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Ministry Addressing Diabetes In Many Ways

April 5, 2002

The Ministry of Health is committed to reducing the number of New Zealanders with diabetes and developing affordable and accessible care for those who already have been diagnosed with the disease.

"We share Diabetes New Zealand's concern about the type 2 diabetes epidemic and are taking a range of approaches to addressing the disease," said chief clinical advisor Dr Sandy Dawson.

"For many people primary care is already appropriate and accessible, but a very significant commitment to making it more affordable is outlined in the Primary Health Strategy. People with diabetes already receive one free check-up a year.

"The introduction of Maori Mobile Disease State nurses for Maori people with diabetes and the Pacific Health and Disability Strategy are major steps towards providing more appropriate, accessible and affordable services for Maori and Pacific people," said Dr Dawson.

The Ministry of Health and Health Research Council have set up a Diabetes Research Strategy and $1.5 million has been committed over three years. The top priority is diabetes primary prevention, and a decision on the successful proposal is expected before May. The Ministry, along with District Health Boards (DHBs) and clinicians, has developed an audit and evaluation tool and piloted this with healthcare providers in two DHBs.

This year there have also been major announcements about primary health care, the launch of a discussion document about new health approaches to improving nutrition and physical activity as well as the publication of new forecasts for the type 2 diabetes epidemic.

"We've done this work because preventing diabetes and providing health care for people living with the disease requires sound information about the impact diabetes is having on New Zealand and accurate forecasts about how this may change in future," said Dr Dawson.

"We're also focusing on promoting nutrition and physical activity as many people suffer severe, disabling and expensive complications from diabetes. 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."

To help DHBs meet the 13 priority health objectives of the New Zealand Health Strategy -- including reducing the incidence and impact of diabetes -- the Ministry launched practical toolkits in October. The toolkits act as a much-needed 'bridge' between the high-level strategic objectives of the New Zealand Health Strategy and the practical issues DHBs need to tackle to improve diabetes care.

This has been reflected in the priority given to addressing diabetes in the DHB's draft strategic plans.

The Government is also working to address one of the associated complications of diabetes -- heart disease -- with thousands more New Zealanders gaining access to subsidised cholesterol-lowering statin drugs from the beginning of this week.

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

BACKGROUND

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 three times higher risk. About 100,000 -110,000 people have known diabetes and as many as 100,000 people have diabetes but do not yet 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. New Zealand's spending on diabetes and related complications is comparable with other Western countries.

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 (available from www.moh.govt.nz) 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.

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.

Has New Zealand considered having a national diabetes register? The Ministry of Health met health sector representatives, including Diabetes New Zealand spokesman Professor Don Beaven, to discuss the options for a national diabetes register. On balance, it was decided to concentrate on increasing the uptake of "free annual checks" and the registers that are held by Primary Care Organisations. These organisations have done a demonstrably world class job of using the information in their registers to provide feedback to general practitioners and nurses and improve the quality of primary care. Before considering setting up any register the Ministry of Health would need to be confident it would improve on the current system.

What about diabetes screening? A national diabetes screening programme has not been established by the Ministry of Health as overseas research does not provide enough support to justify the benefits of such a programme in a country such as New Zealand. However, the Ministry has funded guidelines for diabetes screening, and we expect some DHBs and healthcare providers may set up targeted screening programmes. The diabetes forecasting work will assist DHBs in detecting the people most likely to benefit.

Ends

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