Health+Priority+Area+-+Diabetes

=Incidence of insulin-treated diabetes in Australia 2000–2009= http://www.aihw.gov.au/diabetes/incidence/

Incidence of insulin-treated Type 2 diabetes
This section presents the latest diabetes incidence statistics for people using insulin to treat Type 2 diabetes. Not all people with Type 2 diabetes need insulin for treatment and lifestyle modifications such as regular exercise and a healthy diet, along with medication, can often control Type 2 diabetes without the need for insulin. However, as the duration of diabetes and the age of the person with diabetes increases, many people with Type 2 diabetes will need to begin to use insulin. The following data include only cases of Type 2 diabetes in those aged 10 years and over. Although there are cases of Type 2 diabetes in children younger than 10, these are uncommon. Most of the recorded cases of diabetes in young children are due to data errors and therefore statistics for this age group have not been reported.

Incidence by age and sex
From 2000 to 2009, there were 94,663 males and 77,583 females who began to use insulin to treat their Type 2 diabetes. The average annual rate of new cases over this period was 95 per 100,000 people. This was 108 new cases per 100,000 for males and 82 new cases per 100,000 for females. Until the age of 85 years, the incidence of insulin-treated Type 2 diabetes increased as people got older. For those aged 10–14 the incidence was 3 per 100,000 people and for the 55–69 year age group it was 238 per 100,000.

Figure 9: Average annual incidence rate of insulin-treated Type 2 diabetes, by age at first insulin use and sex, 2000–2009
//Note:// Excludes those aged less than 10 years. //Source:// National Diabetes Register and AIHW analysis of de-identified NDSS data (data extracted July 2011)

Trends in incidence
In 2009, the rate of new cases of insulin-treated Type 2 diabetes was higher than in 2000. The incidence rate was 117 per 100,000 people in 2009 compared with 74 per 100,000 in 2000. The increase in the rate of new cases could be the result of an increase in the number of people with insulin-treated Type 2 diabetes registering with the National Diabetes Services Scheme or it may reflect an actual increase in the underlying number of cases of Type 2 diabetes treated with insulin, or a combination of these factors. Over the period 2000 to 2009, there was a greater increase in the incidence of insulin-treated Type 2 diabetes for males compared with females. In 2009, the incidence rate of insulin-treated Type 2 diabetes was 138 per 100,000 males compared with 81 per 100,000 in 2000. For females, the incidence rate of insulin-treated Type 2 diabetes was 98 per 100,000 in 2009 compared with 67 per 100,000 in 2000.

Figure 10: Incidence rate of insulin-treated Type 2 diabetes among those aged 10 years and over, by sex, 2000–2009
//Notes//

1. Age-standardised to the 2001 Australian population.

2. Analysis of the population aged 10 years and over. //Sources:// National Diabetes Register; AIHW analysis of de-identified NDSS data (data extracted June 2011)

Incidence by location
The average annual incidence rate of insulin-treated Type 2 diabetes over the period 2000 to 2009 for Australians aged 10 and over was 95 per 100,000 people; however this rate varied with the state or territory in which people lived. The incidence rate was highest for those living in New South Wales, at 101 per 100,000 population and lowest in the Australian Capital Territory at 71 new cases per 100,000 population.

Figure 11: Average annual incidence rate of insulin-treated Type 2 diabetes, by state or territory of current residence, 2000–2009
//Notes//

1. Age-standardised to the 2001 Australian population.

2. Analysis of the population aged 10 years and over.

3. Data for the Northern Territory are not displayed due to data quality issues but are included in Australia. //Source:// National Diabetes Register (data extracted June 2011).

Source data and methods
The source tables from which the charts in this section were created: Information on the statistical methods used in the derivation of the data:
 * [|Statistics from the 2009 National Diabetes Register [252KB XLS]]
 * [|Appendix: Statistical notes and methods [191KB DOC]] | [|[530KB RTF]]

Data quality statement

 * [|NDR data quality statement [83KB PDF]]

Notes and corrections
The current version of the publication is presented above.
 * 1) (**28 March 2012**) Additional data relating to the incidence rate of Type 1 diabetes for all ages.

