Diabetes indicator specification table

Proportion of people overweight or obese
Rationale Overweight and obesity is a significant predictor of type 2 diabetes. Excess body fat increases insulin resistance and effective weight management can help prevent type 2 diabetes in people with impaired glucose tolerance.

 

Measurement of the indicator Numerator: Based on Body Mass Index (BMI)―calculated by dividing a persons measured weight in kilograms by the square of their measured height in metres (kg/m2)― is the estimated number of adults aged 18 years and over who are:

 

  • overweight, but not obese (BMI values of 25 to less than 30)
  • obese (BMI values of 30 or more)
  • overweight and obese (BMI values of 25 or more).

Data sources: ABS NHS, 2007–08 (reissue) (Cat No.4634.0); ABS AHS (NHS component), 2011–12 (Cat No.4634.0.55.003); ABS NHS, 2014–15 (Cat No.4634.0.55.001).

Denominator: Total adult population.

Data sources: ABS ERPs.

Data considerations Age-standardised to the 2001 Australian population.

There are some limitations with this method of data collection (see data sources).

The ABS 2007–08 and 2011–12 excluded persons for whom height or weight were not measured. In the 2014–15 ABS NHS, imputation was used to obtain height, weight and BMI scores for persons whose height and weight were not measured (27%).

Results were obtained from National Health Survey: First Results, 2014–15; Table 1: Summary health characteristics, 2001 to 2014–15—Australia.

 

Proportion of people not following guidelines for physical activity
Rationale Participation in physical activity can reduce the risk of developing type 2 diabetes, slow the progression from impaired glucose regulation to type 2 diabetes, and reduce diabetes-related mortality. It can also modify, or reduce the impact of, other risk factors for diabetes and its complications, such as obesity and high blood cholesterol.

 

Measurement of the indicator Numerator: Estimated number of adults aged 18 years and over who reported being inactive or having only low levels of exercise.

Data sources: ABS NHS, 2007–08 (reissue) (Cat No.4634.0); ABS AHS (NHS component), 2011–12 (Cat No.4634.0.55.003); ABS NHS, 2014–15 (Cat No.4634.0.55.001).

Denominator: Total adult population.

Data sources: ABS ERPs.

 

Data considerations Age-standardised to the 2001 Australian population.

Based on self-reported data. There are some limitations with this method of data collection (see data sources).

This indicator uses the NHS levels of physical activity, 'low or no exercise' to align as closely as possible to the insufficient levels of physical activity as outlined in Australian Physical Activity Guidelines (1999) and the Australian Physical Activity and Sedentary Behaviour Guidelines (2010 and 2014).

Exercise is defined as that undertaken for fitness, sport or recreation in the last week.

Results were obtained from National Health Survey: First Results, 2014–15; Table 1: Summary health characteristics, 2001 to 2014–15—Australia.

 

Proportion of people not following dietary recommendations
Rationale Diet plays an important role in the management of diabetes. Poor diet is a risk factor for type 2 diabetes largely through its influence on body weight, and particularly obesity.

 

Measurement of the indicator Numerator: According to the Australian Dietary Guidelines (2013), the estimated number of adults aged 18 years and over who usually consumed:

 

  • inadequate fruit (less than two serves of fruit per day)
  • inadequate vegetables (less than five serves of vegetables per day).

Data sources: ABS NHS, 2007–08 (reissue) (Cat No. 4634.0); ABS AHS (NHS component), 2011–12 (Cat No. 4634.0.55.003); ABS NHS, 2014–15 (Cat No. 4634.0.55.001).

Denominator: Total adult population.

Data sources: ABS ERPs.

Data considerations Age-standardised to the 2001 Australian population.

Based on self-reported data. There are some limitations with this method of data collection (see data sources).

Fruit and vegetable intake represent only a component of dietary guidelines, which encapsulate a wide range of recommendations.

Results were obtained from National Health Survey: First Results, 2014–15; Table 1: Summary health characteristics, 2001 to 2014–15—Australia.

 

Proportion of people effectively managing type 2 diabetes
Rationale Glycated haemoglobin (HbA1c) is used to measure how well a person is managing their diabetes. Maintaining an optimum level of HbA1c decreases a person’s risk of developing a range of complications, including problems with their circulation, kidneys, eyes and feet.

 

Measurement of the indicator Numerator: Number of adults aged between 18 and 69 years with known diabetes, as determined by a fasting plasma glucose (FPG) test, who have an HbA1c level of less than or equal to 7%.

Data source: ABS AHS: Biomedical Results for Chronic Diseases, 2011–12 (Cat No. 4364.0.55.005).

Denominator: Number of adults aged between 18 and 69 years with known diabetes, as determined by a FPG test.

 

Data source: ABS AHS: Biomedical Results for Chronic Diseases, 2011–12 (Cat No. 4364.0.55.005).
Data considerations Persons aged 18 years to 69 years, including pregnant women.

