Type 2 Diabetes: The Hidden Epidemic
By Dr Bryan Betty, College Medical Director
23 September 2020
There’s a hidden epidemic in New Zealand that’s been burning away for 30 years and right now a potential tsunami threatens to overwhelm our health system. Type 2 diabetes is at staggering levels and I believe is the single biggest medical equity issue we have today.
It is now estimated that 11 percent of the world’s (and New Zealand’s) total health budget is spent on diabetes, the majority related to type 2 diabetes, a disease that can be treated early with diet, exercise, and the use of medications.
In 2015 International Diabetes Federation named diabetes one of three global threats next to terrorism and global warning. There are two main types, unimaginatively named as Type 1 and Type 2. Type 1 diabetes is an 'auto-immune' condition that presents randomly, often as a child, but basically means the pancreas, which controls the liver, no longer makes insulin and these patients need to inject it several times daily.
Although type 2 diabetes can have a genetic component, it is also associated with lifestyle where food and exercise choices or options, and obesity, can increase the likelihood of it developing. With type 2 the body loses the ability over time to control its blood sugar levels and the pancreas begins to wind down. Some experts lay the blame at the feet of the explosion of sugary soft drinks, or it could be that New Zealand is now the third most overweight nation on earth behind USA and Mexico. Either way, 220,000 people in New Zealand now have type 2 diabetes.
Years ago, type 2 diabetes was considered a disease of the elderly, ‘a bit of sugar’, but increasingly GPs are diagnosing younger patients. 10-15 years ago, at my practice we very rarely diagnosed Type 2 diabetes in anyone in their twenties, but it happens pretty much every week now. Our youngest Type 2 diabetic is an adolescent.
The issue with younger people being diagnosed is that complications come in at around 20 years of the disease so we’re seeing people with complications in their 40s now whereas that traditionally would have been an aged care issue; the health system is simply not set up to deal with the current population demands, particularly in high-needs areas. If not taken seriously type 2 diabetes can get nasty. It can damage the heart, kidneys, blood vessels, eyes, and nerves. It’s a leading cause in New Zealand of heart attacks, stroke, blindness, leg amputations and kidney disease. In fact, in New Zealand, 54 percent of renal dialysis unit patients (people with advanced kidney disease) are there because of diabetes. Māori and Pacific diabetics that are type 2 are seven to 12 times more likely to progress to end stage renal failure than their European counterparts.
I believe New Zealand has a hospital-focused health system and for type 2 diabetes that’s too late. We need to be addressing it early, and in the community. For years, as a country, we have failed to resource general practice to deal early with issues like type 2 diabetes. We have collectively stood back and watched this situation develop hoping our hospital service will deal with the problem. They can’t. It’s too big. The Government and Ministry of Health need to make a commitment to adequately resource community medical services to tackle the epidemic early. General practice can tackle the issue with the support of hospital-based services and adequate resourcing. We need the new-generation diabetic medication that the rest of the world has access to. The fact is that we’ve fallen 10 years behind the rest of the western world and need a serious rethink of where health system resources are spent to focus more on early intervention.
The only way to tackle type 2 diabetes is to focus on lifestyle at its source: the communities where people live. That means better equitable access to, and resourcing of, quality general practice in the community, an integrated approach with GPs, nurses, dieticians, health improvement practitioners and podiatrists and access to the new generation of diabetes medication.