Diabetes: Australian facts

Risk factors are attributes, characteristics or exposures that increase the likelihood of a person developing a condition or health disorder.

• Some risk factors are called modifiable, because a person can do something about them. For example, smoking is a modifiable risk factor because a person can stop smoking. Non-modifiable risk factors are those which you cannot change, for example, a family history of diabetes.
• Type 1 diabetes is strongly linked to family history with the condition, but the exact cause is unknown at this time. There are no modifiable factors which increase the risk for type 1 diabetes, although maintaining a healthy lifestyle is important for managing the symptoms and long-term complications associated with the condition.
• Both age and sex are key factors which can increase the risk of developing type 2 diabetes, as can family history and certain ethnic backgrounds–through inherited genes or through sharing an environment of risky health behaviours. Diabetes and mental health are also closely associated, where people with mental health conditions are at increased risk of developing diabetes (Lindekilde et al. 2021) and Australians with diabetes are more likely than other Australians to have poor mental health and wellbeing (AIHW 2011). These effects can arise directly, through biological pathways including the side effects of medications, and indirectly, through health behaviours.
• Some factors involved in developing type 2 and gestational diabetes are not linked to modifiable risk factors. However, both conditions are associated with modifiable behavioural and biomedical risk factors that increase the risk of diagnosis and related complications. Clustering of biomedical risk factors with a common underlying cause, as found in metabolic syndrome, also increases the risk of developing type 2 diabetes (Harris 2013).
• The Australian type 2 diabetes risk assessment tool (AUSDRISK) is a short list of questions assessing both modifiable and non-modifiable risk factors which can assess the risk of a person developing type 2 diabetes over the next 5 years. It evaluates both modifiable and non-modifiable risk factors for diabetes, including age, sex, ethnicity, parental history of diabetes, history of high blood glucose levels, use of antihypertensive medications, smoking, physical inactivity and sex/ethnicity-based waist circumference measures.
• Biomedical risk factors are bodily states that have an impact on a person’s risk of disease.  Some biomedical risk factors can be influenced by health behaviours. Biomedical risk factors for type 2 diabetes include:
  • impaired fasting glucose and impaired glucose tolerance
  • high blood pressure (also known as hypertension)
  • dyslipidaemia
  • overweight and obesity
  • abdominal obesity (measured by waist circumference).
• Behavioural risk factors are health-related behaviours that individuals have the most ability to modify. Behavioural risk factors for type 2 diabetes include:
  • unhealthy diet, such as inadequate fruit and vegetable intake
  • insufficient physical activity
  • smoking.
• For most risk factors there is no known threshold at which risk begins. The relationship between risk and disease is continuous – there is an increasing effect as exposure to the risk factor increases. Having multiple risk factors further escalates risk.
• Many chronic conditions, including diabetes, share behavioural and biomedical risk factors. Modifying these risk factors can reduce an individual's risk of developing type 2 diabetes prematurely and result in large health gains by reducing illness and rates of death.