The biomedical component of the 2011–12 ABS AHS contained two tests for detecting biomedical signs of diabetes: a measure of FPG (which measures the level of sugar in the persons blood at the time of testing) and a measure of HbA1C (estimates average blood sugar levels over a 3 month period). For this indicator, known diabetes is derived using a combination of FPG test results, where fasting had lasted for 8 hours or more, and self-reported information on the presence of diabetes and medication use. Around one in five (21%) people aged 18 and over who participated in the AHS did not fast, meaning that their FPG results could not be used.

Results were obtained from the Steering Committee for the Review of Government Service Provision 2013, National Agreement performance information 2012–13: National Healthcare Agreement, Productivity Commission, Canberra; Performance Indicators 1 to 16 attachment; Table 15.1: Proportion of people aged 18 to 69 years with known diabetes who have a HbA1c (glycated haemoglobin) level less than or equal to 7%, by state and territory, by sex, 2011–12.

 

Prevalence of diabetes
Rationale The prevalence (number of cases in the population) of diabetes highlights the burden of diabetes in the community. Ongoing and regular monitoring of the prevalence of diabetes provides important information for evaluating the effectiveness of prevention and treatment strategies.

 

Measurement of the indicator Numerator: Estimated number of people with diabetes, based on self-reported data.

Data sources: ABS NHS, 1989–90 (Cat No. 4366.0); ABS NHS, 1995 (Cat No.4368.0); ABS NHS, 2001 (Cat No.4634.0); ABS NHS, 2004–05 (Cat No.4634.0); ABS NHS, 2007–08 (reissue) (Cat No.4634.0); ABS AHS (NHS component), 2011–12 (Cat No.4634.0.55.003); ABS NHS, 2014–15 (Cat No.4634.0.55.001).

Denominator: Total Australian population.

 

Data sources: ABS ERPs.
Data considerations Age-standardised to the 2001 Australian population.

Based on self-reported data. There are some limitations with this method of data collection (see data sources).

While many individuals are aware of, and accurately report their diabetes, there are some who may not be aware that they have diabetes. This means that information based on self-reported data only is likely to underestimate the prevalence of diabetes. Results from the 2011–12 ABS AHS indicate for every 4 adults with diagnosed diabetes, there is approximately 1 with undiagnosed diabetes.

 

Incidence of diabetes
Rationale The incidence (number of new cases) of diabetes helps to predict future needs for health services and to evaluate the effectiveness of prevention programs.

 

Measurement of the indicator Numerator: Number of new cases of type 1 diabetes.



Data source: AIHW analysis of National (insulin-treated) Diabetes Register (NDR) 2014.



Denominator: Total Australian population.



Data sources: ABS ERPs.
Data considerations Age-standardised to the 2001 Australian population.

The coverage of insulin treated diabetes on the NDR is dependent on the coverage of its primary data sources—the National Diabetes Service Scheme (NDSS) and Australasian Paediatric Endocrine Group (APEG). People must register with the NDSS to access subsidised products to administer insulin and manage their diabetes. As insulin is required for all people with type 1 diabetes, registering with the NDSS provides an incentive for people with type 1 diabetes to obtain these products at subsidised prices—it is for this reason that most people with type 1 diabetes are likely to be captured on the NDR.

 

Prevalence of cardiovascular disease among people with diabetes
Rationale People with diabetes tend to have higher blood pressure and abnormal cholesterol levels, both which are factors that increase the risk of developing cardiovascular disease (CVD). People with diabetes can slow or delay the onset of CVD by improving their diabetes management and self care.

 

Measurement of the indicator Numerator: Estimated number of people with diabetes and CVD.

Data sources: AIHW analysis of ABS Microdata: AHS, 2011–12 (NHS component); and NHS, 2014–15.

Denominator: Estimated total number of people with diabetes, based on self-reported data.

Data sources: AIHW analysis of ABS Microdata: AHS, 2011–12 (NHS component); and NHS, 2014–15.

 

Data considerations Age-standardised to the 2001 ABS NHS diabetes population.

Based on self-reported data. Information based on self-reported data only is likely to underestimate the prevalence of diabetes and CVD as respondents may not have known or been able to accurately report their health status (see data sources).

CVD is defined to include persons who reported having hypertensive disease, ischaemic heart diseases, cerebrovascular diseases, tachycardia, oedema, diseases of arteries, arterioles and capillaries, diseases of veins and lymphatic vessels, other diseases of the circulatory system and symptoms and signs involving the circulatory system that were current and long term.

Persons who reported having ischaemic heart diseases, other heart diseases and cerebrovascular diseases that were current and not long term or not current were also counted.

 

Prevalence of vision loss among people with diabetes
Rationale People with diabetes are at risk of developing diseases such as retinopathy, cataracts and glaucoma, which can lead to vision loss if left untreated. Optimal management of blood glucose levels and blood pressure, and regular comprehensive eye examinations, can reduce the risk of developing diabetes associated eye problems.

