New Forecasts On Scale Of Diabetes Epidemic

New Ministry of Health forecasts about the type 2 diabetes epidemic over the next decade are a sharp reminder to health agencies about the importance of this mostly preventable disease.

The Ministry of Health today released four bulletins and a summary pamphlet, collectively titled Diabetes in New Zealand: Models and Forecasts 1996 ? 2011, said Deputy-Director General of Public Health Dr Don Matheson.

The Ministry's model estimates about 5000 adults were newly diagnosed with type 2 diabetes in 1996, and that this may rise to 11,000 in 2011.

"Unlike this summer's weather, this is a forecast we can do something about. The actions we all take today -- especially eating healthily and being active -- will make a difference to the extent of the epidemic over the next decade.

"Action is required not just at the individual level but across our whole society. Our society fattens people up rather than encourages them to be active and healthy."

Dr Matheson said health officials had known for some time that the epidemic would worsen and had been actively working to minimise its impact.

Addressing the epidemic of type 2 diabetes in New Zealand, driven by our growing and ageing population and increasing level of obesity, is a top health priority for the health sector and District Health Boards as indicated in the New Zealand Health Strategy.

"Preventing diabetes and providing health care for people living with the disease requires sound information about the impact this disease is having on New Zealand and accurate forecasts about how this may change in future."

Diabetes incidence, prevalence and mortality are estimated for 1996 and the model then projects these estimates to 2011, taking into account anticipated trends in population size and structure, obesity, and healthcare.

Maori and Pacific people were about three time more likely to have type 2 diabetes than Europeans in 1996, and will be most severely hit by the worsening epidemic.

"The twin epidemics of diabetes and obesity are already impacting severely on the health of New Zealanders and are contributing to the alarming health inequalities between the major ethnic groups."

The model estimated about 1500 adult deaths were caused by type 2 diabetes in 1996 -- about twice the number recorded on death certificates -- and that this could rise to about 2100 in 2011. The model conservatively estimates that in 1996 about 82,000 adults were known to have type 2 diabetes. By 2011, this could increase to over 145,000 people. At least a third of this increase is driven by increasing numbers of overweight and obese people.

"Many people suffer severe, disabling and expensive complications from diabetes but the real tragedy is that for many people more physical activity and healthier eating can prevent type 2 diabetes from developing in the first place," said Dr Matheson.

Type 2 diabetes is New Zealand's most common type of diabetes, accounting for almost 90 percent of cases.

New Zealand is developing a world class diabetes programme that focuses on people with diabetes and their individual needs. If you have diabetes you are entitled to a free annual check for complications each year.

This report is the first in a series of forecasts the Ministry of Health is fronting for the sector. The New Zealand Health Strategy calls for a preventive approach.

"These forecasts help focus the debate so the need for prevention does not get overwhelmed by the immediate needs of today," Dr Matheson said.

For more information contact: Anne-Marie Robinson, Media Advisor, ph: 04-496-2067 or 025-802 622 http://www.moh.govt.nz/media.html

or

Dr Robert Scragg Dept of Community Health University of Auckland phone: 09 373 7599 ext 6336 (daytime only).

Dr Robyn Toomath President New Zealand Society for the Study of Diabetes Endocrinologist phone: (March 8 only) 09 6251462 phone: (usual work number) 04 3855999 extn/page 5237 cell-phone 021 455 453

Most District Health Boards also have diabetes action teams. For local information about diabetes prevention and other programmes in your area please contact the Communications Manager at your nearest DHB.

Questions and Answers

What is diabetes? Diabetes is a metabolic disorder where the body is unable to control the amount of glucose in the blood. The level of blood glucose is controlled by insulin ? a hormone produced by the pancreas. There are three types of diabetes: Type 1 diabetes ? an estimated 11,000 people in New Zealand have this. It is more common in European people than Maori or Pacific people, Most people with type 1 diabetes develop it as children or teenagers. Type 2 diabetes ?an estimated 90,000 to 100,000 people in New Zealand have type 2 diabetes. Maori and Pacific people are almost three times as likely to develop type 2 diabetes as European people are. Most people with type 2 diabetes develop it after the age of 40. People over 40 years who are overweight or inactive (especially Maori, Pacific Islands or Asian people), are more at risk of developing type 2 diabetes. Gestational diabetes occurs in some women while they are pregnant. Blood glucose levels usually return to normal once the baby is born, but women who have gestational diabetes are more likely to develop type 2 diabetes later in life. Diabetes in pregnancy remains a leading cause of congenital abnormalities, stillbirths and miscarriages.

What is the impact of diabetes? Diabetes damages the arteries and nerves in the body, from the high levels of blood glucose. It is the leading cause of blindness, kidney failure and lower limb amputation. It is also a major risk factor for impotence, stroke, heart disease and early death. Diabetes in pregnancy remains a leading cause of congenital abnormalities, stillborn and spontaneous abortions.

