes incidence in the population. Nevertheless, it does provide an incidence estimate for the more severe cases of type 2 diabetes.

In 2016, there were over 16,000 new cases of insulin-treated type 2 diabetes recorded on the NDR (AIHW 2018). The incidence was highest in those aged 70–79 years (224 per 100,000 population) (Figure 1.1.1) and higher among males than females (74 and 49 per 100,000 population respectively)

Incidence of insulin-treated type 2 diabetes was over twice as high among people living in the most disadvantaged areas of Australia, compared to those living in the least disadvantaged areas, and 2.6 times as high in Indigenous Australians than other Australians (Figure 1.1.2). However, it is important to note that the NDR may have a lower coverage rate of Indigenous Australians and people living in Remote and Very remote areas and, as a result, the true incidence in these population groups may be underestimated (AIHW 2016a).

Figure 1.1.1 Incidence of insulin-treated type 2 diabetes, by age at first insulin use and sex, 2016

The vertical bar chart shows that the incidence rate of insulin–treated type 2 diabetes per 100,000 population. The incidence rate increased with increasing age, reaching a peak in those aged 70-79 years in both males (283 per 100,000 population) and females (169 per 100,000 population). With the exception of the 0–39 year age group, the incidence was higher among males than females.

Source: AIHW 2018. See data table ‘Indicator 1.1’ for data notes.

Figure 1.1.2 Incidence of insulin- treated type 2 diabetes, by population characteristics, 2016

The horizontal bar chart displays the age-standardised incidence rate of insulin-treated type 2 diabetes by Indigenous status, remoteness area and socioeconomic status. The incidence was 2.6 times as high among Indigenous Australians compared with non-Indigenous Australians, and higher among those living in the most disadvantaged areas when compared to those living in less disadvantaged areas.

Note:

  1. Age-standardised to the 2001 Australian population.

Source: AIHW 2018. See data table ‘Indicator 1.1’ for data notes.

Indicator 1.2 Prevalence of type 2 diabetes

In 2014–15, an estimated 1,005,700 people had type 2 diabetes based on self-reported data, which corresponds to 4.4% of the population. The prevalence increased with age, reaching a peak in those aged 75 and over (Figure 1.2.1). Among those 75 and over, around 1 in 6 people had type 2 diabetes. After adjusting for age, the proportion of males with self-reported type 2 diabetes was significantly higher than the proportion of females (4.4% and 3.4%, respectively).

Self-reported type 2 diabetes was significantly higher among those living in the most disadvantaged areas when compared to those living in the least disadvantaged areas (5.6% and 2.5%, respectively) (Figure 1.2.2). There were no significant differences by remoteness area or between states and territories.

In 2012–13, an estimated 36,700 Indigenous Australians had type 2 diabetes based on self-reported data, representing 6% of the Indigenous population. There was no significant difference between the age-standardised proportion of Indigenous males and females with type 2 diabetes (9.2% and 10.5%, respectively) (Data tables). It is important to note that non-Indigenous comparisons could not be obtained from the available Australian Bureau of Statistics (ABS) National Health survey data. As a result, all results based on ABS survey data compare Indigenous Australians with all Australians and results should be interpreted with this in mind.

In 2011–12 the ABS found that, based on biomedical data, around 1 in 5 people with diabetes were unaware that they had the condition (ABS 2013). Therefore, the estimates reported here, which are based on self-report, will be an underestimate of the total prevalence of type 2 diabetes in the Australian population.

Figure 1.2.1 Prevalence of type 2 diabetes, by age group and sex, 2014–15

The vertical bar chart shows the prevalence of type 2 diabetes, as a percentage of the population, by age group and sex. The prevalence increased with age, and reached a peak in those aged 75 years and older in both males (19%25) and females (14%25).

Source: AIHW analysis of ABS 2016a. See data table ‘Indicator 1.2’ for data notes.

Figure 1.2.2 Prevalence of type 2 diabetes, by population characteristics, 2014–15(2)

The horizontal bar chart displays the age-standardised prevalence of type 2 diabetes, by Indigenous status, remoteness area and socioeconomic status. The prevalence was higher among Indigenous Australians, compared with non-Indigenous, and higher among those living in areas of high socioeconomic disadvantage, and Outer Regional and Remote areas.

