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This summarises what has been done (by others and the Department of Health) about the problem so far. Depending on your topic, some of this might already have been presented in the ‘Background’ section. The objective of this section is to inform the reader of options that have already been pursued, if any.

This section delineates the possible courses of action or inaction that you believe could be taken.

Please provide the Minister with at least three potential courses of action; some of them may be unrealistic in your opinion but please pose them as options nonetheless.

What is being proposed: what are the options available to the government?

Why are you recommending these options?

What are the advantages and disadvantages of each? Ensure you consider any potential backlash from stakeholders/the public.

Background

Cases of the increase in incidences of diabetes type 2 in Australia has increased from 4.4% to 5.1% in 2014 to 2015 (Australian Bureau of Statistics, 2015). By 2015, it was estimated that approximately 1.2 million people aged 2 years and above; representing 5.1% of the population, were diagnosed with diabetes. These startling facts prompts the question, what action is required to alleviate the prevalence of diabetes in Australia?

A normal and proper working body condition requires the conversion of glucose (sugar) from food into energy. Insulin hormone is responsible for this conversion. Diabetes is a result of inadequate production of insulin amounts or total lack of it in the body (American Diabetes Association, 2014). Type 2 diabetes is due to hereditary factors (Murea and Freedman, 2012) and lifestyle risk factors such as poor diet, lack or inadequate physical activity and obesity or overweight (Gregg et al., 2012). Cases of diabetes type 2 has been on the rise in Australia. The prevalence of diabetes in Australia are basically projected from the findings that emanate from the National Health Survey carried out by the Australia Bureau of statistics (ABS). According to the Australian Bureau of Statistics (2015), the rate of diabetes prevalence has increased from 4.4% to 5.1% in 2014 to 2015.  According to the self-reported ABS 2014-2015 National Health Survey, approximately 85% (1,002,000 people) of those who were diagnosed with diabetes had type 2 diabetes. On the basis of age groups, more males (6%) were diagnosed with diabetes type 2 than women from 55 years onwards. This scenario was relatively the same across major cities (5%), outer regional and remote areas (6%) and in the inner region (6%). The areas with lowest socioeconomic groups had twice as high (8%) incidences of type 2 diabetes compared with the areas of the highest socioeconomic group (3%) (Australian Institute of Health and Welfare, 2018).  More specifically, the Australian Bureau of Statistics (2016) reports show that diabetes type 2 is most common among Aboriginal and Torres Strait Islander people, with 12.8% of those of over 15 years of age showing positive test results that they had diabetes type 2. Thus, diabetes type 2 in Australia affects mature adults more compared to young people, however, trends of young people being diagnosed with the disease is on the rise due to the increase of obesity and overweight cases both in the young and old. 2.5% of Australians aged between 35 and 45 years have diabetes type 2 compared to 23.6% of those with over 75 years.

Pre-Existing Policies/Activity

The rise in the Australian cases of diabetes type 2 have primarily been attributed to various factors. For instance, 25% of the cases of diabetes type 2 have been attributed to cardiovascular diseases and chronic kidney disease. Other common risk factors include inadequate physical activity, poor diet, and obesity or overweight. The specific unmodifiable risk factors of diabetes type 2 include increase in age, genetic predisposition, race, and family history (The Department of Health, Diabetes, 2016). All these predisposing factors are as a result of the nutrition of the Australian population which is characteristic of consuming a lot of energy-dense foods with low nutrients, and eating very little nutrient based foods such as vegetables, nuts, and fruits (Chen et al., 2010).

Various preventable and curative measures can be implemented to help alleviate the current condition of diabetes type 2 in Australia. The Australian Department of Health can provide subsidies for patient care including medication and management of chronic and terminal conditions of diabetes type 2 and cardiovascular and chronic diseases that co-exist with diabetes. Moreover, the department of health should offer free seminars that promote healthy living.

The government of Australia deals with the issue of diabetes at the national level through a number of programs and initiatives geared towards supporting the treatment and management of conditions associated with diabetes. The Medicare Benefits Schedule is a program that offers subsidies for patient care for the planning and management of chronic and terminal illnesses. The Pharmaceutical Benefits Scheme is another initiative that is still providing subsidies for medical items used in the diagnosis of diabetes (The Department of Health, Diabetes, 2016). Additionally, the Diabetes Australia manages the National Services Scheme through which it supplies subsidised medical items such as syringes and needles, test strips for blood glucose levels among others. The National Health and Medical Research Council (NHMRC) has also invested in diabetes research with an objective of providing better care to patients with multiple and intricate chronic disease such as diabetes.

Several possible courses of action can be taken to effectively address the issue of diabetes type 2. Measures can be preventive or curative. Studies have demonstrated that the disruption of metabolism causing diabetes can be halted and regressed by the help of effective diet and modification in lifestyles in addition to the use of some drug therapies (Barnard et al., 2009). The studies conducted in the United States of America show that the development of structure lifestyle behaviour prevented the increase of diabetes type 2 incidences (American Diabetes Association, 2015).