What causes type 2 diabetes? There is no one cause for diabetes. Obesity (especially around the stomach) , lack of physical activity and excess food intake, especially fat. are the main risk factors that can be changed. Diabetes also has a hereditary component, and runs in families. It is more common in Maori, Pacific and Asian people. Its prevalence increases with age. Up to one in six of those over 60 years have diagnosed diabetes.

Why is the Government concerned about diabetes? Diabetes is estimated to cause over 1500 deaths a year. Complications of diabetes include kidney failure, blindness and heart disease. Rates overall are projected to increase, with Maori and Pacific people at up to 10 times higher risk. As many as 80,000 people have diabetes but do not know it. More than $170 million is spent each year by the Government on treating diabetes and diabetes-related conditions such as heart and kidney disease.

How important is addressing diabetes to the Government? The New Zealand Health Strategy says reducing the incidence and impact of diabetes is one the top objectives for District Health Boards. Promoting physical activity, improving nutrition, and preventing obesity are also priority objectives and are critical in preventing diabetes. This builds on a considerable amount of work which has already been done through the Diabetes 2000 strategy and the nationwide adoption of Local Diabetes Teams to support improved quality of care. A three-strand population health approach has been developed: identifying target populations targeting diabetes services at high risk people and groups evaluation and quality improvement Increasingly the focus and resources have shifted to primary care and, within that, Maori and Pacific providers.

What is being done to address diabetes? These are four of the many nationwide initiatives underway to address the diabetes epidemic:

Toolkits The diabetes toolkit provides information and resources to assist District Health Boards in reducing the incidence and impact of diabetes in their communities. It includes: ? a summary of the existing New Zealand strategies and the relevant international evidence about the incidence and impact of diabetes ? an outline of the existing national framework for diabetes services ? links providing information about the most effective interventions, with practical suggestions for quality improvement in New Zealand ? nationally consistent clinical indicators for use by DHBs to monitor quality improvements and diabetes trends over time. Obesity and physical activity toolkits also provide advice for DHBs on reducing the major risk factors for diabetes.

Diabetes 2000 This is an initiative aimed at early intervention and improved chronic disease management for diabetes. Early intervention in the disease and self-management are important factors in reducing avoidable death and disability. Local diabetes teams that include consumers and clinicians were set up in each District Health Board area as part of Diabetes 2000 to develop suggestions about ways to improve local services. Diabetes education and management services are currently delivered by multidisciplinary teams in hospitals or in community settings. Improving the effectiveness of diabetes education and self-management is a major challenge for diabetes educators. Effective self-management is also a major challenge for the people who matter most ? people with diabetes.

Get Checked As part of Diabetes 2000, a free annual check is funded through the national Get Checked programme for all people with an established diagnosis of type 1 or type 2 diabetes. The free annual check is delivered by a general practitioner or appropriately trained primary care nurse with access to primary care notes. The free annual check screens for the risk factors and complications of diabetes and promotes early detection and intervention. An updated treatment plan for each person with diabetes is agreed on.

Healthy Action: Healthy Eating This new draft strategy to address the burgeoning health consequences of lack of physical activity and increasing obesity was released for public comment in February 2002. It looks at improving environments and lifestyles so it is easier for New Zealanders to be active and access a healthier diet. This strategy will define the Government's key priorities for physical activity, nutrition and reducing obesity over the next five years. Many of New Zealand's most serious diseases and conditions, such as heart disease, stroke, hypertension, type 2 diabetes, some cancers, osteoporosis, anaemia and dental caries are closely associated with physical inactivity, poor nutrition and obesity. Maori and Pacific people and people of low socioeconomic status are disproportionately affected.

Healthy Action: Healthy Eating aims to develop innovative and integrated solutions. These solutions won't be just lifestyle changes that individuals make for themselves, but they will require major commitment and change in areas such as transport, local government, the food industry and the workplace so that a healthy, more active lifestyle is more achievable for everyone.

Can we slow the epidemic? Slowing the epidemic depends on our success in improving nutrition and increasing physical activity among all population groups, so slowing the increase in obesity. Physical activity also decreases the diabetes risk independently of obesity. The model suggests that slowing the growth of the diabetes epidemic to half its current rate -- probably the best we could realistically achieve -- would translate into 10 percent fewer people living with diabetes in 2011 than projected assuming the current trend in obesity continues unabated.

What are the population changes that account for two-thirds of the forecast increase in type 2 diabetes? About two thirds of the projected increase in diabetes prevalence is estimated to result from demographic trends, such as increasing population size, older age structure and changing ethnic composition.

What are some of the limitations around the model? The model is based on a very limited empirical base: diabetes prevalence data from the 1996/97 New Zealand Health Survey, obesity prevalence data from the 1997 National Nutrition Survey and earlier surveys, and mortality data from the NZHIS. This means statistical forecasting methods cannot be used and the model generates scenarios rather than projections. The modelling method and reports have been peer reviewed both locally and internationally. The reports emphasise the uncertain and provisional nature of the forecasts, and that conservative assumptions have been used throughout.

How will the forecasts be used? This information helps the health sector develop evidence-based diabetes policies, health promotion and disease prevention programmes, and to plan and resource diabetes-related health services more effectively and efficiently than might otherwise be the case.

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