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DIABETES BIOMARKERS

Diabetes is a chronic condition where insulin, a hormone that controls blood glucose levels, is no longer produced or not produced in sufficient amounts by the body.¹ If left undiagnosed or poorly managed, diabetes can lead to coronary heart disease, stroke, kidney failure, limb amputations or blindness. In 2011, diabetes was the sixth leading cause of death in Australia.²

The National Health Measures Survey (NHMS) provides an objective measurement of the number of people with diabetes in Australia. It included two tests to measure diabetes: a fasting plasma glucose test and a glycated haemoglobin test (commonly referred to as HbA1c). Estimates of diabetes prevalence and management from the NHMS were derived using a combination of blood tests, medications use (see AHS referral form in the Downloads page of this product) and self reported information on diabetes from the National Health Survey (NHS) and the National Nutritional and Physical Activity Survey (NNPAS). The biomedical results from the NHMS can be used together with the self reported data to estimate disease prevalence rates. For details on self reported diabetes information, see the relevant Diabetes Mellitus chapter in this product.

DIABETES PREVALENCE

Diabetes prevalence was derived using a combination of blood test results and self-reported information on diabetes diagnosis and medication use.

A person was considered to have known diabetes if:

• they had ever been told by a doctor or nurse that they have diabetes and they were taking diabetes medication (either insulin or tablets); OR
• they had ever been told by a doctor or nurse that they have diabetes and their blood test result for fasting plasma glucose was greater than or equal to the cut off point for diabetes (that is, ≥7.0 mmol/L).

• A person was considered to have newly diagnosed diabetes if they reported no prior diagnosis of diabetes but had a fasting plasma glucose value ≥7.0 mmol/L.

• A person was considered to be at high risk of diabetes if they did not currently have diabetes, but had an impaired fasting plasma glucose result, that is, a fasting plasma glucose level ranging from 6.1 mmol/L to less than 7.0 mmol/L.³

	Fasting plasma glucose (FPG) (mmol/L)(a)	HbA1c (%)(b)
Has diabetes	≥7.0	≥6.5
At high risk of diabetes	6.1 to <7.0	6.0 to <6.5
No diabetes	<6.1	<6.0

Figure 1: 2011–12 NHMS diabetes classification


* Cut off points for FPG: Indicates diabetes ≥7.0 mmol/L; At high risk of diabetes 6.1 to <7.0 mmol/L; Does not indicate diabetes <6.1 mmol/L.
Cut off points for HbA1c: Indicates diabetes ≥6.5%; At high risk of diabetes 6.0% to <6.5%; Does not indicate diabetes <6.0%.

• Fasting blood glucose levels between 4.0–6.0 mmol/L
• HbA1c levels less than or equal to 7.0%
• Total cholesterol less than 4.0 mmol/L
• HDL 'good' cholesterol greater than 1.0 mmol/L
• LDL 'bad' cholesterol less than 2.0 mmol/L
• Non-HDL-C cholesterol less than 2.5 mmol/L
• Triglycerides less than 2.0 mmol/L
• Albumin creatinine ratio (a kidney function test) less than 3.5 mg/mmol for women and less than 2.5 mg/mmol for men
• Blood pressure less than or equal to 130/80 mmHg
• 'Normal' Body Mass Index (i.e. a BMI score of between 18.0 and 24.9)
• Non-smoker
• Alcohol intake less than or equal to 2 standard drinks per day**
• At least 30 minutes of physical activity 5 days per week**