Australian National Diabetes Strategy

20162020
Paper-based publications ISBN: 978-1-76007-217-9
Commonwealth of Australia 2015 Online ISBN: 978-1-76007-218-6
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Australian National Diabetes Strategy 20162020

Contents
Executive summary 1
Acknowledgements 2
Abbreviations 3
Introduction 4
The approach 6
The challenge of diabetes 8
Goal 1: Prevent people developing type 2 diabetes 10
Goal 2: Promote awareness and earlier detection of type 1 and type 2 diabetes 11
Goal 3: Reduce the occurrence of diabetes-related complications andimprove quality of life
amongpeople with diabetes 12
Goal 4: Reduce the impact of pre-existing and gestational diabetes inpregnancy 15
Goal 5: Reduce the impact of diabetes among Aboriginal andTorresStrait Islander peoples 16
Goal 6: Reduce the impact of diabetes among other priority groups 18
Goal 7: Strengthen prevention and care through research, evidence and data 21
References 22

Australian National Diabetes Strategy 20162020

Australian National Diabetes Strategy 20162020
Executive summary
The Australian National Diabetes Strategy
aims to outline Australias national response
to diabetes and inform how existing limited
health care resources can be better coordinated
and targeted across all levels ofgovernment.
ThisStrategy identifies the most effective and
appropriate interventions to reduce theimpact
of diabetes in the community andlead the
way internationally in diabetes prevention,
management andresearch.
Overcoming the many barriers toimproving
diabetes prevention and care requires
amulti-sectoral response led by governments
and implemented at the communitylevel.
ThisStrategy provides a framework for
collaborative efforts by governments and
other parts of the community, including people
withdiabetes, health care professionals,
non-government organisations, researchers,
families,carers, communities and industry,
toreduce the incidenceof, andmorbidity
and mortality from, diabetes and
itsassociatedcomplications.
This Strategys vision is to strengthen all sectors
in developing, implementing and evaluating
an integrated and coordinated approach for
reducing thesocial, human and economic
impact of diabetes in Australia. To achieve this,
thisStrategyoutlines seven high-level goals
with potential areas for action andmeasures
ofprogress.
The goals fall under a number of guiding
principles which will help to align and
focus effort. These guiding principles
willneed to beincorporated into the
policies and programmes considered
fortheimplementationof this Strategy.
Enabling factors which influence the
ability to achieve goals include leadership
andgovernance, workforce, information and
research capacity, financing and infrastructure,
andpartnerships and networks.
This Strategy has been informed bythe expert
advice of the National Diabetes Strategy
Advisory Group and consultations with
keystakeholders andthe community.
This Strategy was developed in consultation
with jurisdictions through representations on
the Australian HealthMinisters Advisory Council
andthe Council of Australian Governments
(COAG) Health Council.
Further work is required to develop policy
options to implement thisStrategy, including
metrics to evaluate progress towards achieving
thegoals. This will build on existing work
to enhance current investment in diabetes
action and care and focus on high-impact
achievable actions underpinned by the best
availableevidence. Implementation will involve
alllevels of government, incollaboration with
the health sector and relevantorganisations.
Weencourage stakeholders to look actively for
opportunities to develop newand strengthen
existingpartnerships to develop and support
theachievement of thisStrategys goals.
Australian National Diabetes Strategy 20162020 1
Acknowledgements
Many individuals and organisations have given
their time and expertise to the development
of this Strategy. In particular, the Government
thanks all organisations and individuals
who provided feedback to the online
publicconsultation paper in 2015, aswellas
those who participated intheface-to-face
workshops in 2014.
The Government recognises the significant
burden that diabetes places on individuals and
theirfamilies. Theinvolvement and willingness
of people to share their personal experiences
and knowledge is greatly appreciated and has
provided a valuable resource for informing
thisStrategy.
National Diabetes Strategy AdvisoryGroup
The National Diabetes Strategy Advisory Group
was established in 2014 to provide advice on all
aspects ofthe Strategy development process.
The Advisory Group, co-chaired by the
Hon.JudiMoylan and ProfessorPaulZimmetAO,
possessedawide range of experience and
expertise in diabetes-related health care,
researchand population health, aswellas
linkswith keystakeholders.
The advice prepared by the Advisory Group
has been fundamental indeveloping the
Strategy to ensure itsusefulness and relevance
to diabetescare, prevention, management
andresearch acrossthecountry.
2 Australian National Diabetes Strategy 20162020
The Advisory Group was assisted by experts
in the field. Together they developed two key
documents which informed the development
ofthisStrategy:
A strategic framework for action: consultation
paper for the development of the Australian
National Diabetes Strategy released for
online public consultation from 15April
31May 2015. Keystakeholders were notified
and all Australians were encouraged to
provide their thoughts and ideas on a range
of key goals and areas for national action on
diabetes as identified by the National Diabetes
Strategy Advisory Group.
A strategic framework for action: advice
to Government on the development
of the Australian National Diabetes
Strategy 20162020 prepared by the
NationalDiabetesStrategy Advisory Group
at the request of the Australian Government
and presented to the Commonwealth Minister
forHealthduring August 2015.
The material contained in this document
islargely drawn from thisadvice.
The Government recognises and thanks the
Advisory Group and experts for committing
theirtime and specialist knowledge throughout
the development of the Strategy. Their collective
expertise and tireless dedication to increasing
theawarenessof, and action on, diabetes
isadmirable.
More information on the National Diabetes
Strategy Advisory Group can be found
attheDepartment of Healths website,
http://www.health.gov.au.
Abbreviations
AusDiab
Australian Diabetes, Obesity andLifestyle Study
CALD
Culturally and linguistically diverse
DKA
Diabetic ketoacidosis
GDM
Gestational diabetes mellitus
GP
General practitioner
HbA1c
Glycated haemoglobin
My Health Record
The Australian Governments national
electronic health record, previously known
asthe personally controlled electronic
healthrecordorPCEHR
PHNs
Primary Health Networks