=Diabetes Mellitus - One of Australia's top six health priorities= http://www.healthinsite.gov.au/content/internal/page.cfm?ObjID=00001FB3-0318-1D2D-81CF83032BFA006D&PID=1758

By //[|Professor Paul Zimmet] AO,MB,BS,MD,PhD,FRACP,FRCP,FAFPHM, FTSE, Emeritus Director and Director of International Research,// [|Baker IDI Heart and Diabetes Institute] //, and// //[|Dr Dianna J Magliano] BAppSci (Hon),PhD, Senior Epidemiologist and Senior Lecturer, Department of Epidemiology and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences,// //Monash University// Diabetes mellitus is recognised as a serious global health problem often resulting in substantial morbidity and mortality, primarily from cardiovascular complications, eye and kidney diseases and limb amputations, and will be one of the major health problems facing Australia in the 21st century (1) Prevention of diabetes is a major challenge that faces nearly every nation and it is now being recognised by the international community. Against the background of the escalating diabetes epidemic, in December 2006 the United Nations General Assembly voted unanimously to pass Resolution 61/225 declaring diabetes an international public health issue. For the first time, governments acknowledged that a non-infectious disease poses as serious a threat to world health as infectious diseases .such as HIV/AIDS, tuberculosis and malaria. This United Nations resolution recognised that tackling diabetes is likely to be one of the most important challenges for the global public health community in the 21st century.
 * Background **

Indeed, our former Prime Minister and now Minister for Foreign Affairs, Kevin Rudd, in a 2008 speech to the Sydney Institute said that diabetes will be the number one disease in men, and only second to breast cancer in women, by 2020.

The existence of at least 2 clinical types of diabetes was first demonstrated convincingly 50 years ago by a distinguished Melbourne physician/biochemist, Joseph Bornstein. He developed an insulin bio-assay and showed there was no measurable insulin in the blood of juvenile-onset diabetics. This important finding preceded, by a decade, the Nobel Prize winning discovery of a more sophisticated technology in the insulin radio-immunoassay which only confirmed Bornstein's earlier observations. Diabetes is a collection of closely related diseases. The classification is based on differences in causation, natural history and clinical presentation. The three major categories of diabetes are: Type 1 diabetes (formerly known as insulin-dependent diabetes mellitus) Type 1 diabetes is one of the most common childhood diseases in developed nations and constitutes about 10% of all persons with diabetes in Australia. It has been called a variety of names including insulin-dependent, immune-mediated or juvenile-onset diabetes. There is destruction of the insulin-producing cells of the pancreas and the cause is still controversial. Some people believe it is due to an auto-immune reaction where they are attacked by the body's defence system. However, it is possible that the autoimmune attack is secondary to some other destructive process – for example, a virus attack or a food or other environmental toxin. Whatever the initial attack, the beta cells of the pancreas produce no insulin. This is the chemical substance (hormone) that allows glucose to enter body cells and generate energy for their metabolism.
 * Classification of diabetes **

Type 1 diabetes can affect people of any age, but usually occurs in children or young adults. It is said to be one of the most common endocrine and metabolic conditions in childhood. They need as many as 4 injections of insulin every day in order to control the levels of glucose in their blood. In recent times, insulin pumps have become popular – small units that deliver a continuous supply of insulin, usually resulting in much better control of blood sugar levels. Without insulin, people with type 1 diabetes will die.

Type 1 diabetes onset is often sudden and dramatic and if unrecognised, could be fatal. The symptoms include: In most countries including Australia and we know not why, the incidence of type 1 diabetes is increasing every year. This is likely to be mainly due to changes in environmental risk factors. Environmental risk factors, such as increased height and weight development, increased maternal age at delivery, and possibly some aspects of diet and exposure to some viral infections, may initiate autoimmunity or accelerate already ongoing beta cell destruction. Type 2 diabetes (formerly known as non-insulin dependent diabetes mellitus) Type 2 diabetes constitutes about 85% of all diabetes in Australia. It could be said that Type 2 diabetes is the fast growing disease in human history! It is characterized by insulin resistance (the body tissues become refractory to insulin) and relative insulin deficiency (a tired pancreas!), either of which may be present at the time that diabetes becomes clinically manifest.
 * abnormal thirst and a dry mouth
 * frequent urination
 * extreme lack of energy
 * constant hunger
 * sudden and dramatic weight loss
 * recurrent infections
 * blurred vision