Notes:

  1. Age-standardised to the 2001 Australian population.
  2. Indigenous results were estimated using data from the ABS Australian Aboriginal and Torres Strait Islander Health Survey, 2012–13

Sources: AIHW analysis of ABS 2016a and ABS 2015a. See data table ‘Indicator 1.2’ for data notes.

Indicator 1.3 Waist circumference

In 2014–15, based on physical measurements obtained in the National Health Survey, it is estimated that over 60% of Australian adults had a waist circumference that put them at increased risk of developing a chronic disease. The age-standardised proportion was significantly higher in women compared to men (64% and 58%, respectively), and this was consistent across all age groups (Figure 1.3.1).

The proportion of people with an at-risk waist circumference was significantly higher among those living in the most disadvantaged areas compared to those in the least disadvantaged areas (63% and 57% respectively). Further, the proportion of people at risk increased with remoteness (Figure 1.3.2).

In 2012–13, 71% of Indigenous adults had a waist circumference that increased their risk of disease. The age-standardised proportion of at-risk females was significantly higher than males (84% and 68%, respectively) (Data tables).

Figure 1.3.1 Increased risk of developing a chronic disease based on waist circumference, by age group and sex, 2014–15

The vertical bar chart shows the proportion of adults with a waist circumference that puts them at increased risk of developing a chronic disease, by age group and sex. The proportion was higher among females than males in all age groups, and peaked in women aged 75 years and above (84%25) and males aged 65–74 years (82%25).

Source: AIHW analysis of ABS 2016a. See data table ‘Indicator 1.3’ for data notes.

Figure 1.3.2 Increased risk of developing a chronic disease based on waist circumference, by population characteristics, 2014–15(2)

The horizontal bar chart displays the age-standardised proportion of adults with a waist circumference that puts them at increased risk of a chronic disease, by Indigenous status, remoteness area and socioeconomic group. The proportion with an at-risk waist circumference increased with increasing levels of remoteness, and was higher among those who were living in the most disadvantaged areas compared to those living in less disadvantage.

Notes:

  1. Age-standardised to the 2001 Australian population.
  2. Indigenous results were estimated using data from the ABS Australian Aboriginal and Torres Strait Islander Health Survey, 2012–13

Sources: AIHW analysis of ABS 2016a and ABS 2015a. See data table ‘Indicator 1.3’ for data notes.

Indicator 1.4 Overweight and obesity

In 2014–15, it was estimated that almost two thirds of Australian adults were overweight or obese based on their measured body mass index (BMI). The age-standardised proportion of males who were overweight or obese was significantly higher than the proportion of females (71% and 55%, respectively, Data tables). Overweight and obesity peaked in those aged 55–64, affecting 3 in 4 people in this age group.

The prevalence of overweight and obesity was higher among people living in the most disadvantaged areas of Australia and outside of Major cities (Figure 1.4.2).

In 201213, after adjusting for age, 72% of Indigenous males and 73% of Indigenous females were overweight or obese based on physical measurements obtained in the National Health Survey (Data tables).

Figure 1.4.1 Overweight and obesity, by age group and sex, 2014–15

The vertical bar chart shows the proportion of males and females who were overweight and obese, by age group. A higher proportion of males were overweight or obese when compared with females across all age groups. The proportion peaked in males aged 45–74 years, where four in five were overweight or obese. Among females, the proportion was highest among those aged 65–74 years (69%25).

Source: AIHW analysis of ABS 2016a. See data table ‘Indicator 1.4’ for data notes.

Figure 1.4.2 Overweight and obesity, by population characteristics, 2014–15(2)

The horizontal bar chart displays the age-standardised proportion of adults who were overweight or obese by Indigenous status, remoteness area and socioeconomic group. The proportion was higher among those living in the most disadvantaged areas and outside of Major cities. The proportion of Indigenous Australians who were overweight or obese was higher than the proportion of non-Indigenous Australians (72%25 and 63%25 respectively).