Australian National Diabetes Strategy 20162020 3

Introduction
The Australian National Diabetes Strategy At a national level there is considerable
(theStrategy) is an opportunity to consider focus on the prevention and management of
current approaches to diabetes services chronicconditions. This focus is assisted by:
andcare; consider the role of governments
the Primary Health Care Advisory Group,
at alllevels, as well as other stakeholders;
whichwill investigate options to provide
evaluatewhether current efforts and
bettercare for people with complex
investments align with identified needs;
and chronic illness; innovative care and
maximise the efficient useof existing limited
fundingmodels; betterrecognition and
health care resources; and articulate a vision
treatment of mental health conditions;
forpreventing, detecting and managing diabetes
andgreater connection between primary
and for diabetes research efforts. This Strategy
health care andhospital care
aims to better coordinate health resources
across all levels ofgovernment and to focus the Medicare Benefits Schedule
these resources where they are needed most. ReviewTaskforce, which will consider how
services can be aligned with contemporary
The Government has important roles
clinical evidence and improve health
inmaintaining access to affordable,
outcomesfor patients
high-quality medicines, devices and
servicestosupportpeople with diabetes in the National Strategic Framework for Chronic
self-management and treatment. TheAustralian Conditions, which is being developed
Government provides support to people in partnership with jurisdictions and
with diabetes through the National Diabetes stakeholders as an overarching framework
ServicesScheme, thePharmaceutical toguide the prevention, management and
BenefitsScheme, the Insulin Pump Programme careofa range of chronic conditions.
and Medicare. ThisStrategy will not replace
or override existingprocesses established Further, this Strategy is also an opportunity
bythe Australian health systemforassessing to align with international policy, including
thesafety, qualityandcost-effectiveness of the approach of the Global Action Plan for the
newmedicines, devices,testsand procedures. Prevention and Control of Non-Communicable
Diseases and the Global Monitoring Framework
The health care system is subject to ongoing
for Non-Communicable Diseases that were
national reform, such as the establishment
developed by the World Health Organization
of Primary Health Networks (PHNs),
in2013.
implementation of the My Health Record
andthe post-market review of products used
in the management of diabetes and subsidised
under the Pharmaceutical Benefits Scheme,
and evaluation of the Diabetes Care Project.
Theimplementation of this Strategy will be
informed by this work.

4 Australian National Diabetes Strategy 20162020

Purpose
This Strategy supersedes the National Diabetes
Strategy 20002004. It aims to prioritise
Australias response to diabetes and identify
approaches to reducing the impact of diabetes
in the community. It recognises the social and
economic burden of the disease and provides
action areas that:
prevent, detect and manage diabetes
improve diabetes services and care
recognise the different roles and
responsibilities of all levels of government
andthe non-government sector
promote coordination of health resources
across all levels of government
facilitate coordinated, integrated
andmultidisciplinary care
improve use of primary care services
increase recognition of patient needs
acrossthe continuum of care.
Audience
This Strategy has been developed for
policymakers at all levels of government,
non-government organisations such as
nationalpeakbodies, stakeholder organisations,
researchers and health professionals
who advocate for and provide education,
treatmentand management of diabetes.
Time frame
The time frame for this Strategy is five years,
from 2016 to 2020. It is anticipated that this
Strategy will be reviewed after three years.
Next steps
Further work is required to operationalise
each of the goals through development of
animplementation plan that will consider the
ways to direct funding and other resources,
and further develop measures to evaluate
theprogress of this Strategy.
This will occur in collaboration with
stakeholders across all levels of governments,
the health sector and relevant organisations.
Australian National Diabetes Strategy 20162020 5
The approach
This Strategy articulates a vision supported
by seven high-level goals. Each goal contains
potential areas for action and measures of
progress informed by the expert advice of
theNational Diabetes Strategy Advisory Group
andconsultations with key stakeholders
andthecommunity.
This Strategy includes principles to guide
actionwithin the goals and common
enablerstoachieve them. The enablers
represent cross-cutting themes that will
strengthen efforts across each of the goals.
Vision
Strengthen all sectors in developing,
implementing and evaluating an integrated
andcoordinated approach for reducing
the social, human and economic impact
ofdiabetesin Australia.
Principles
Five key guiding principles underpin the goals.
These principles are expected to guide the
policies and programmes considered for
theimplementation of this Strategy.
1. Collaboration and cooperation
toimprovehealth outcomes
Working in partnership across government,
organisations and other sectors can
maximise use of resources and technology,
and encourage coordination and integration
inprevention, detection andmanagement
ofdiabetes
2. Coordination and integration of diabetes
care across services, settings, technology
andsectors
Diabetes care is multidisciplinary across
providers and settings: coordination and
communication are essential to ensure
appropriate interventions and continuity
ofcare
6 Australian National Diabetes Strategy 20162020
3. Facilitation of person-centred care
and self-management throughout life
Individuals are at the centre of their own
health care
People are supported to take responsibility
fortheir own care
4. Reduction of health inequalities
Actions will be driven by a focus on
minimising the social, human and economic
impact on those disproportionately
affected by diabetes
5. Measurement of health behaviours
andoutcomes
To enable measurement of progress and
success relevant data will be collected,
analysed and reported
Enablers
The enablers are factors which are embedded
throughout the goals and influence the ability
toachieve success:
Leadership and governance to ensure
effective and appropriate oversight, attention
to system design and accountability
Workforce high-quality, person-focused and
integrated multidisciplinary teams spanning
the health continuum will support all actions
Information and research capacity
translating research into policy; innovation
based on emerging evidence and new medical
technologies will support improvements
incare
Financing and infrastructure the right
mix of financial incentives and funding
arrangements can better support coordinated
care and access to services
Partnerships and networks integrated and
coordinated interactions between patients,
health care providers and the health care
system will drive improved health outcomes.
Potential measures of progress The table below lists thecomponents
ofthisStrategy.
This Strategy outlines potential ways to measure
progress against each goal. The measures
are expressed as high-level indicators, as itis
anticipated that refinements will be made
through the development of an implementation
plan and associated metrics, including units of
measurement and reporting responsibilities.