The diagnosis of Type 2 diabetes usually occurs after the age of 40 years but could occur earlier, especially in populations with a high diabetes frequency for example Pacific Islanders, Asian Indians, people from the Middle East and even our own Indigenous community. It is not uncommon now to see adolescents from these ethnic groups with Type 2 diabetes. It is a penalty of our life-style.

Type 2 diabetes can remain undetected, i.e. without symptoms, for many years and the diagnosis is often made from associated complications or incidentally through an abnormal blood or urine glucose test. However, damage may already being done to the eyes, kidneys and heart.

Type 2 diabetes is often, but not always, associated with obesity, which itself can cause insulin resistance and lead to elevated blood glucose levels. It is strongly familial, that is hereditary, but genetic studies have not yet identified the major gene or genes. There are several possible factors in the development of type 2 diabetes. These include:

Poor maternal environment eg nutrition, obese or diabetic mother
 * Obesity
 * Poor diet
 * Physical inactivity
 * Increasing age
 * Strong family history of diabetes
 * Ethnicity

High risk groups for diabetes include:

• People who are obese or have high blood pressure or existing heart disease;

• People with a strong family history of diabetes;

• Aboriginal and Torres Strait Islanders;

• Asians and Pacific Islanders;

• Women with a past history of gestational diabetes;

• The elderly.

Gestational Diabetes Some women develop diabetes during their pregnancy and this is known as gestational diabetes. This is thought to be because hormones and other factors released during normal pregnancy cause resistance to the actions of insulin. This means that insulin production needs to be almost doubled to keep glucose levels under control. Some women, however, do not have the capacity for this increase, especially older women and overweight women and glucose levels rise. Although levels usually return to normal after delivery, women with gestational diabetes have a substantially increased risk of developing type 2 diabetes as they get older. A global and national perspective World-wide, diabetes is in epidemic mode. The most recent global predictions by our Institute for the International Diabetes Federation (IDF) suggest that there are 285 million people with diabetes currently worldwide. This is set to escalate to 438 million by 2030, resulting in a 54% increase.

Changes in society over recent decades have impacted on lifestyle leading to lower levels of physical activity and unfavourable changes in our diet with consequent increase in obesity(3). These factors, and the ageing of the Australian population have led to high levels of morbidity from a number of chronic diseases which contribute greatly to national health costs. Diabetes and cardiovascular disease are two of these conditions (1;3). As a result they were included by the Federal, State and Territory governments in the six National Health Priority Areas which also include cancer, trauma, asthma and mental health.

Diabetes is recognised as:

• the second commonest cause for commencing kidney dialysis,

• the most common cause of blindness in people under the age of 60 years,

• the most common cause of non-traumatic lower limb amputation, and

• one of the most common chronic diseases in children (4). The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) study Accurate, representative and recent prevalence data for diabetes in Australia were unavailable or inadequate prior to the 1999-2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) - the first national study to provide estimates of the number of people with diabetes (based on blood tests) and its public health and societal impact. This important initiative was an integral component of the National Diabetes Strategy that resulted from the vision and commitment of the Federal Minister, Dr Michael Wooldridge, to tackle the mounting problem of diabetes and its complications in Australia.

AusDiab was a national population-based study which surveyed participants in each state and the Northern Territory of Australia, involving 11,247 participants over 18 months of testing. Details relating to the methods of this study have been published elsewhere (5). The key findings of the study were that in 2000, the prevalence of diabetes was 7.4% in the Australian population aged 25 years and older - 8.0 % for males and 6.8% for females. The prevalence of diabetes rose from 2.4% in people 35 to 44 years to 23.0% in those 75 years and over. In summary:

• For every known case of diabetes, there was another undiagnosed case.

• There were approximately 940,000 people over the age of 25 years with diabetes in Australia.

