MANAGING THE RISKS

In Australia, the National Preventative Health Taskforce has a policy of coordinated care for people with diabetes to improve management of their condition and help them stay healthy and out of hospital. Initiatives include enabling access to services such as dieticians, and supporting practice nurses to undertake a broad range of prevention activities, such as health assessments, health promotion and advice, and educating patients on lifestyle issues [18]. People with diabetes and high glucose levels are encouraged to self manage their condition through a range of measures, such as:

• medication;
• monitoring blood glucose levels;
• monitoring the condition of their feet;
• weight control;
• improving physical activity levels; and
• reducing tobacco and alcohol consumption.

TREATMENT

In general, Type 1 diabetes is treated by insulin, diet and exercise. For people with Type 2 diabetes, initial treatment involves diet, exercise and weight reduction to normalise blood glucose levels. As the condition progresses, most people will need one or more medications and may also require insulin [19].

In 2007-08, just under two-thirds of people with diabetes used medication to help manage their condition (63%), and one out of five used insulin every day (21%). More women (24%) than men (18%) used insulin every day. About 6% of people with diabetes used vitamin or mineral supplements or natural or herbal remedies.




Around 13% of people with Type 2 diabetes used insulin every day.

CONTROLLING BLOOD GLUCOSE LEVELS

Regular testing of blood glucose levels allows people with diabetes to adjust their diet and treatment schedule to maintain control of their levels. Advice to general practitioners is that a reasonable approach in a patient with stable glucose control would involve testing at different times of the day on 2–3 days a week [19]. Controlling blood glucose levels can significantly reduce the risk of developing serious health problems associated with diabetes [20].

Just under half of people with diabetes (45%) tested their blood glucose levels at least once a day, and an additional 22% tested their blood glucose levels at least once a week. A third of people with diabetes tested their blood glucose less regularly than once a week, with 2% reporting that they did not check their blood glucose levels at all in the past year.

FOOT CHECKS

People with diabetes are encouraged to have regular foot checks, as diabetes can cause nerve damage and poor circulation in the lower limbs. This can increase the risk of developing foot ulcers and infections, which in turn can result in foot or leg amputations [13].

In 2007-08, 10% of people with diabetes checked their feet at least once a day and a further 9% checked their feet at least once a week. Just over a quarter of people with diabetes had not had their feet checked at all in the past year (27%).

HEALTHY EATING AND WEIGHT LOSS

Maintaining a healthy diet can play an important role in the prevention and management of diabetes through its influence on body weight, particularly obesity. Increased body weight can lead to increased resistance to insulin as well as affecting the production of insulin. Losing weight reduces the risk of diabetes in people who are overweight or obese by improving insulin sensitivity [13].

In Australia, three out of four people with diabetes (74%) followed a changed eating pattern or diet to help manage their diabetes. Men were more likely to do this than women (78% compared with 70%). Around 17% of people with diabetes reported losing weight to help manage their diabetes.

One in three people with diabetes who said they changed their eating pattern or diet reported that their weight had decreased in the past year (33%), with more women than men reporting this (40% and 28% respectively). Around 16% of people with diabetes that had changed their diet reported they had gained weight.

Just over half the people with diabetes who said they tried losing weight to help manage their condition reported that their weight decreased in the past year (55%), while 17% who tried losing weight reported a weight increase in that time (Graph 6).




IMPROVING PHYSICAL ACTIVITY LEVELS

Exercise has been shown to significantly improve blood glucose control and reduce mortality for people who have diabetes, particularly for those who have Type 2 diabetes [13]. Of people with diabetes, around a quarter (27%) reported that they had exercised most days in the last 2 weeks specifically to help manage their diabetes.