Reason for hope and cause for concern
By Dr Elizabeth Holmes-Truscott and Prof Jane Speight
It is National Diabetes Week (14 – 20 July 2024) here in Australia. Usually, it is not so much a celebration, as a call to action. So, it is timely to reflect on the recent report from the Parliamentary Inquiry: The State of Diabetes Mellitus in Australia in 2024.
What was the Inquiry?
The Inquiry was announced in May 2023. It focused on five areas (see Box 1). The Inquiry Committee invited written submissions from the public. By July 2023, there were almost 500. Fifteen public hearings were held from June 2023 to March 2024.
Box 1: Inquiry Terms of Reference
What did the Inquiry find?
On 3rd July 2024, the findings were published in a 270-page report. There are 23 recommendations (see Box 2).
Box 2: Summary of Inquiry Recommendations
Our reflections
Broadly, the diabetes community has welcomed the Inquiry and its findings.
A crucial win is the recommendation to increase access to diabetes technologies. Diabetes Australia’s theme for National Diabetes Week is the need for equitable access to diabetes technologies for all types of diabetes. Last week, a Consensus Statement on Automated Insulin Delivery for Type 1 Diabetes in Australia was launched. This all aligns with recent policy changes elsewhere, such as the UK and New Zealand.
The news media has focused largely on the call for a ‘sugar tax’ (#4). This and related measures reflect public health calls over many years. Such policies may benefit the health of all Australians, particularly those who are most vulnerable and/or disadvantaged. However, this recommendation does not make the link between diabetes and obesity clear. Yet, media headlines suggest a direct link and do not specify diabetes type. Headlines ask questions such as “Does Australia need a sugar tax to tackle diabetes?”. Other important risk factors for type 2 diabetes and gestational diabetes are ignored. For example, genetics, age, depression, sleep quality.
While we celebrate the potential of the Inquiry’s recommendations to bring benefits, we also see the potential for harm.
First, by linking diabetes with obesity, the fallout is stigma of both conditions. An international consensus shows that diabetes stigma has a negative impact on health and well-being. Another international consensus shows similar impacts of weight stigma. Yet, it appears that the Inquiry report has led directly to media headlines that perpetuate this stigma. Unfortunately, this is not a surprise. Here is our blog from the Inquiry launch. Instead of addressing the complex causes and management of all types of diabetes (and obesity), the national conversation focuses on simplistic solutions, like ‘eat less and move more’. The Inquiry reinforces the view that obesity is the key ‘culprit’ in diabetes of any type. Further, the report places blame and shame on people with type 2 diabetes and gestational diabetes. For example, the Chair’s foreword on type 2 diabetes opens with a scathing remark: ‘Increasingly, there is a huge burden being placed on health resources by people with type 2 diabetes and this is across virtually the entire health spectrum of disease…’. While the Chair’s foreword on type 1 diabetes opens by discussing scientific advances and effective technologies and states, ‘more must be done to increase the availability of this technology’.
Second, the 23 recommendations largely ignore the emotional and mental health burden experienced by people living with diabetes. People with diabetes want and need better integration of psychological care within routine diabetes care. But training for diabetes health professionals and mental health professionals is needed. Importantly, research shows that including psychologists in diabetes care teams improves clinical care and outcomes. So, this would have been an important recommendation. The National Diabetes Strategy also recommends greater focus on mental health in diabetes. Goal 3 of the Strategy calls for mental health screening to be added to the annual cycle of diabetes care. Yet, this was not recommended by the Inquiry either.
Wrap up
Like many Australians living with or affected by diabetes, we eagerly awaited the Inquiry findings. If implemented well, several recommendations could enable long overdue and fair access to diabetes technologies and promote a healthier environment for all. This is an opportunity for the Australian Government to take a multi-faceted approach to improving the well-being of all Australians affected by diabetes.
We live in hope. Unfortunately, we also have concerns. In particular, there are no recommendations to help bring an end to diabetes stigma (or weight stigma). In fact, there are several missteps, which will likely fuel both. We are also concerned by the lack of focus on emotional well-being.
Only time will tell if equitable access to diabetes technologies will be realised for Australians with all types of diabetes. Or, whether diabetes stigma will quash that effort. In the meantime, we call on everyone in the diabetes community to minimise the potential for harm. Take the Pledge to end diabetes stigma.
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