Table 1: Components of the Australian National Diabetes Strategy, 20162020

Vision
Strengthen all sectors in developing, implementing and evaluating an integrated and
coordinatedapproach for reducing the social, human and economic impact of diabetes in Australia

Principles
1. Collaboration and cooperation toimprove
health outcomes
2. Coordination and integration of
diabetes care across services, settings,
technologyand sectors
3. Facilitation of person-centred care and
self-management throughouttheir life
4. Reduction of health inequalities
5. Measurement of health
behavioursandoutcomes

Goals
1. Prevent people developing type 2 diabetes 5. Reduce the impact of diabetes
among Aboriginal and Torres Strait
2. Promote awareness and earlier detection
Islanderpeoples
of type 1 and type 2 diabetes
6. Reduce the impact of diabetes
3. Reduce the occurrence of diabetes-related
amongotherpriority groups
complications and improve quality of life
among people with diabetes 7. Strengthen prevention and care
throughresearch, evidence anddata
4. Reduce the impact of pre-existing and
gestational diabetes in pregnancy

Enablers
Factors which influence the ability to achieve goals such as leadership and governance,
workforce, information and researchcapacity, financingand infrastructure,
andpartnershipsandnetworks

Australian National Diabetes Strategy 20162020 7

The challenge of diabetes
Diabetes mellitus is a chronic disorder
thatimpedes the bodys ability to produce
and/or utilise insulin (a hormone produced
bythe pancreas to regulate blood sugarlevels).
Thisresults in high blood sugar levels,
whichlead to serious complications such
asstroke; diabetes-related eye disease
such as diabetic retinopathy; heart disease;
highbloodpressure; kidneydisease;
vasculardisease; nerve damage;
andfootproblems.
There are three commonly recognised forms
ofdiabetes:
Type 1 diabetes an autoimmune condition
that causes the immune system to destroy
cells in the pancreas that produce insulin.
It usually has onset in childhood or early
adulthood but can occur at any age.
Thereisnocure and people with type1
diabetes require daily treatment with
insulinfor survival.
Type 2 diabetes the most common form
of diabetes. It is largely preventable, as it
is often associated with lifestyle factors.
Insulin production by the pancreas becomes
progressively slower and key organs in the
body become resistant to the effects ofinsulin
(which means that they are less able to
utilise glucose from the blood). In thepast,
type2 diabetes was typically diagnosed after
50years of age, but diagnosis in younger
adults, adolescents and even children
isincreasinglycommon.
Gestational diabetes mellitus (GDM)
firstoccurs during pregnancy and
usuallydisappears following the birth of
the baby, although women who have had
GDMare atsignificant risk of subsequently
developingdiabetes.
8 Australian National Diabetes Strategy 20162020
People with prediabetes (impaired fasting
glucose and/or impaired glucose intolerance)
have blood sugar levels that are higher than
normal but not sufficiently high to diagnose
type2 diabetes (1).
Diabetes often occurs alongside
(andshares risk factors with)
otherchronicconditions, includingheart
disease andchronickidneydisease (2).
However,muchofthe impact of diabetes is
preventable, eitherthrough improving the
health of the population to prevent people from
getting diabetes or by optimising how the health
system supports people who have diabetes to
prevent or delaythe onset of complications.
The impact of diabetes in Australia
It is difficult to estimate the exact number of
people with diabetes in Australia, but it is likely
that more than 1.1million Australians are living
with the disease.
Type 2 diabetes accounts for approximately
85per cent of people with diabetes.
Approximately 12 per cent of Australians with
diabetes are diagnosed with type 1 diabetes(3).
Around 12 to 14 per cent of pregnant women
willdevelop GDM (4).
Diabetes has a significant, and often
preventable, impact on the health and
wellbeingof the Australian population. In 2011,
diabetes was the underlying cause of 3 per cent
of all deaths and an underlying or associated
cause of 10 per cent of all deaths (2). Thereare
a significant number of diabetes-related
complications, many of which are preventable.
They include heart attack, stroke, amputation,
blindness, kidney failure, depression and
nervedisease.
Prediabetes was examined as part of
the Australian Diabetes, Obesity and
Lifestyle Study (AusDiab), which found
that 16percent of adultsover the age of
25years approximately2.5 million people
haveprediabetes (5). Between 15 and 30 per cent
of people with prediabetes are likely to develop
type 2 diabetes within five years (6).
It is difficult to estimate the total economic There are several other groups for which
and social impact of diabetes. Health care efforts should be prioritised due to theirhigh
that is directly attributable to diabetes risk of diabetes. People from South-EastAsia,
