Diabetes is a chronic condition marked by high levels of glucose (sugar) in the blood. It is caused by the body being unable to produce insulin (a hormone made by the pancreas to control blood glucose levels) or to use insulin effectively, or both.

The main types of diabetes are:

  • type 1 diabetes—an autoimmune disease that usually occurs in childhood or early adulthood
  • type 2 diabetes—the most common form of diabetes, generally occurring in adulthood. It is largely preventable and is often associated with lifestyle factors such as insufficient physical activity, unhealthy diet, obesity and tobacco smoking. Risk is also associated with genetic and family-related factors
  • gestational diabetes—when higher than normal blood glucose is diagnosed for the first time during pregnancy
  • other diabetes—a name for less common forms of diabetes resulting from a range of different health conditions or circumstances. This includes diseases affecting the pancreas and endocrine system, viral infections, genetic syndromes and in some cases diabetes triggered from medications needed to manage or treat another health condition.

Treatment aims to maintain healthy blood glucose levels to prevent both short- and long-term complications, such as heart disease, kidney disease, blindness and lower limb amputation. Insulin replacement therapy is required by all people with type 1 diabetes, as well as by a proportion of people with other forms of diabetes as their condition worsens over time.

How common is diabetes?

Prevalence

An estimated 1 in 20 (4.9%, or 1.2 million) Australians had diabetes in 2017–18, based on self-reported data from the Australian Bureau of Statistics (ABS) 2017–18 National Health Survey. This includes people with type 1 diabetes, type 2 diabetes, and type unknown, but excludes gestational diabetes (ABS 2019a).

The prevalence of diabetes increases with age. Almost 1 in 5 (19%) Australians aged 75 and over had diabetes in 2017–18, 4 times as high as for 45–54 year olds (4.5%) and 1.9 times as high as for 55–64 year olds (10%). Diabetes was also more common in males (5.0%) than females (3.8%) after controlling for age (ABS 2019a).

The age-standardised rate of self-reported diabetes increased from 3.3% in 2001 to 4.4% in 2017–18. The rate of self-reported diabetes remained stable between 2014–15 and 2017–18 (Figure 1).

The prevalence rates presented above are likely to underestimate the true prevalence of diabetes in the Australian population. This is because they are based on people who have received a formal medical diagnosis of diabetes. However, Australian studies have shown that many people have undiagnosed diabetes. For example, half of the participants in the 1999–2000 AusDiab Study had test results indicating undiagnosed diabetes prior to participating in the study (Dunstan et al. 2001). In the more recent 2011–12 ABS Australian Health Survey, which collected blood glucose data, 20% of participating adults aged 18 and over had undiagnosed diabetes prior to the survey (ABS 2013a). Further research is required to examine whether or not the proportion of people with undiagnosed diabetes in Australia has decreased over time and the impact of this on the prevalence of disease in Australia.
 

This chart shows the estimated age-standardised proportion of people with diabetes based on self-reported data from the ABS National Health Surveys between 2001 and 2017–18. The proportion increased from 3.3% in 2001 to 4.4% in 2017–18 but remained stable between 2014–15 and 2017–18.

Incidence

Around 47,800 new cases of type 1 diabetes were diagnosed between 2000 and 2018 according to the National (insulin-treated) Diabetes Register (NDR). This was around 2,500 new cases of type 1 diabetes each year—an average of 7 new cases a day (AIHW 2020).

There were 2,800 total new cases (incidence) of type 1 diabetes in Australia in 2018, equating to 12 cases per 100,000 population after controlling for age (AIHW 2020). Work is under way to refine methods for reporting type 2 diabetes incidence.

The incidence of type 1 diabetes remained relatively stable between 2000 and 2018, fluctuating between 11 and 13 new cases per 100,000 population each year (AIHW 2020).

In 2017–18, around 1 in every 6 females aged 15–49 who gave birth in hospital were diagnosed with gestational diabetes (16%, or 43,100 females), according to the National Hospital Morbidity Database.

Between 2000–01 and 2017–18, the rate of females diagnosed with gestational diabetes in Australia more than tripled (Figure 2). However, caution should be taken when comparing rates over time. A number of factors, including new diagnostic guidelines, are likely to have had an impact on the number of females diagnosed with gestational diabetes in recent years. See the discussion on changing trends in the AIHW’s Incidence of gestational diabetes in Australia report for more detail.
 

