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INTRODUCTION

This article provides a brief overview of the differentials in prevalence, risk factors, actions taken after diagnosis of diabetes mellitus, and resultant conditions from diabetes mellitus, using data from the 2001 ABS National Health Survey. A study is also made of the health of persons aged 45 years and over, comparing those in the population diagnosed with diabetes mellitus, with the rest of that age group. The article also draws on data from the ABS Causes of Death collection.

INQUIRIES

For further information about these and related statistics, contact the National Information and Referral Service on 1300 135 070 or Jane Griffin-Warwicke on Canberra (02) 6252 6535.

DIABETES

Diabetes was identified as a National Health Priority Area in 1996. It is a chronic condition in which blood glucose levels become too high due to the body producing little or no insulin, or not using insulin properly. Insulin is a hormone produced by the pancreas to assist the body to use glucose. Unless otherwise stated this article presents information sourced from the 2001 ABS National Health Survey (NHS).

TYPES OF DIABETES

There are three types of diabetes:

• Type 1, or insulin dependent diabetes mellitus (likely to develop before 18 years of age).
• Type 2, or non-insulin dependent diabetes mellitus (likely to develop after 40 years of age).
• Gestational diabetes mellitus (occurs in about 4-6% of pregnancies). In this analysis, gestational diabetes has not been discussed as it is not a long-term condition.

• In 2001, 2.9% of the whole population reported that they had diabetes.
• The prevalence of diabetes rose from 1.2% in 1989-90 to 2.0% in 1995, and to 2.9% in 2001.
• In 2001, those reporting they had Type 1 diabetes accounted for 17% of those with long-term diabetes, those reporting they had Type 2 diabetes accounted for 78%, while 5% reported diabetes but did not know which type.
• Based on studies comparing self-reported diabetes with medical testing for diabetes, there is evidence that for every known case of diabetes, there is one undiagnosed case (International Diabetes Institute 2001, King & Rewers 1993).

AGE DISTRIBUTION OF PERSONS WITH DIABETES, BY TYPE, 2001

• The difference in prevalence between males and females was not statistically significant (2.9% compared with 3.0%).
• 24.7% of diabetics lived in the most disadvantaged areas, whereas 13.7% of those with diabetes lived in the most advantaged areas (as measured as being in the first or fifth quintiles of the Index of Relative Socio-Economic Disadvantage (SEIFA) respectively).
• Indigenous Australians, Pacific Islanders, people of Chinese descent and those from the Indian sub-continent were more likely than other Australians to have Type 2 diabetes (AIHW 2002).

• Diabetes was reported by 5% of the Indigenous population.
• After adjusting for age, Indigenous Australians were more than three times as likely as non-Indigenous population to have diabetes (11% compared with 3%).
• Indigenous Australians living in remote rather than non-remote areas were approximately twice as likely to have diabetes (16% in remote areas, 9% in non-remote areas).

PREVALENCE OF DIABETES BY INDIGENOUS STATUS AND AGE GROUP, 2001

TYPE 2

Non-modifiable factors:

These include age, ethnicity, family history and women who have had gestational diabetes, and their children.

Modifiable factors:

Excess weight

• Overweight adults are three times more likely and obese adults possibly 10 times more likely, of developing Type 2 diabetes (AIHW 2002). Of those with diabetes over the age of 15 and with a reported Body Mass Index (BMI), 69.9% were either overweight or obese, compared to 47.5% of the rest of the population.
• Physical activity and diet modification can delay or prevent progression to Type 2 diabetes (AIHW 2002, refers to Diabetes Prevention Program Research Group 2002; Tuomilehto et al. 2001). In 2001, 77.1% of those with diabetes over the age of 15 had no, or low levels of exercise, compared to 68.2% of those without diabetes. Diabetics are more likely to do no, or have a low level of exercise, and be known to be obese or overweight (54.9% compared with 33.6%). Those with no, or a low level of exercise, are also more likely to be living in the most disadvantaged areas (in the first or second quintiles of the Index of Relative Socio-Economic Disadvantage).

