What will New Zealand be like in 2025 with the high incidence of diabetes?

To mark World Diabetes Day, Diabetes New Zealand has invited a selection of New Zealanders to predict what diabetes will be like in this country in 2025. The opinions range from a change in definition to a change in environment.

• Professor Russell Scott (Clinical Professor of Medicine, Diabetes and Lipid Disorders, Christchurch Clinical School of Medicine)
• Hon David Cunliffe (Minister of Health)
• Suzanne Snively (Economist and partner at PriceWaterhouseCoopers)
• Professor Don Beaven (Emeritus Professor Christchurch School of Medicine, University of Canterbury. Diabetes New Zealand Co-Patron)
• Dr Rod Jackson (Professor of Epidemiology and Head of Epidemiology & Biostatistics University of Auckland)
• Dr Robyn Toomath (Clinical endocrinologist Wellington Hospital. Spokesperson Fight the Obesity Epidemic (FOE))

 

Professor Russell Scott

Clinical Professor of Medicine, Diabetes and Lipid Disorders, Christchurch Clinical School of Medicine

Diabetes is exploding in the world and will more heavily impact on certain sectors of the New Zealand community. The treatments that are available today are not really different from 40 years ago and will remain little changed in the next 20 years.

The rise in obesity and diabetes has been more rapid than anyone predicted. The toxic environment for obesity and diabetes is well entrenched and will not be easily modifiable. While wide scale community prevention seems a dream, a cure seems further off than ever.

 

Hon David Cunliffe

Minister of Health

The further we look forward to predict, the less exact the predictions can be.

If we take ourselves back 18 years in time to 1989 and try to predict 2007 levels of diabetes it gives us some pause for thought at how unaware we were of what was ahead for us.

Not many saw the almost rampant increase in Type 2 diabetes incidence, nor the unexplained increase in Type 1 diabetes that was looming. Although we can argue that we now have a better understanding of the disease, we neither fully understand all the factors that have caused this increase, nor halted its rise.

But we have started to act. Our children and youth are increasingly aware of the part which diet, nutrition and lifestyle plays in staying healthy and of the negative health consequences of ignoring that awareness.

Diabetes remains one of this country’s largest public health challenges and I think it will remain so in 2025. Equally we can rise to that challenge.

Increasing the percentage of people with diabetes who access free annual checks and better manage their diabetes is one of the ten major health targets launched in August 2007, aimed to improve health outcomes for all New Zealanders.

There are clusters of excellence around New Zealand.

The Counties Manukau DHB Lets Beat Diabetes campaign is a success story. Since its inception in 2005, there are now around 60 different Lets Beat Diabetes projects and initiatives operating in partnership with local communities that are preventing the onset of Type 2 diabetes, slowing its progression and improving the quality of life for people with diabetes living in the Counties Manukau district.

If we achieve this level of action in all 21 of our DHBs, our health landscape in 2025 will be a credit to the people who are working so hard now.

 

Suzanne Snively

Economist and partner at PriceWaterhouseCoopers

New Zealand has a huge opportunity as a small country with a caring population to make a difference by focusing PHOs and DHBs on the most effective ways of preventing and treating diabetes.

PwC's outcome model calculates that for a $60 million additional investment now in prevention, the taxpayer will save $400 million that would otherwise have to be spent on Type 2 diabetes complications in 2021.

Recent trends have shown as esculation in the prevalence of Type 2 diabetes. Projecting these trends forward, this single disease will require as estimated 15% of the health budget to be devoted to the treatment of the awful complications of Type 2 diabetes, including loss to eyesight, limb amputations, heart disease, strokes and so on.

An implication of this is that the treatment costs of Type 2 diabetes will swamp DHBs, putting further pressure on their already limited resources to treat chronic conditions and crowding out the potential to provide the resources to support effective preventative initiatives through the PHOs.

Recent experience of DHBs and PHOs, backed up increasingly by actual experience of some go-ahead primary care practices, research and clinical trials, shows that increased investment in programs aimed at prevention and early detection of the disease can massively reduce the future costs of treating the complications of Type 2 diabetes.

All that's required is for the government to make available the resources to support known services and treatments. When this includes the research to continuously improve clinical services, not only will this turn around trends in those with serious complications, but also, in a relatively short time, start to deliver cost savings of $400 million a year to DHBs.

 

Professor Don Beaven

Emeritus Professor Christchurch School of Medicine, University of Canterbury. Diabetes New Zealand Co-Patron

I once rock-climbed in Wales with a gentleman who sold Rolls-Royce cars to wealthy Sheiks and African Prime Ministers. He made a point of asking about the body armour built around the chassis engine – it has to be strong, otherwise over-heavy bodies may cause the engine to fail before its 50-year guarantee.

It’s a point worth remembering when considering the human chassis. Body mechanisms remain 99% the same as 2 million years ago. Then hunter-gatherer children ran or walked 6 hours daily.

Today our children’s increased food intake and low levels of physical activity mean that this extra fuel is stored in fat cells. Fat stored in fat cells demands overwork by insulin-making machinery.

By 2025, without new public health regulations we’re in great danger of our engines failing before we can reach our 50-year guarantee.

 

Dr Rod Jackson

Professor of Epidemiology and Head of Epidemiology & Biostatistics University of Auckland

In 2025 there will be no type 2 diabetes in New Zealand. Nor will there be any obesity, hypertension or hypercholesterolaemia.

Glycaemia, fatness, blood pressure and blood cholesterol are all continuously related to risk of vascular disease and they also interact with each other to increase risk. So the best way to determine which patients are at highest risk is to combine all vascular risk factors in a risk score.

Well before 2025 we will have accurate scores to do this and it will no longer be necessary to crudely divide patients into two categories; those with and those without diabetes. Terms like diabetes will no longer have much clinical relevance.

This change away from a narrow focus on glycaemia and diabetes to a more holistic vascular risk approach will benefit our patients. No longer will patients be labelled as having an incurable disease. It will also encourage both patients and practitioners to consider all the relevant risk factors.

For some patients, making small changes in all risk factors maybe their preferred option. For others who prefer to tackle one thing at a time, there is a wide range of options to choose from, as the main goal is now a reduction in vascular risk rather than glycaemia.

 

Dr Robyn Toomath

Clinical endocrinologist Wellington Hospital. Spokesperson Fight the Obesity Epidemic (FOE)

Individuals with diabetes will have a different experience in many ways but they will still need to be expert nutritionists, keen on exercise and have a good working relationship with their health care providers.

Technically we are likely to have continuous glucose monitoring with alarms for high and low readings and there is a good chance that the monitors can be connected to an insulin delivery system to produce a biomechanical pancreas. Hopefully progress with pancreatic islets will continue so that this will be one of the options.

The most exciting changes however will be in the environment. The government will have realised that in order for the population to remain healthy we need to be eating well.

Advertisements for unhealthy food and drinks will have gone the way of those for tobacco. Supermarket checkouts won’t be lined with sweets, and gigantic bottles of soft drink and chippies will be a thing of the past.

Fruit and vegetables will be cheaper than pies and take away food and nutritious food will be all that is available in all schools and work-places.

Cycling to work won’t be the hazardous experience it is now as a result of new cycle ways and road rules that give cyclists and pedestrians right of way over cars.