Australia needs a paradigm shift in diabetes care and research

Improving Health and Wellbeing

Diabetes expert, Professor Jane Speight argues that a new focus and much more research investment are needed to improve diabetes care.

In the latest edition of the “Medical Journal of Australia,” one of Australia’s leading experts on diabetes, Professor Jane Speight, has claimed that the health profession needs to rethink its approach to diabetes.

She also calls on the Federal Government to focus its spending to support this.

Australia is experiencing a diabetes epidemic that is costing the nation around $14 billion per annum, with these costs predicted to more than double by 2025. More than 1.1 million Australians have diabetes, about 85 per cent of whom have type 2 diabetes (T2D).

Only about one in four adults with diabetes have a glycated haemoglobin (HbA1c) value in the target range. Achieving this target is important for minimising the risk of devastating long-term complications, Professor Speight explained.

“Albert Einstein is credited with defining insanity as ‘doing the same thing over and over again and expecting different results’… diabetes care in Australia is in danger of being overcome by this basic behavioural error,” she said.

“Most diabetes research continues to focus on developing and trialling new medicines and technologies, while clinical practice focuses on screening for complications and prescribing. Meanwhile, costs are spiralling and outcomes are not improving.”

Professor Speight is Foundation Director of the Australian Centre for Behavioural Research in Diabetes (ACBRD), which was established by Diabetes Victoria and Deakin University in 2010. She is also Chair in Behavioural and Social Research in Diabetes at Deakin.

“Now is the time for a paradigm shift to focus on how human behaviour and psychology can inform policy and practice to improve the health and lives of one million Australians.”

She argues that much more research investment is needed to improve diabetes care.

“While spending on diabetes care is estimated to be $14 billion per year and increasing annually, only $0.36 billion has been invested in diabetes research in the past five years.”
Professor Jane Speight
Professor Jane Speight Australian Centre for Behavioural Research in Diabetes

“This woeful under-investment, especially compared with cancer and cardiovascular disease, is a looming national disaster, given that diabetes was predicted in 2010 to become the leading cause of disease burden in Australia from 2017.

“Moreover, behavioural and psychological research attracts a minute fraction of the diabetes funding pool each year, arguably less than two per cent in the 2015 funding round. Thus, there is negligible investment in developing, trialling and implementing the behavioural insights that can improve self-management and the physical and mental health of people with diabetes.”

The first major undertaking of the ACBRD was to conduct the largest, most comprehensive study of the psychological and behavioural aspects of diabetes ever seen in Australia. The survey attracted responses from 3338 adults with diabetes (59% with type 2 diabetes) on their self-care, health beliefs and emotional health.

Professor Speight said that the Diabetes Management and Impact for Long-term Empowerment and Success (MILES) study offered a road map for improving Australian outcomes.

She explained that one in five MILES respondents with T2D reported that they never or infrequently ate healthily, while two in three did not engage in sufficient physical activity.

“Many people do not take medications as recommended, likely due to the demands of managing diabetes in the workplace and the fact that people with diabetes feel stigmatised,” she said.

“Also, many people with diabetes overestimate their risk of long-term complications, but a recent pilot study has shown that intervening with actual, personalised risk profiles and counselling was feasible and could reduce risk overestimation levels and diabetes distress.”

She noted that the United Kingdom has taken the lead on researching and promoting the role of structured diabetes education. It has introduced national structured programs that are proving effective in changing health beliefs, addressing burden and distress, and engaging people in their diabetes care.

“Much more can be done in Australia to implement existing behavioural insights in a national, co-ordinated and systematic approach to improve the health and well-being of people with diabetes, and much more needs to be done to encourage and support behavioural innovation to address what is arguably the greatest health challenge facing Australia.”

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