costs approximately $1.7billion per year(7). NorthAfrica and the Middle East, Oceania
In terms of indirect costs, the full cost (excluding Australia), and southern and
of diabetes maybeashigh as $14billion eastern Europe have higher rates of diabetes
per year. Theseindirect costs include than otherAustralians. Older Australians
reduced productivity, absencefromwork, alsohavehigher rates of diabetes (particularly
early retirement and premature death type 2 diabetes) and experience higher rates
andbereavement. Costs are heavily of disability associated with the disease (11).
concentrated in particular sub-groups of people People with diabetes who live in rural and
with diabetes. Annual direct costs for people remote communities have more difficulty
with diabetes complications are more than twice accessing health services to manage
as much as for people without complications: theirdiabetes.
$9600 compared with $3500 (8).
Finally, individuals living with diabetes are
at increased risk for depression and anxiety.
Aboriginal and Torres Strait Islander peoples People being treated for mental health
and other priority groups disorders such as depression, anxiety and
schizophrenia may be at higher risk of diabetes.
Australia has enormous cultural and social
These comorbidities compromise adherence
diversity and, while diabetes is increasingly
todiabetes treatment and thus increase the
common across the country, it is particularly
riskof complications.
problematic within certain communities.
Aswith the general population, it is difficult to
estimate the exact number of Aboriginal and
Torres Strait Islander peoples with diabetes,
and prevalence estimates vary considerably.
A review of the prevalence of diabetes among
Aboriginal andTorres Strait Islander peoples
found that, across the 24 studies conducted,
prevalence ranged from 3.5 per cent to
33.1percent(9). TheAustralian Health Survey
(National Aboriginal and Torres Strait Islander
Health MeasuresSurvey, 201213) found that
one in five Aboriginal and Torres Strait Islander
people over the age of 25 years have diabetes (10).
Thiscompares with rates of between 6 and 8 per
cent of the general population in the same age
group (taken from the Australian Health Survey
and AusDiab, respectively) (11) (5). These data
demonstrate that Aboriginal and Torres Strait
Islander peoples experience a disproportionate
share of the burden of diabetes as a result of
these considerably higher diabetes rates.

Australian National Diabetes Strategy 20162020 9

Goal 1: Prevent people developing type 2 diabetes
This Strategy recommends a community- Increase the availability of and demand for
andworkplace-based approach for the healthier food or reduce the availability of and
general population and those at a high risk of demand for unhealthy food (including through
developing diabetes. Those considered at high continued implementation and targeted
risk of developing type 2 diabetes are those education on the Front-of-Pack Labelling
with prediabetes as well as certain risk factors. Health Star Rating system)
Thestrongest evidence of effective prevention
Reduce the exposure of children and others
is in this group.
to marketing, advertising, promotion and
Health risk factors are attributes, sponsorship of energy-dense, nutrient-poor
characteristicsor exposures that increase foods and beverages (e.g. through voluntary
thelikelihood of a person developing orcompulsory advertising codes of conduct)
adiseaseor health disorder. These can
Strengthen, upskill and support the primary
be non-modifiable e.g.age, sex, genetics;
health care and public health workforce to
orpotentiallymodifiable e.g. overweight
support people in making healthychoices,
orobesity, insufficient physicalactivity.
especially in Aboriginal Community
It is important to emphasise that, ControlledHealth Services, where they exist
inaddressing common modifiable risk factors,
Address maternal, family and child health,
diabetesprevention programmes are not
enhancing early life and growth patterns
one-dimensional and can have broader
impactscontributing to population health,
Identify high-risk individuals and consider
quality of life and reducing the strain on
effective, evidence-based interventions
thehealth system.

Potential measures of progress

Potential areas for action
People developing or with type 2 diabetes
Reduce modifiable risk factors
inthegeneralpopulation Modifiable risk factors in the general
population such as overweight and obesity,
Drive change to support the development
and levels of physical activity
of ahealth-promoting environment that
encourages people to increase levels Development of local healthy community
of physicalactivity, reduce sedentary environment plans
behaviourand improve healthy eating
Embed physical activity and
healthyeatingineveryday life
(e.g.workplaces,schoolsandcommunities)
Consider education and social media
campaigns to encourage people to increase
their levels of physical activity and
healthyeating (e.g. a campaign to educate
parents about nutrition and physical activity)