This chart shows that the proportion of females being diagnosed with gestational diabetes in Australia more than tripled according to the National Hospital Morbidity Database, from 5.2% in 2000–01 to 16.1% in 2017–18. Caution should be taken when comparing rates over time as a number of factors, including new diagnostic guidelines, are likely to have had an impact on the number of females diagnosed with gestational diabetes in recent years.

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Impact

Burden of disease

In 2015, type 2 diabetes contributed to 2.2% of the total disease burden (fatal and non-fatal) in Australia. Type 2 diabetes was the 12th leading contributor to total burden. Overall, the burden from type 2 diabetes increased slightly from 1.8% in 2003 to 2.2% in 2015. Type 1 diabetes contributed to 0.3% of Australia’s disease burden in 2015—unchanged from both 2003 and 2011 (AIHW 2019a).

In 2015, 4.7% of the total burden of disease could have been prevented by reducing exposure to the modifiable risk factor ‘high blood plasma glucose levels’ (including diabetes) (AIHW 2019a).

See Burden of disease.

Expenditure

In 2015–16, an estimated 2.3% ($2.7 billion) of total disease expenditure in the Australian health system was attributed to diabetes (AIHW 2019c).

See Health expenditure.

Adverse effects in pregnancy

Based on data from the National Perinatal Data Collection for 2014–2015, mothers with pre-existing diabetes (type 1 and type 2 diabetes) and gestational diabetes had higher rates of caesarean section, induced labour, pre-existing and gestational hypertension, and pre-eclampsia compared with mothers with no diabetes in pregnancy (AIHW 2019b).

Compared with babies of mothers with gestational diabetes or no diabetes, babies of mothers with pre-existing diabetes had higher rates of pre-term birth, stillbirth, low and high birthweight, low Apgar score, resuscitation, and special care nursery/neonatal intensive care unit admission, and stayed longer in hospital (AIHW 2019b).

See Health of mothers and babies.

Deaths

According to the AIHW National Mortality Database, diabetes was the underlying cause of around 4,700 deaths in 2018. However, it contributed to around 16,700 deaths (10.5% of all deaths) (AIHW 2019e).

See Causes of death.

Treatment and management

Glycaemic control

Glycosylated haemoglobin (HbA1c) can be used to assess the average blood glucose over the preceding 6–8 weeks and is considered the gold standard for assessing glycaemic control. Targets for HbA1c in people with diabetes should be individualised, but a general target of less than or equal to 7.0% is recommended for people with type 2 diabetes (Phillips 2012).

In 2011–12, an estimated 55% of adults with known diabetes achieved the target level for HbA1c based on measured data from the 2011–12 Australian Health Survey. The proportion who effectively managed their diabetes increased with age for both men and women. Overall, 40% of adults aged 18–54 effectively managed their diabetes and this proportion rose to 71% among those aged 75 and over (AIHW 2018).

In 2018, the mean HbA1c of individuals attending services for diabetes care at 50 diabetes centres across Australia was 8.2%, according to the Australian National Diabetes Audit–Australian Quality Self-Management Audit (ANDA-AQSMA) (National Association of Diabetes Centres 2018). The average HbA1c has remained relatively stable since 2010.

See Biomedical risk factors.

Medicines

In 2018–19, over 14 million Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) prescriptions for medicines used to treat diabetes were dispensed to the Australian community (Department of Health 2019). Metformin was the eighth most dispensed medicine in 2018–19.

According to the NDR, 31,300 people began using insulin to treat their diabetes in 2018. Of the people with diabetes who began using insulin, 54% had type 2 diabetes, 34% were females who had gestational diabetes, 9.0% were people who were newly diagnosed with type 1 diabetes and 2.0% were people who had other forms of diabetes (AIHW 2020).

See Medicines in the health system.

Hospitalisations

Around 1.2 million hospitalisations were associated with diabetes in 2017–18, with 4.5% recorded as the principal and 95.5% recorded as the additional diagnosis, according to the AIHW National Hospital Morbidity Database. This represents 11% of all hospitalisations in Australia (AIHW 2019d).