Considerations

Patients diagnosed with type 2 diabetes regardless of their age can always benefit from physical activity. Regular physical activity improves metabolic control, lowers cardiovascular risks and can minimize the risk of developing type 2 diabetes (The Department of Health, 2017). Also, glucose tolerance is increased in bodies with low-level aerobic exercise, physical resistance training, energy expenditure, general well-being, work capacity, better lipid profiles, and blood pressure. Research shows that individuals diagnosed with diabetes or IGT should undergo moderate intensity exercise for 125 minutes each week or more vigorous and intensive exercise but should not forgo training for two consecutive days (Hordern et al., 2012). However, clinical advice should be offered to discontinue physical activity in patients with developing hypoglycaemia symptoms until assessed by their GP.

A dietary assessment of the Australian population should be carried out because most of the burden of disease is as a result of poor nutrition in Australia (Grantham et al., 2013). The recommended Australian Dietary Guidelines include consuming nutritious foods from groups of vegetables, fruits, cereals, lean meats, eggs, poultry, and milk. Others include drinking plenty of water, limit the consumption of foods with saturated fat, and additional sugars (National Health and Medical Research Council, 2013).

Smoking cessation can also be used to prevent incidences of diabetes type 2. All smokers should be offered training seminars and advice to cease smoking (Zwar et al., 2011). Studies have shown that smoking is a highly predisposing factor in the development of diabetes (Martínez-González et al., 2008), hence the reason why higher doses of insulin are recommended for diabetic type 2 patients who are smokers (Chiolero, Faeh, Paccaud, and Cornuz, 2008). 

  • A healthy diet under the modification approach helps in achieving blood sugar control
  • The lifestyle modification approach helps to prevent and manage complications associated with diabetes such as heart disease and cancer
  • The antioxidants from a healthy diet assists in boosting the immune system which helps to fight the daily stressors in the system that act as predisposing factors to diabetes type 2.
  • A balanced and healthy diet with carbohydrate sources, recommended fat sources such as nuts and lean proteins have been shown to aid metabolic syndrome which is a potential complication for diabetes.
  • This approach is cost effective compared to medications for diabetic type 2 patients because it only provides directions on the daily intake of foods. This implies that it can be applied even in areas with insufficient medical supplies for diabetic patients (RACGP, 2014).

The lifestyle modification approach is too rigid because it recommends eating the same quantity of food at almost the same time daily. The consistency and timing is significant for it helps to regulate blood sugar levels. This approach may thus be difficult for those with dynamic work schedules which is always the case with diabetic type 2 patients.

Patients should be evaluated in order to develop an all-inclusive assessment of persons to ascertain the factors affecting the health and quality life of the patient. Some people diagnosed with diabetes type 2 in Australia have other medical conditions (not automatically associated with diabetes), work or economical, and family related stresses. Others are also battling with lifestyle issues such as poor sleep, alcohol drinking, smoking, lack of exercise all of which predispose them to cardiovascular diseases that co-exist with diabetes type 2 (RACGP, 2014).  The study by Aikens (2012) found out that diabetic type 2 patients are at risk of low emotional wellbeing, in addition to depression and anxiety. These factors affect the effective management of diabetes and outcomes. Thus, a comprehensive appraisal of cardiovascular risk and the impairment of end-organs should be carried at initial stages. The areas of evaluation include eating plan, lifestyle, and treatment. Moreover, the evaluation can be done each year.

  • The evaluation of diabetic patients can help ascertain risk factors out of which recommendations can be made to prevent the development of the disease.
  • This approach will help in early detection and management of diabetes type 2.
  • This approach is effective in areas with enough medical supplies and healthcare officers, thus becoming difficult to apply in marginalised communities

Lifestyle Modification

The provision of quality and safety in diabetes begins with coordinated, continuous and detailed primary healthcare. Primary care is a fundamental aspect of care across all diabetic patients: including those in the early stage, under medications, and those with chronic conditions through to the end of life. A medical home is the general practice chosen by a patient to offer continuous, detailed, and patient-centred care. A medical home takes care of the health of the patient’s health in the whole journey of health (RACGP, 2014).

  • The medical home leads to improved continuity of the outcomes of the patients and their families (American Academy of Family Physicians, 2008).
  • The medical home model results in improved quality care and is cost effective for patients with a chronic disease.
  • Medical homes leads to equal access to quality care among minority communities, leading to better overall population health and reduced spending in healthcare
  • This approach requires constant monitoring by healthcare experts thus making it ineffective in areas with insufficient medical practitioners.

Based on the above considerations of the approaches towards alleviating the rising incidences of diabetes type 2, the lifestyle modification approach is hereby recommended.  This approach is cost effective and easy to apply under the guidance of a healthcare professional. Also, the instructions can easily be replicated. According to the study done by Barnard et al. (2009) a healthy diet helps to boost the immune system which further assists in fighting the daily stressors that predispose the body to diabetic conditions. The lifestyle modification approach is hereby recommended to the department of health as the best approach towards addressing the increasing incidences of diabetic type 2 because it is both preventive and curative.