10 Australian National Diabetes Strategy 20162020

Goal 2: Promote awareness and earlier detection of
type 1 and type 2 diabetes

Type 1 diabetes Potential areas for action

Failure to recognise the early symptoms Type 1 diabetes
of type1diabetes, such as severe
Increase awareness and recognition of the
fatigue andthirst, can lead to diabetic
symptoms of type 1 diabetes and timely
ketoacidosis(DKA). Thisis an acute
detection among health care providers and
complicationwhich can be life-threatening
thecommunity, including parents, teachers
andoften requires hospitalisation.
andothers involved in the care of children
Aroundonein five people who are
newlydiagnosed with type 1 diabetes
Type 2 diabetes
only learnabout the diagnosis of diabetes
uponpresenting to hospital with DKA (12). Increase recognition and awareness of type2
diabetes and early detection among health
careproviders and the community
Type 2 diabetes
Promote increased use of risk screening
It is estimated that, for every 100 people with
toolsand early management of diabetes
a diagnosis of type 2 diabetes inAustralia,
withafocus on groups at high risk of
at least 25 people may be living with
developingtype 2 diabetes
undiagnoseddiabetes (11). People with
undiagnosed type 2 diabetes are unaware of Consider ways of integrating diabetes testing
their condition and are therefore not accessing with assessment of other chronic conditions
the necessary care. They may already have such as cardiovascular and kidney disease
complications of their diabetes. By providing
information on and increasing awareness and
Potential measures of progress
early detection of type 2 diabetes, people can
be supported to make informed health-related People with type 1 diabetes who present
decisions and actions, and this will improve withdiabetic ketoacidosis upon diagnosis
health literacy (13).
People tested for risk of type 2 diabetes

Australian National Diabetes Strategy 20162020 11

Goal 3: Reduce the occurrence of diabetes-related complications
andimprove quality of life among people with diabetes
Best-practice, high-quality diabetes care is Explore the role of PHNs in developing
bestachieved when health care professionals locally tailored pathways of care for people
work seamlessly and in partnership across with diabetes and other chronic conditions,
primary health, community and specialist care reflecting local service configuration and
services with direct consumer (the person population needs
with diabetes), carer and family involvement.
Consider complication prevention
Achieving this will not be easy, however,
programmes in PHNs and across the health
becauseit will require a transformation in the
system more generally. These may be
way care is delivered in order to make it more
integrated programmes covering multiple
consumer focused, team based and proactive.
complications or single complication
Consumer engagement, awarenessand
prevention programmes
self-management will be major factors
inthesuccessof this goal. Explore the role of the My Health Record in
clinical workflows so as to better manage
Primary Health Networks (PHNs) have been
complex conditions and medication among
established to increase the efficiency and
theindividuals health care providers
effectiveness of medicalservices, particularly
for those at risk of poor healthoutcomes,
Expand consumer engagement
and to improve coordination of care
and self-management
forpatients. PHNswill work directly with
general practitioners (GPs), other primary Enhance access to structured
care providers, secondary care providers and self-management education
hospitals to better coordinate care across the programmesforpeople with diabetes,
local health system so that people requiring including the newly diagnosed and people
help from multiple health care providers, starting insulin. Particular attention must
suchas people with diabetes, receive the be given to programmes for children
rightcare inthe right place at the right time. withdiabetes, adolescents transitioning
intoadult services, and older people
andtheircarers
Potential areas for action
Ensure that peer support programmes
Develop nationally agreed clinical guidelines,
(either face-to-face, telephone or online)
local care pathways and complications
areaccessible to all people with diabetes
prevention programmes
Consider education and social
Develop a nationally endorsed set of
marketingcampaigns with a focus on
diabetes guidelines, assessed against
people with diabetes, their carers and primary
the clinical practice guidelines criteria
healthstaff on the importance of regular
agreed by the Australian Health Ministers
diabetes-related complication monitoring
AdvisoryCouncil. Support should be provided
for theirimplementation and monitoring
Consider developing clinical care standards
fordiabetes care

12 Australian National Diabetes Strategy 20162020

Develop and implement quality Facilitate and encourage use of the My Health
improvementprocesses Record among health care providers through
supported software technology to access
Support the involvement of people with
thenational online health record
diabetes, and health care providers who
care for people with diabetes, in quality Measures will need to include a range of formats
improvement processes. This may include in order to be inclusive of people withdisability
health care providers reporting data against
Improve affordable access to medicines
clinical guidelines and outcomes
anddevices
Encourage uptake and use of the My Health
Continue to develop and design efficient
Record among health care providers as an
pathways for assessment, evaluation
online and accessible management tool
and funding that enable timely access to
forconditions, treatments and medicines
newdiabetes treatments and devices
Enhance data connectivity to improve
clinicalcare Improve workforce capacity
Upskill the existing generalist health
Use information and
workforceon diabetes
communicationtechnology
Upskill Aboriginal and Torres Strait Islander
Promote the uptake and meaningful use
workers and practitioners on diabetes
of theMy Health Record by consumers
andhealthcare providers Consider the adequacy of the diabetes
specialist workforce (diabetologists
Support current access to flexible
andcredentialled diabetes educators)
telemedicine consultations (e.g. medical
consultations fordiabetes, eye screening Consider redistributing some aspects
programmes and telephone-based of diabetes care to different roles
lifestylecoaching) and explore the expansion (e.g.communitynurses delivering
of telehealth services within existing diabeteseducation, credentialled diabetes
MedicalServices Advisory Committee educators taking on expanded roles in
assessment processes diabetes management)
Facilitate the use and application of consumer Develop clear competencies for the diabetes
engagement and education platforms workforce and other health professionals
involved in diabetes care (e.g. pharmacists,
Harness emerging remote
dentists and podiatrists) based on national
monitoringtechnologies
clinical guidelines in a culturally informed
Facilitate the availability of andlanguage-appropriate way
connectedandconsistent software
programmes for diabetes management
for general practitioners and allied health
professionals within the primaryhealth
caresystem