 

Measurement of the indicator Numerator: Estimated number of people with a sight condition caused by diabetes.

Data source: AIHW analysis of ABS Microdata: AHS, 2011–12 (NHS component); and NHS, 2014–15.

Denominator: Estimated total number of people with diabetes, based on self-reported data.

Data sources: AIHW analysis of ABS Microdata: AHS, 2011–12 (NHS component); and NHS, 2014–15.

 

Data considerations Age-standardised to the 2001 ABS NHS diabetes population.

Based on self-reported data. Information based on self-reported data only is likely to underestimate the number of people with diabetes and vision loss as respondents may not have known or been able to accurately report their health status (see data sources).

 

Prevalence of treated end-stage kidney disease among people with diabetes
Rationale People with diabetes are at greater risk of kidney damage which results from high blood glucose levels damaging the blood-filtering capillaries in the kidneys. Diabetes is the leading cause of end-stage kidney disease (ESKD). Maintaining good blood glucose control and blood pressure can greatly reduce the risk of developing kidney damage.

 

Measurement of the indicator Numerator: Number of ESKD cases among people with diabetes.

Data source: AIHW analysis of Australian and New Zealand Dialysis and Transplant Authority (ANZDATA) prevalence 2014.

Denominator: Estimated total number of people with diabetes, based on self-reported data.

Data sources: AIHW analysis of ABS Microdata: NHS, 2001, 2004–05, 2007–08 and 2014–15; and AHS (NHS component), 2011–12.

 

Data considerations Age-standardised to the 2001 ABS NHS diabetes population.

The denominator which is based on self-reported diabetes information may underestimate the number of people with diabetes as respondents may not have known or been able to accurately report their health status (see data sources).

 

Incidence of non-traumatic amputation among people with diabetes
Rationale For people with diabetes, high blood sugar levels can damage the nerves and blood vessels, particularly in the feet, potentially resulting in the need for lower limb amputation. Timely and effective management, through regular comprehensive feet examinations and diabetes management and self care, can reduce the risk and occurrence of diabetes-related complications.

 

Measurement of the indicator Numerator: Number of hospitalisations where non-traumatic lower-limb amputation procedure is performed at least once for those admitted to hospital for a diagnosis of diabetes.

Data sources: AIHW analysis of the National Hospital Morbidity Database 2000–01, 2004–05, 2007–08, 2011–12 and 2014–15. ICD-10 codes E10–E11, E13–E14 and O24.4 were used to define diabetes.

Denominator: Estimated total number of people with diabetes, based on self-reported data.

Data sources: AIHW analysis of ABS Microdata: NHS, 2001, 2004–05, 2007–08 and 2014–15; and AHS (NHS component), 2011–12.

 

Data considerations Age-standardised to the 2001 ABS NHS diabetes population.

The denominator which is based on self-reported diabetes information may underestimate the number of people with diabetes as respondents may not have known or been able to accurately report their health status (see data sources).

Hospitalisation data is based on episodes of care and it is not possible to link records of multiple hospitalisations in the database to individuals. Therefore people admitted for a second lower-limb amputation procedure will be counted twice.

Changes in the interpretation of how the coding standard for additional diagnoses should be applied under the ICD-10-AM 6 edition (used 1 July 2008 to 30 June 2010) and changes in coding practice for classifying diabetes under the ICD-10-AM 7th edition (used from the 1 July 2010) resulted in a decrease in the number of hospitalisations reported for diabetes between 2009–10 and 2010–11. In 2012, further changes in coding practice resulted in an increase in the number of hospitalisations for diabetes between 2011–12 and 2012–13. This should be taken into account when interpreting trends over time.

 

Diabetes-related death rate
Rationale Diabetes has a substantial impact on mortality in Australia (among the top ten leading causes), however it may not be diabetes itself that directly leads to deaths, but one of its many complications including heart disease, stroke and kidney disease.

 

Measurement of the indicator Numerator: Number of people who had diabetes listed as the underlying cause or as an associated cause of death on their death certificate.

Data source: AIHW analysis of National Mortality Database (1997 to 2013). ICD-10 codes E10–E11, E13–E14, O24.0–O24.4 and O24.9 were used to define diabetes.

Denominator: Total Australian population.

Data sources: ABS ERPs.

 

Data considerations

Age-standardised to the 2001 Australian population.

Mortality data were provided by the Registries of Births, Deaths and Marriages, the ABS and the National Coroners Information System. These data are held by the AIHW in the National Mortality Database.

Deaths for 2012 and 2013 are based on revised and preliminary data, respectively, and are subject to further revision.

Abbreviations

ABS—Australian Bureau of Statistics
AHS—Australian Health Survey
ERP—Estimated Resident Population
NHS—National Health Survey