This approach can easily be applied in the marginalized Australian communities; the Aboriginal and Torres Strait Islander people who have the highest incidences of diabetes type 2. This is because the approach is cost effective and the instructions can easily be replicated, thus making it a self-management approach. This will reduce cases of diabetes type2 in Australia since it will have effectively addressed the disease where it is most prevalent.

References 

Aikens, JE, 2012, Prospective associations between emotional distress and poor outcomes in type 2 diabetes, Diabetes care, p.DC_120181.

American Academy of Family Physicians, 2008, Joint principles of the Patient-Centered Medical Home, Delaware Medical Journal, 80(1), p.21.

American Diabetes Association, 2014, Diagnosis and classification of diabetes mellitus. Diabetes care, 37(Supplement 1), pp.S81-S90.

American Diabetes Association, 2015, Standards of medical care in diabetes—2015 abridged for primary care providers, Clinical diabetes: a publication of the American Diabetes Association, 33(2), p.97.

Australian Bureau of Statistics 2016, 4714.0 - National Aboriginal and Torres Strait Islander Social Survey, 2014-15, retrieved 13 Aug. 2018, https://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/4714.0Main+Features22014-15?OpenDocument.

Australian Bureau of Statistics, 2015, 4364.0.55.001 - National Health Survey: First Results, 2014-15, retrieved 13 Aug. 2018, https://www.abs.gov.au/ausstats/[email protected]/PrimaryMainFeatures/4364.0.55.001?OpenDocument.

Australian Institute of Health and Welfare, Diabetes Snapshot: Type 2 Diabetes, 2018, retrieved,13 Aug. 2018, https://www.aihw.gov.au/reports/diabetes/diabetes-snapshot/contents/how-many-australians-have-diabetes/type-2-diabetes.

Barnard, ND, Cohen, J, Jenkins, DJ, Turner-McGrievy, G, Gloede, ., Green, A and Ferdowsian, H 2009, A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial– The American journal of clinical nutrition, 89(5), pp.1588S-1596S.

Chen, L, Magliano, DJ, Balkau, B, Colagiuri, S, Zimmet, PZ, Tonkin, AM, Mitchell, P, Phillips, PJ and Shaw, JE, 2010, AUSDRISK: an Australian Type 2 Diabetes Risk Assessment Tool based on demographic, lifestyle and simple anthropometric measures, Medical Journal of Australia, 192(4), p.197.

Chiolero, A, Faeh, D, Paccaud, F and Cornuz, J, 2008, Consequences of smoking for body weight, body fat distribution, and insulin resistance, The American journal of clinical nutrition, 87(4), pp.801-809.

Grantham, NM, Magliano, DJ, Hodge, A, Jowett, J, Meikle, P and Shaw, JE, 2013, The association between dairy food intake and the incidence of diabetes in Australia: the Australian Diabetes Obesity and Lifestyle Study (AusDiab), Public health nutrition, 16(2), pp.339-345.

Gregg, EW, Chen, H, Wagenknecht, LE, Clark, JM, Delahanty, LM, Bantle, J, Pownall, HJ, Johnson, KC, Safford, MM, Kitabchi, AE, and Pi-Sunyer, FX, 2012, Association of an intensive lifestyle intervention with remission of type 2 diabetes, Jama, 308(23), pp.2489-2496.

Hordern, MD, Dunstan, DW, Prins, JB, Baker, MK, Singh, MAF and Coombes, JS, 2012, Exercise prescription for patients with type 2 diabetes and pre-diabetes: a position statement from Exercise and Sport Science Australia, Journal of Science and Medicine in Sport, 15(1), pp.25-31.

Martínez-González, MÁ, De la Fuente-Arrillaga, C, Nunez-Cordoba, JM, Basterra-Gortari, FJ, Beunza, JJ, Vazquez, Z, Benito, S, Tortosa, A and Bes-Rastrollo, M, 2008, Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study, Bmj, 336(7657), pp.1348-1351.

Murea, M, Ma, L and Freedman, BI, 2012, Genetic and environmental factors associated with type 2 diabetes and diabetic vascular complications, The review of diabetic studies: RDS, 9(1), p.6.

National Health and Medical Research Council, 2013, Australian Dietary Guidelines (2013), retrieved 13 Aug. 2018, https://www.nhmrc.gov.au/guidelines-publications/n55.

RACGP, 2014, General practice management of type 2 diabetes, retrieved 13 Aug. 2018, file:///C:/Users/Admin/Downloads/Documents/5ed214a6-4cff-490f-a283-bc8279fe3b2f.pdf.  

The Department of Health, 2017, Australia’s Physical Activity & Sedentary Behaviour Guidelines for Adults (18-64 years), retrieved 13 Aug. 2018,

https://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-phys-act-guidelines#apaadult.

The Department of Health, Diabetes, 2016, retrieved 13 Aug. 2018, https://www.health.gov.au/internet/main/publishing.nsf/content/chronic-diabetes.

Zwar, N, Richmond, R, Borland, R, Peters, M, Litt, J, Bell, J, Caldwell, B and Ferretter, I, 2011, Supporting smoking cessation: a guide for health professionals, Melbourne: The Royal Australian College of General Practitioners.

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