Australian National Diabetes Strategy 20162020 13

Improve funding mechanisms
Explore and consider innovative funding
mechanisms for the diabetes workforce,
e.g.forpatients who require higher utilisation
of health care services, including allied health
and Aboriginal and Torres Strait Islander
healthservices
Provide mental health care for people
withdiabetes
Routinely monitor people with diabetes
formental health issues
Perform a mental health assessment upon
diagnosis of diabetes and consider regular
monitoring by adding the assessment
totheAnnual Cycle of Care
Promote use of mental health services
bythediabetes community
Strengthen and expand transition
fromchildtoadult services
Potential measures of progress
Strengthen programmes which assist
youngpeople with diabetes in the
transitionfrom paediatric to adult
careservices, includingaccess to
psychologicalsupportservices
Make preschool, school and child care
diabetessafe environments
Support collaborative efforts
betweenparents, the health care team
andthe education environment to allow
children withtype 1 diabetes to participate
fully andsafely inthe school experience
14 Australian National Diabetes Strategy 20162020
Provide high-quality hospital care
Consider adding diabetes to the Australian
Commission on Safety and Quality in Health
Care clinical care standards programme.
Clinicalcare standards can play an
important role in delivering appropriate
care and reducing unwarranted variation,
as they identify and define the care people
should expect to be offered or receive,
regardlessofwhere they aretreated
Provide education and training to hospital
staff involved in the care of patients
withdiabetes
Consider expanding the scope of the National
Safety and Quality Health Service Standards
to include a standard for diabetes for clinical
handover that broadens the discharge plan
from within services to ensure principles of
continuity and coordination of care between
clinicians and organisations
People with diabetes who achieve target
levels of HbA1c, albuminuria, cholesterol
orbloodpressure
People with diabetes undertaking
regularassessment for complications
People who have had their medication
planreviewed by a doctor or pharmacist
People with diabetes complications
Quality standards for diabetes in hospitals
Goal 4: Reduce the impact of pre-existing and gestational diabetes
inpregnancy
Diabetes in pregnancy places women and Potential areas for action
theirchildren at significant risk during and
Provide accessible pre-pregnancy
after the pregnancy. Foetal and infant death is
programmes to women with pre-existing
fourtimes more likely among women who have
diabetes and those with previous history
diabetes prior to pregnancy (14). It is important
of GDM to identify and address risk factors
that steps are taken to mitigate this risk prior
thatmay result in adverseoutcomes
to pregnancy (i.e. through pre-conception care
forboth men and women), during pregnancy Ensure that all women with known diabetes
andfollowingdelivery. receive pre-pregnancy programmes
andadvice
While all women should be included in
general preventative care, women with GDM Ensure that all pregnant women are
in previous pregnancies warrant a particular appropriately tested for diabetes
focus in terms of health and lifestyle owing
Ensure that women with diabetes in pregnancy
toa high risk of future diabetes. The provision
have access to a credentialled diabetes
of ongoing support and care after pregnancy
educator and expert advice on diet and
is essential to help prevent the development
physical activity
of type 2 diabetes. Long term, half of women
who had GDM will develop type 2 diabetes. Provide post-pregnancy programmes
Inaddition, their children are at increased risk of forallwomen with diabetes in pregnancy
developing obesity and also type 2 diabetes(15).
Ensure that women who have previously
Identification and normalisation of maternal
hadGDM receive counselling regarding
hyperglycaemia gives the opportunity to
thefuture risk of diabetes
minimise the short-term complications and
reduce the later development of diabetes and Provide paediatric follow-up for at-risk
obesity and their associated complications. children (e.g. children of mothers with GDM
In addition, there is evidence to suggest that orobesity)
breastfeeding reduces the risk of diabetes not
only in the baby but also in the mother (16). Consider a reminder system for those
registered on the National Gestational
Diabetes Register for future diabetes testing

Potential measures of progress

Pregnant women with diabetes having
measurements of HbA1c in the first and
thirdtrimesters
Reduction in perinatal and infant deaths
ofchildren of mothers with diabetes
Mothers with GDM having postpartum
diabetestesting

