Impact of diabetes
Burden of disease
Burden of disease refers to the quantified impact of living with and dying prematurely from a disease or injury and is measured using disability-adjusted life years (DALY). One DALY is equivalent to one year of healthy life lost.
In 2018, type 2 diabetes was responsible for 112,500 DALY in Australia – equating to 4.5 per 1,000 population. Type 2 diabetes was the 12th leading contributor to total burden. After accounting for differences in the age structure of a population, the overall burden from type 2 diabetes decreased slightly from 3.9 per 1,000 population in 2003 to 3.8 per 1,000 population in 2018. Type 1 diabetes was responsible for 17,000 DALY, equating to 0.3 per 1,000 population – this was similar to the contribution in 2003 (0.4 per 1,000 population) (AIHW 2021a).
In 2018, 4.3% of the total burden of disease could have been prevented by reducing exposure to the modifiable risk factor ‘high blood plasma glucose levels’ (including diabetes) (AIHW 2021b).
See Burden of diabetes.
In 2018–19, an estimated $3.0 billion of expenditure in the Australian health system was attributed to diabetes, representing 2.3% of total disease expenditure. Of the $3.0 billion in expenditure:
- type 2 diabetes represented 61%
- type 1 diabetes 11%
- gestational diabetes 2.0%
- other diabetes 26% (AIHW 2021c).
See Health system expenditure.
Adverse effects in pregnancy
Based on data from the NHMD for 2020–21, mothers with pre-existing diabetes (and to a lesser extent, gestational diabetes) were more prone to complications during pregnancy and intervention in childbirth with higher rates of caesarean section, induced labour, pre-existing and gestational hypertension, and pre-eclampsia compared with mothers with no diabetes in pregnancy.
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).
See Pregnancy complications.
According to the AIHW National Mortality Database, in 2020, diabetes was the underlying cause of around 5,100 deaths. However, it contributed to around 17,500 deaths (10.8% of all deaths) when associated causes are included. (AIHW 2021e).
See Life expectancy and causes of death.
Treatment and management of diabetes
What is HbA1c?
Glycated haemoglobin, haemoglobin A1c or HbA1c, is the main biomarker used to assess long-term glucose control in people living with diabetes. Haemoglobin is a protein in red blood cells which can bind with sugar to form HbA1c. It is directly related to blood glucose levels and strongly related with the development of long-term diabetes complications. Because red blood cells can live for up to 120 days, HbA1c gives an indication of blood glucose over a few months.
HbA1c was endorsed for the diagnosis of diabetes in 2010 by the Australian Medical Association. Diagnosis is confirmed using HbA1c levels ≥48 mmol/L or ≥6.5%. HbA1c targets for people living with diabetes depend on the type of diabetes, life expectancy, risk of hypoglycaemia and other comorbidities.
According to the National Prescribing Service (NPS) MedicineInsight general practice insights report (NPS MedicineWise, 2021) in 2019–20, 67% of general practice patients with a diagnosis of diabetes (20 years and older) had at least one test result for HbA1c levels. Among MedicineInsight patients without a diagnosis of diabetes, only 11% had received at least one test for HbA1c levels.
According to the Australian National Diabetes Audit–Australian Quality Clinical Audit (ANDA–AQCA) 2021, among all adult patients with recorded diabetes (n=4,262), the median HbA1c level was 63.0 mmol/mol. Median HbA1c was slightly higher among patients with type 1 diabetes (66.0 mmol/mol) and slightly lower in patients with type 2 diabetes (62.0 mmol/mol). Patients with gestational diabetes had significantly lower median HbA1c levels (34.0 mmol/mol) (ANDA 2021).
See Ongoing monitoring.
In 2020–21, there were over 16.5 million prescriptions dispensed for diabetes medicines through Section 85 of the Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme, representing 5.3% of total prescriptions. Metformin, a glucose-lowering medication for patients with type 2 diabetes, was the seventh most dispensed medicine in 2020–21 (Department of Health 2021b).
According to the NDR, 30,800 people began using insulin to treat their diabetes in 2020. Of the people with diabetes who began using insulin, 52% had type 2 diabetes, 35% had gestational diabetes, 10% were newly diagnosed with type 1 diabetes and 2% had other forms of diabetes (AIHW 2022b).
See Medicines use.
Hospitalisations and procedures
Almost 1.3 million hospitalisations were associated with diabetes in 2020–21, with 4.7% recording diabetes as the principal diagnosis and around 95% recording diabetes as an additional diagnosis, according to the NHMD. This represents 11% of all hospitalisations in Australia (AIHW 2021d).
Of these, around 1.1 million recorded type 2 diabetes as the principal and/or additional diagnosis and 64,600 hospitalisations recorded type 1 diabetes as the principal and/or additional diagnosis.
People with diabetes may require procedures to manage their diabetes or treat the complications of diabetes. According to the NHMD, there were 4,500 weight loss procedures and 5,300 lower limb amputations undertaken for people with type 2 diabetes in 2020–21 (18 and 21 per 100,000 population, respectively).
Variation between population groups
The impact of diabetes varies between population groups. To account for differences in the age structures of these groups, the data presented below is based on age-standardised rates.
In recent years, the impact of diabetes has been higher among Aboriginal and Torres Strait Islander people, those living in lower socioeconomic areas and those living in remote areas (Figure 3). The diabetes prevalence rate was 2.9 times as high among Indigenous Australians as non–Indigenous Australians based on age–standardised self–reported data from the 2018–19 National Aboriginal and Torres Strait Islander Health Survey (ABS 2019b).
Generally, the impact of diabetes increases with increasing remoteness and socioeconomic disadvantage. Deaths related to diabetes were 1.9 times as high in Remote and very remote areas compared with Major cities, and 2.4 times as high in the lowest compared with the highest socioeconomic areas (Figure 3).
Figure 3: Variation in the impact of diabetes between selected population groups