See Hospital care.

Variation between population groups

The impact of diabetes was higher among Aboriginal and Torres Strait Islander people, those living in lower socioeconomic areas and in remote areas. The diabetes prevalence rate was 2.9 times as high among Aboriginal and Torres Strait Islander people as among non-Indigenous Australians based on age-standardised self-reported data from the 2018–19 National Aboriginal and Torres Strait Islander Health Survey (ABS 2019b). Generally, the impact of diabetes increases with increasing remoteness and socioeconomic disadvantage. Deaths related to diabetes were 2.1 times as high in Remote and very remote areas compared with Major cities, and 2.3 times as high in the lowest compared with the highest socioeconomic areas (Figure 3).
 

This figure shows the impact of diabetes within selected population groups in 2017–18.  In general, the impact of diabetes varies between population groups, with rates for the prevalence of diabetes, hospitalisations, deaths and burden of disease being 2.9–5.6 times as high among Indigenous Australians as non-Indigenous Australians. Rates were 1.2–2.3 times as high in Remote and very remote areas as Major cities. The impact of diabetes also increased with the level of socioeconomic disadvantage with rates being 2.0–2.3 times as high in the lowest compared with the highest socioeconomic areas. 

Where do I go for more information?

For more information on diabetes, see:

Visit Diabetes for more on this topic.

References

ABS (Australian Bureau of Statistics) 2003. Microdata: National Health Survey, 2001. ABS cat. no. 4324.0.55.001. Findings based on detailed microdata file analysis. Canberra: ABS.

ABS 2009. Microdata: National Health Survey, 2007–08. ABS cat. no. 4324.0.55.001. Findings based on detailed microdata file analysis. Canberra: ABS.

ABS 2013a. Australian Health Survey: biomedical results for chronic diseases, 2011–12. ABS cat. no. 4364.0.55.005. Canberra: ABS.

ABS 2013b. Microdata: Australian Health Survey: National Health Survey, 2011–12. ABS cat. no. 4324.0.55.001. Findings based on detailed microdata file analysis. Canberra: ABS.

ABS 2016. Microdata: National Health Survey, 2014–15. ABS cat. no. 4324.0.55.001. Findings based on detailed microdata file analysis. Canberra: ABS.

ABS 2019a. Microdata: National Health Survey, 2017–18. ABS cat. no. 4324.0.55.001. Findings based on detailed microdata file analysis. Canberra: ABS.

ABS 2019b. National Aboriginal and Torres Strait Islander Health Survey, 2018–19. ABS cat. no. 4715.0. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2016. Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Australian Burden of Disease Study series no. 6. Cat. no. BOD 7. Canberra: AIHW.

AIHW 2018. Diabetes indicators for the Australian National Diabetes Strategy 2016–2020. Cat. no. CVD 81. Canberra: AIHW.

AIHW 2019a. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Australian Burden of Disease series no. 19. Cat. no. BOD 22. Canberra: AIHW.

AIHW 2019b. Diabetes in pregnancy 2014–2015. Bulletin no. 146. Cat. no. CDK 7. Canberra: AIHW.

AIHW 2019c. Disease expenditure in Australia. Cat. no. HWE 76. Canberra: AIHW.

AIHW 2019d. National Hospital Morbidity Database. Findings based on unit record analysis. Canberra: AIHW.

AIHW 2019e. National Mortality Database. Findings based on unit record analysis. Canberra: AIHW.

AIHW 2020. Incidence of insulin-treated diabetes in Australia. Cat. no. CDK 11. Canberra: AIHW.

Department of Health 2019. PBS expenditure and prescriptions report 1 July 2018 to 30 June 2019. Canberra: Australian Government. Viewed 6 January 2020.

Dunstan D, Zimmet P, Welborn T, Sicree R, Armstrong T, Atkins R et al. 2001. Diabesity & associated disorders in Australia—2000: the accelerating epidemic. Melbourne: International Diabetes Institute.

National Association of Diabetes Centres 2018. ANDA-AQSMA 2018 final report. Viewed 18 February 2020.

Phillips PJ 2012. HbA1c and monitoring glycaemia. Australian family physician 41(1/2):37.