Australian National Diabetes Strategy 20162020 15

Goal 5: Reduce the impact of diabetes among Aboriginal
andTorresStrait Islander peoples
Australias Indigenous community has one of Potential areas for action
the highest rates of type 2 diabetes and its
The actions within the preceding goals
complications both nationally and globally.
also apply to this goal. The following
Increasingly, diabetes is being diagnosed
additionalactions, to be developed
inchildren, adolescents and young adults(17),
in consultation withcommunities,
with rising rates of diabetes in pregnancy
arerecommended:
establishing intergenerational patterns of
premature disease (18). The prevalence and Develop and implement community-wide,
severity of diabetes-related complications culturally relevant awareness programmes
among Aboriginal and Torres Strait Islander (including school education programmes)
peoples is of particular concern (10). thatcommunicate the seriousness of diabetes
and its complications. Educationshould
To prevent diabetes and improve
be provided in a culturally and language
diabetesmanagement, it is important to ensure
appropriate manner, which includes
that the communities have access to, and can
translatingmaterials andservices
benefit from, diabetes support, education
andservices e.g. Aboriginal Community Promote pre-conception, pregnancy and
Controlled Health Services, where they exist, early years programmes that enhance the
orculturally competent mainstream services education and health of Indigenous men
as an integral part of their primary health andwomen; detect gestational and previously
care services. Food security, healthier choices undiagnosed diabetes and manage it
and lifestyle changes need to be encouraged throughpregnancy; and coordinate follow-up
and facilitated; and family and child health and postnatal care for mothers and babies
needs tobe improved through pregnancy
Enhance the pre-conception education
andearlyyears programmes.
and health of Indigenous women,
Aboriginal and Torres Strait Islander includingthrough targeted efforts to reduce
peoples may experience cultural and the use of alcohol, tobacco and other drugs
linguistic barriers, as well as geographic and to promote ahealthy diet
and socio-economic barriers, that limit
Develop and implement community-wide
their accesstodiabetes-related services
interventions to increasetheavailability,
and education.Actionsforruraland remote
affordability and consumption
Australians (see Goal 6) apply to this group.
of freshfoodsand reduce the
Thiscultural diversity, along with varying
consumptionofsugar-sweetened
local and regional circumstances, needsto be
beveragesand high-fat, high-sugar,
recognised and respected and should inform
high-salt and highlyprocessedfoods
thedevelopment of action thatserves to
reducethe burden and impact ofdiabetes.

16 Australian National Diabetes Strategy 20162020

 Promote access to necessary specialist Potential measures of progress
support through strategically located regional
Aboriginal and Torres Strait Islander people
networks of care, optimising telehealth
with diabetes
services and linked facilities for the treatment
of the serious complications of diabetes Aboriginal and Torres Strait Islander people
inparticular, kidney and eye disease with diabetes complications
Encourage primary health care services Aboriginal and Torres Strait Islander women
to better identify and manage diabetes with gestational diabetes
(including among adolescents and children),
Aboriginal and Torres Strait Islander people
incorporate risk calculators and electronic
with above-target HbA1c, albuminuria,
decision support mechanisms and increase
cholesterol or blood pressure
opportunities for Aboriginal and Torres Strait
Islander patients to better self-manage Aboriginal and Torres Strait Islander people
theirdiabetes who receive regular testing for complications
Consider the adequacy of the diabetes Rates of smoking and alcohol consumption
educator workforce working with and among pregnant Aboriginal and Torres Strait
within Aboriginal and Torres Strait Islander Islander women with diabetes
primary care settings and support the
The cost of a healthy food basket,
capacity development of the workforce to
monitoredto assess the availability
improveaccess to essential, high-quality,
and affordability of foods required
evidence-based diabetes care
forahealthydiet
Provide stimulating early years education and
Aboriginal and Torres Strait Islander children
intervention programmes which help address
participating in evidence-based early
developmental vulnerabilities and address
childhood education programmes
the social and environmental determinants
ofAboriginal and Torres Strait Islander
peoples health
Encourage uptake and use of the My Health
Record among health care providers in
ruraland remote locations, with online
access to the individuals medical history
andprescriptions

Australian National Diabetes Strategy 20162020 17

Goal 6: Reduce the impact of diabetes among other priority groups
Australia is socially and culturally diverse and Older Australians
this has important implications for this Strategy.
Diabetes (particularly type 2 diabetes) is
The areas for action that have been suggested
more prevalent among older Australians (11).
for all Australians in the preceding goals also
Furthermore, older people with diabetes
apply to communities with a higher prevalence
experience higher rates of multi-morbidities
of diabetes. Examples include culturally and
(i.e. higher rates of diagnosis with other medical
linguistically diverse communities (CALD),
conditions alongside diabetes) and disability,
olderAustralians, rural and remote communities
aswell as earlier onset of functional decline
and mental health consumers. Each warrants
andfrailty (19). Dementia may impact on
particular attention and may require different
apatients ability to self-manage their diabetes.
policy or health system approaches.

Australians living in rural and remote areas

Culturally and linguistically diverse people
People with diabetes who live in rural
People from some CALD backgrounds are
and remote communities may experience
at higher risk of developing type 2 diabetes
geographical barriers that limit their access
(perhapsreflecting a predisposition
toservices (20). Rural and remote communities
to diabetes in their environmental or
are associated with areas of social disadvantage
geneticbackgrounds). Peoplefrom these
and include Aboriginal and Torres Strait
backgrounds who have diabetes may also
Islander peoples and people from all ethnic
experience cultural and linguistic barriers
and culturalbackgrounds, some of whom may
that limit their access to diabetes-related
experience additional cultural and linguistic
services andeducation. Actions for both the
barriers to accessing services.
prevention of diabetes and its management
need to be tailored to the specific needs of the
respectiveCALDcommunities to ensure that
person-centred, culturally safe care respects
the many diverselanguages, religious beliefs
andculturalpractices in those communities.