• The number of people with diabetes had trebled since a broadly based blood survey was undertaken in 1981 in Busselton, a rural Western Australian town,(see Figure 1) for the change over the years from 1981 to 2000.

• The prevalence of impaired glucose metabolism (either impaired glucose tolerance (IGT), impaired fasting glycaemia (IFG), or diabetes) of the survey population was 23.7% - 25.3 % for males and 22.2 % for females


 * ALMOST 1 IN 4 AUSTRALIANS 25 YEARS AND OVER HAD EITHER DIABETES OR A CONDITION OF IMPAIRED GLUCOSE METABOLISM. THIS IS ASSOCIATED WITH SUBSTANTIALLY INCREASED IMMEDIATE RISK OF HEART DISEASE AS WELL AS INCREASED RISK OF DIABETES IN THE FUTURE (6).**

In 2004/5, remaining survivors of the AusDiab cohort were invited back for a re-examination similar to that conducted in 2000. The follow-up of the cohort allowed the measurement of the incidence of diabetes. AusDiab is one of the only national population-based studies in the world that allowed the measurement of the incidence of diabetes using an oral glucose tolerance test. The age-standardized annual incidence of diabetes for men and women was 0.8% (95% CI 0.6–0.9) and 0.7% (0.5– 0.8), respectively (7).

The follow-up of the AusDiab cohort also allowed the development of a 5 year diabetes risk assessment tool for Australia based on demographic, lifestyle and simple anthropometric measures. This tool is called AUSDRISK. AUSDRISK is a paper- based tool which uses simple non clinical markers to predict diabetes and can be used by the individual or by the general practitioner to predict 5 year risk of diabetes (8). Those who score over 12 points on this tool are referred to a diabetes prevention program. AUSDRISK is an important initiative which has allowed the identification of Australian adults at high risk of type 2 diabetes who might benefit from interventions to prevent or delay its onset. AUSDRISK can be accessed at http://www.health.gov.au/internet/main/publishing.nsf/Content/diabetesRiskAssessmentTool

More recent estimates suggest that there are well over 1,500,000 people with diabetes in Australia in 2010.

References

1. McCarty DJ, Zimmet P, Dalton A, Segal L, Welborn TA: The rise and rise of diabetes in Australia, 1996: A review of statistics, trends and costs. Canberra, International Diabetes Institute & Diabetes Australia, 1996

2. Australian Bureau of Statistics: Causes of Death, Australia, 1996. Canberra, Australian Bureau of Statistics, 1997

3. Australian Institute of Health and Welfare: Australia's Health 1998: the sixth biennial health report of the Australian Institute of Health and Welfare. Canberra, AIHW, 1998

4. Colagiuri S, Colagiuri R, Ward J: National Diabetes Strategy and Implementation Plan. Canberra, Diabetes Australia, 1998

5. Dunstan D, Zimmet P, Welborn T, Cameron A, Shaw J, deCourten M, Jolley D, McCarty D, On behalf of the AusDiab Steering Committee: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab) - methods and response rates. Diabetes Research and Clinical Practice 57:119-129, 2002

6. Dunstan DW, Zimmet PZ, Welborn TA, De Courten MP, Cameron AJ, Sicree RA, Dwyer T, Colagiuri S, Jolley D, Knuiman M, Atkins R, Shaw JE: The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 25:829-834., 2002

7. Magliano DJ, Barr EL, Zimmet PZ, Cameron AJ, Dunstan DW, Colagiuri S, Jolley D, Owen N, Phillips P, Tapp RJ, Welborn TA, Shaw JE. Glucose indices, health behaviors, and incidence of diabetes in Australia: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 31:267-72, 2008

8. Chen L, Magliano DJ, Balkau B, Colagiuri S, Zimmet PZ, Tonkin AM, Mitchell P, Phillips PJ, Shaw JE. AUSDRISK: an Australian Type 2 Diabetes Risk Assessment Tool based on demographic, lifestyle and simple anthropometric measures Med J Aust. 192:197-202. 2010. Erratum in: Med J Aust.192:274, 2010. Updated November 2010