Notes:

  1. Age-standardised to the 2001 Australian population.
  2. Indigenous results were estimated using data from the ABS Australian Aboriginal and Torres Strait Islander Health Survey, 2012–13

Sources: AIHW analysis of ABS 2016a and ABS 2015a. See data table ‘Indicator 1.4’ for data notes.

Indicator 1.5 Insufficient physical activity

In 2014–15, based on self-reported data, it was estimated that more than half (52%) of Australian adults aged 18–64 were insufficiently active or inactive in the previous week (<150 minutes of activity over 5 or more sessions) (Data tables). The proportion was slightly higher in women (54%) than men (51%), and increased with age (Figure 1.5.1).

Insufficient activity increased with increasing level of socioeconomic disadvantage. Over half (63%) of people living in the most disadvantaged areas were insufficiently active, compared with 40% of those living in the least disadvantaged areas. Further, insufficient activity increased with increasing remoteness, from 50% among those living in Major cities to 60% among people living in Outer regional and Remote areas (Figure 1.5.2).

In 2012–13, 62% of Indigenous Australians aged 18–64 were inactive or did not do sufficient physical activity in the past week, based on self-reported data.

For those aged 65 years and above, the physical activity recommendation is for at least 30 minutes of moderate intensity physical activity on five or more days of the week (AIHW 2018b). Based on this guideline, in 2014–15, an estimated three in four Australians over the age of 65 were classified as insufficiently active. There was no significant variation by remoteness area. However, the proportion meeting the activity guideline increased with decreasing socioeconomic disadvantage, from 19% among those living in the most disadvantaged areas to 31% among those in the least disadvantaged areas.

Figure 1.5.1 Insufficient physical activity, 18–64 years, 2014–15

The vertical bar chart displays the proportion of adults aged 18–64 years who are inactive, insufficiently active and sufficiently active by age group. The proportion who were inactive or insufficiently active increased across age groups and reached a peak those aged 55–64 years.

Source: AIHW 2018b. See data table ‘Indicator 1.5’ for data notes.

Figure 1.5.2 Insufficient physical activity, 18–64 years, by population characteristics, 2014–15

The horizontal bar chart displays the age-standardised proportion of the population aged 18–64 years who were inactive, insufficiently active and sufficiently active by remoteness area and socioeconomic status. Insufficient activity increased with increasing levels of socioeconomic disadvantage and levels of remoteness.

Note:

  1. Age-standardised to the 2001 Australian population.

Sources: AIHW 2018b. See data table ‘Indicator 1.5’ for data notes.

Indicator 1.6 Inadequate fruit and/or vegetable consumption

Almost all Australians failed to meet the 2013 Australian Dietary Guidelines for fruit and vegetable intake (NHMRC 2013) (Data tables). Based on self-reported data, the proportion of adult males with inadequate fruit and/or vegetable intake was significantly higher than the proportion of adult females (97% and 93%, respectively). There were no significant differences by remoteness area or by socioeconomic status (Figure 1.6.2).

In 2012–13, 97% of Indigenous Australians reported that they did not meet the guidelines for adequate fruit and/or vegetable intake. After adjusting for age, a slightly higher proportion of Indigenous males than females did not meet the recommended intake (98% and 95%, respectively) (Figure 1.6.2).

Figure 1.6.1 Inadequate fruit and/or vegetable consumption, by age group and sex, 2014–15

The vertical bar chart displays the proportion of Australians who did not meet the 2013 Australian Dietary Guidelines for fruit and vegetable intake by age group and sex. Across all age groups, the proportion who failed to meet the guidelines was approximately 90%25 or higher.

Source: AIHW analysis of ABS 2016a. See data table ‘Indicator 1.6’ for data notes.

Figure 1.6.2 Inadequate fruit and/or vegetable consumption, by population characteristics, 2014–15(2)

The horizontal bar chart displays the age-standardised proportion of the population who did not meet the 2013 Australian Dietary Guidelines for fruit and vegetable intake by Indigenous status, remoteness area and socioeconomic status. There was little variation, with the proportion failing to meet the guidelines greater than 90%25 among all population groups.

Notes:

  1. Age-standardised to the 2001 Australian population.
  2. Indigenous results were estimated using data from the ABS Australian Aboriginal and Torres Strait Islander Health Survey, 2012–13

Sources: AIHW analysis of ABS 2016a and ABS 2015a. See data table ‘Indicator 1.6’ for data notes.