18 Australian National Diabetes Strategy 20162020

Mental health issues
People with diabetes may experience
depressionor anxiety and may also
find themselves overwhelmed with
thedemandsofself-management.
Attending to behavioural and mental health
factors at diagnosis and as the illness progresses
is crucial to preventing complications,
maximising outcomes andminimising the costs
of diabetes care. Thetransition from child to
adult diabetes services can also be a time
whenpeople requireextra support.
In addition, people being treated for mental
health disorders such as depression,
anxietyand schizophrenia may be at higher
risk of diabetes due to the impact of therapies
such aspsychotropic medications and
resultingweight gain (21).
GPs and allied health professionals can facilitate
mental health assessment and monitoring as
acomponent of holistic, ongoing patient care.
Potential areas for action
Culturally and linguistically diverse people
Translate consumer resources on
preventionand management into
theappropriate languages
Encourage the use of appropriate translation
services during health care encounters
Improve health literacy by disseminating
culturally appropriate information and
programmes for the management and
careofdiabetes
Older Australians
Promote the implementation of relevant
guidelines on managing diabetes in
olderpeople to inform care and clinical
decision-making across health and
agedcaresettings
Ensure that staff in aged care settings
aretrained in managing diabetes
Ensure appropriate care transitions
betweenservices
Facilitate early discharge planning and
communication with the diabetes care team
and/or treating GP
Support the role of carers forolderpeople
withdiabetes through information,
educationand links to services,
includingculturally appropriate
localsupportgroups
Encourage sharing of care and transition plans
between health professionals and individuals
through the use of the My Health Record
Ensure consideration of care contexts,
care planning and diabetes-specific risk
assessments to enable proactive and
preventive care approaches
Australian National Diabetes Strategy 20162020 19
Australians living in rural and remote areas Potential measures of progress
Coordinate regional services across primary, People developing or with type 2 diabetes
secondary and tertiary care to facilitate access among priority groups
to care and the necessary support services
People with diabetes among priority groups
Support community-based health workers with above-target HbA1c, cholesterol,
through training and education albuminuria and blood pressure
Ensure the availability of telehealth and People among priority groups who
internet medical services and ensure are overweight, obese or have other
equitableaccess to other technologies modifiablerisk factors
andservices as appropriate
People among priority groups who
Examine the possible benefits of utilising receivetesting for complications
community pharmacies and other health
Complications in people with diabetes
professionals to provide diabetes advice
amongpriority groups
andcare where other primary health care
access is limited Hospitalisations among older Australians
withdiabetes
Encourage uptake and use of the My Health
Record among health care providers in rural
and remote locations, providing online
access to a patients medical conditions
andprescriptions through this record
Develop partnerships and linkages between
local clinicians and health professionals
andmajor specialist diabetes centres

Mental health issues

Perform a mental health assessment upon
diagnosis of diabetes and consider regular
monitoring by adding the assessment to
theAnnual Cycle of Care
Routinely monitor people with diabetes
formental health issues
Routinely monitor people with
mentalhealthillness for diabetes

20 Australian National Diabetes Strategy 20162020

Goal 7: Strengthen prevention and care through research,
evidence and data
Diabetes has a significant impact on Australias Developing the evidence base for continuous
health and productivity, and research into glucose monitoring and insulinpump
thecondition including the basic science of programmes to improve diabetes care
the disease, its social and economic impacts
Translating research into improved therapies
and appropriate clinical responses is an
for the optimal management ofdiabetes
important priority. Although Australia currently
has multiple diabetes research fundingstreams, Within the recognised legislative and
research efforts need tobefurther focused privacyrequirements, linking existing data
on strengthening evidence-based practice sets to provide de-identified aggregate
for the prevention of diabetes and its data that can be analysed to inform
complications, identifying a cure fordiabetes, theknowledge base fordiabetes
informing health policy decisions and
Collating and disseminating
potentially offeringmoretimely access
researchfindings in a timely manner
tonewerandimproved medications.
Improve and expand data linkage
Potential areas for action andfacilitateease of access
Develop a national research agenda Provide information on how to
accessdiabetes-relevant datasets
Develop a national research agenda designed
forresearchpurposes
to coordinate diabetes research across
multiple funding streams, with particular Facilitate and improve the connectivity of
attention to: keydata systems between different providers
of health care, including through increased
E
 xamining the barriers to best practice
participation with the My Health Record
andthe availability of (and access to)
appropriate health services in order to Undertake a regular national biomedical
develop specific strategies to address health survey that includes diabetes and
andovercome thesebarriers chronic conditions and an Aboriginal and
Torres Strait Islander peoples component
I dentifying the cause(s) of type 1
diabetes and how to prevent, cure and
treat the condition (including research Potential measures of progress
into the potential benefits of stem cell
Development of a national research agenda
technologyand isletcelltransplantation)
Regular reports from national datasets and
I dentifying the cause(s) of type 2 diabetes
surveys on diabetes parameters such as
and ways to improve outcomes for people
burden of disease and health system usage
with the condition (including Aboriginal
and Torres Strait Islander peoples, children
andadolescents, and other priority groups)

Australian National Diabetes Strategy 20162020 21

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Australian National Diabetes Strategy 20162020 23

11309 November 2015

www.health.gov.au
All information in this publication is correct as at November 2015