• are 25 years or older;
• have a history of glucose intolerance or previous gestational diabetes;
• are from certain high-risk ethnic groups;
• are from a family with a history of diabetes;
• have a history of 'large for gestational age' babies; and
• are overweight or obese before their pregnancy (AIHW 2002).

• The most common actions taken were to change eating patterns (81.2%) and to use insulin (21.3%) or other pharmaceutical medications (60.6%).
• No action was taken by 4.5% of those who reported that they had diabetes.

• In 2002, diabetes was the sixth leading underlying cause of death of Australians (AIHW 2002)
  • It was the underlying cause of 3,329 registered deaths, which was 2.5% of all deaths.
  • There were 8,138 deaths where diabetes was reported on death certificates in 2002, but not as the underlying cause.
• Diabetes can result in many long term health conditions eg. heart disease, stroke, blindness, kidney failure, neuropathy and lower limb amputations.
  • Of those with an eye condition, 18.3% were known to have the condition due to diabetes.
  • Diabetics were less likely to be a current smoker (17.4%) than non-diabetics (24.6%), but more likely to be an ex-smoker (36.2% compared with 25.9%).

Indirect age standardised rates, persons aged 45 years and over, 2001 National Health Survey - Australia
		Diabetics	Non-diabetics	Rate ratio(a)
		%	%
Type of heart or circulatory condition(b)
	High blood pressure	40.8	25.0	1.6
	High cholesterol	23.3	14.4	1.6
	Fluid problems/fluid retention	8.8	3.7	2.4
	Angina	7.1	3.5	2.0
	Heart attack	3.6	1.5	2.4
	Stroke	2.9	1.3	2.2
	Does not suffer from heart or circulatory condition	37.4	57.7	0.6
Labour force status
	Employed	36.0	45.8	0.8
	Not in the labour force	57.8	52.5	1.1
Main source of personal income
	Wage or salary	27.4	34.4	0.8
	Government pension or allowance	48.6	39.3	1.2
Total weekly personal income
	Less than $300 per week	55.4	47.3	1.2
	$700 and over	18.2	20.5	0.9
Index of Relative Socio-Economic Disadvantage (SEIFA)
	1st and 2nd quintile (most disadvantaged)	47.3	37.8	1.3
	3rd quintile	18.0	18.8	1.0
	4th and 5th quintile (least disadvantaged)	33.5	43.3	0.8
(a) Rate ratio is calculated by dividing the proportion of diabetics by the proportion of non-diabetics.
(b) Person may have more than one condition specified.

REFERENCES

Australian Bureau of Statistics 2001, National Health Survey: Summary of results, Australia cat. no. 4364.0, ABS, Canberra.

Australian Bureau of Statistics 2001, National Health Survey, unpublished data.

Australian Bureau of Statistics 2001, National Health Survey: Aboriginal and Torres Strait Islander Results, Australia cat. no. 4715.0, ABS, Canberra.

Australian Bureau of Statistics 2002, Causes of Death, Australia,cat.no. 3303.0, ABS, Canberra .

Australian Institute of Health and Welfare 2001, National diabetes register statistical profile December 2000, Diabetes Series No. 2. AIHW Cat. No. CVD 18, Canberra.

Australian Institute of Health and Welfare 2002, Diabetes: Australian Facts. National Centre for Monitoring Diabetes.

Diabetes Prevention Program Research Group 2002, Reduction in the incidence of Type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346:393-403.

International Diabetes Institute, Diabesity & Associated Disorders in Australia 2000, The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) 2001, Melbourne.

King, H., & Rewers., M 1993, Global estimates for prevelence of diabetes mellitus and impaired glucose tolerance in adults. Diabetes Core, 6(1):157-77.

Tuomilehto, J., Lindstrom. J., Eriksson, J., et al. 2001, Prevention of Type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine, 344 (18):1343-50.