Indicator 1.7 Total energy intake from saturated fatty acids

In 2011–12, Australian adults reported that 12% of their energy intake was from saturated fats (including trans fatty acids), which exceeds the recommended intake of no more than 10% of energy (Data tables). There was no significant difference between men and women, and little difference across age groups (Figure 1.7.1).

There was no significant difference in the energy intake from saturated fat by socioeconomic status. While those living in Major cities consumed a significantly lower proportion of saturated fat compared with those living in other areas, differences were small (Figure 1.7.2).

In 2012–13, Indigenous Australian's consumed 13% of their total energy intake from saturated fats. There was no significant difference between Indigenous men and women (Data tables).

Figure 1.7.1 Mean proportion of energy intake from saturated fat (including trans fatty acids), by age group and sex, 2014–15

The vertical bar chart displays the mean proportion of energy intake from saturated and trans fatty acids, by age group and sex. There was little variation in the mean intake by age group or sex. The highest intake was among males aged 2–17 years (14%25) and lowest among females aged 55–64 years (11%25).

Source: AIHW analysis of ABS 2016c. See data table ‘Indicator 1.7’ for data notes.

Figure 1.7.2 Mean proportion of energy intake from saturated fat (including trans fatty acids), by population characteristics, 2014–15(2)

The horizontal bar chart displays the age-standardised mean proportion of energy intake from saturated and trans fatty acids by Indigenous status, remoteness area and socioeconomic status. There was little variation by Indigenous status or socioeconomic status. However, intake was slightly lower among those living in Major cities compared with those in other areas.

Notes:

  1. Age-standardised to the 2001 Australian population.
  2. Indigenous results were estimated using data from the ABS Australian Aboriginal and Torres Strait Islander Health Survey: Nutrition Results - Food and Nutrients, 2012-13

Sources: AIHW analysis of ABS 2016c; ABS 2015b. See data table ‘Indicator 1.7’ for data notes.

Indicator 1.8 Exclusive breastfeeding

The current Australian infant feeding guidelines recommend that children should be exclusively breastfed to around 6 months of age (NHMRC 2013). In 2014–15, it was estimated that 1 in 4 children aged 6 to 24 months exclusively breastfed to at least 6 months of age (ABS, 2017).

Data from the 2010 Australian National Infant Feeding Survey showed that exclusive breastfeeding was initiated for 90% of all children aged 0–24 months (AIHW 2011). However, only 2% of infants were exclusively breastfed to 6 months of age (Figure 1.8.1).

The rate of exclusive breastfeeding to 6 months of age was lower in Remote and Very remote areas compared with less remote areas. By socioeconomic status, the rate of exclusive breastfeeding to 6 months was highest in the most disadvantaged areas (Figure 1.8.2).

While numbers were too small to estimate the proportion of Indigenous mothers who breastfed exclusively to 6 months of age, the rate of initiation was slightly lower among Indigenous mothers (87%) compared with non-Indigenous mothers (90%) and the decline in exclusive breastfeeding was more rapid. At 4 months of age, the rate of exclusive breastfeeding was more than twice as high among non-Indigenous mothers when compared with Indigenous mothers (40% and 11% respectively, Data tables).

Figure 1.8.1 Exclusive breastfeeding by child’s age in months, 2010

The vertical bar chart displays proportion of children who were exclusively breastfed by the child’s age in months. While around 90%25 of children began exclusive breastfeeding, the proportion declined rapidly with age and, at 6 months, only 2%25 were exclusively breastfed.

Source: AIHW 2011. See data table ‘Indicator 1.8’ for data notes.

Figure 1.8.2 Exclusive breastfeeding to 6 months of age, by population characteristics, 2010

The horizontal bar chart displays the proportion of children who were exclusively breastfed to 6 months of age by remoteness area and socioeconomic status. Exclusive breastfeeding was highest among those living in the most disadvantaged areas (3%25) and lowest among those living in Remote or Very remote areas (1%25). However, differences between population groups were small.

Source: AIHW 2011. See data table ‘Indicator 1.8’ for data notes.