Summary

Diabetes is an Australia's health topic

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Diabetes

Diabetes is a chronic condition marked by high levels of glucose (sugar) in the blood. It is caused by the inability 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, type 2 diabetes, gestational diabetes and other diabetes.

Treatment aims to maintain healthy blood glucose levels to prevent both short- and long-term complications, such as cardiovascular 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 if their condition worsens over time.

See What is diabetes? for more information.

How common is diabetes?

In 2020, an estimated 1 in 20 (almost 1.3 million) Australians were living with diabetes (prevalence) and were registered with the National Diabetes Services Scheme (NDSS) and Australasian Paediatric Endocrine Group (APEG) state-based registers. This includes people with type 1 diabetes, type 2 diabetes and other diabetes, but excludes gestational diabetes.

In 2020, the prevalence of diabetes increased with age with almost 1 in 5 Australians aged 80–84 living with diabetes – almost 30 times as high as for those aged under 40 (0.7%). Diabetes was more common in males (4.8%) than females (3.8%), after controlling for age.

After accounting for differences in the age structure of the population, the age-standardised prevalence rate of diabetes on the linked NDSS and APEG data increased from 2.4% in 2000 to 4.3% in 2020. The diabetes rate peaked in 2016 and remained stable between 2016 and 2020 (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 are living with undiagnosed type 2 diabetes. For example, in the 1999–2000 AusDiab Study, half of all diabetes was undiagnosed (Dunstan et al. 2001). In the 2011–12 Australian Bureau of Statistics (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 2013). In addition, registration with the NDSS is voluntary and people with type 2 diabetes are more likely to register if they access diabetes consumables to monitor their diabetes at home or require insulin. Despite these limitations, these data sources provide the best picture into the number of people living with diabetes in Australia to monitor changes in populations at risk and trends over time.

Further research is required to examine whether the proportion of people with undiagnosed type 2 diabetes in Australia has changed over time and the impact of this on the prevalence of disease in Australia.

Figure 1: Prevalence of diabetes from linked NDSS and APEG data, 2000 to 2020

This chart shows the estimated age–standardised proportion of people with diabetes based on data from the linked National Diabetes Services Scheme and Australasian Paediatric Endocrine Group between 2000 and 2020. The proportion increased from 2.4% in 2000 to 4.3% in 2020 but remained relatively stable between 2015 and 2020.

Type 1 diabetes

Around 55,400 people were newly diagnosed (incidence) with type 1 diabetes between 2000 and 2020 according to the National (insulin–treated) Diabetes Register (NDR).

In 2020, there were 3,100 people newly diagnosed with type 1 diabetes in Australia, equating to 12 diagnoses per 100,000 population.

The incidence of type 1 diabetes remained relatively stable across the last 2 decades, fluctuating between 11 and 13 new cases per 100,000 population.

See Type 1 diabetes for more information.

Type 2 diabetes

Around 1.3 million people were newly diagnosed with type 2 diabetes between 2000 and 2020, according to linked NDSS and APEG data. This was around 60,000 people each year – an average of 166 new diagnoses a day.

There were 48,300 people newly diagnosed with type 2 diabetes registered on the linked NDSS and APEG data in Australia in 2020, equating to 188 diagnoses a day per 100,000 population.

According to the linked NDSS and APEG data, age-standardised incidence rates for type 2 diabetes have varied over time. Incidence rates peaked in 2008 at 336 per 100,000 population and have almost halved from 2008 to 2020 (172 per 100,000 population).

See Type 2 diabetes for more information.

Gestational diabetes

Around 1 in 6 (49,000) females aged 15–49 who gave birth in hospital in 2020–21 had been diagnosed with gestational diabetes during their pregnancy, according to the National Hospital Morbidity Database (NHMD).

After adjusting for changes in the age structure of the population over time, the incidence of gestational diabetes more than tripled in Australia between 2000–01 and 2020–21 from 5.2% to 17.9%, largely through successive increases recorded between 2011–12 and 2017–18 and a further upward spike in 2020–21 (Figure 2).

The rising incidence of gestational diabetes in the last decade is likely driven by several factors including increasing maternal age, higher rates of maternal overweight and obesity, and a growing proportion of higher risk ethnic groups in the population (Laurie and McIntyre 2020). The introduction of new diagnostic guidelines across all states and territories between 2011 and 2013 is also likely to have had an impact on rates.

See Incidence of gestational diabetes in Australia – Changing trends and Gestational diabetes for more information.

Figure 2: Incidence of gestational diabetes, 2000–01 to 2020–21

The chart shows the proportion of females diagnosed with gestational diabetes in Australia more than tripled from 5.2% in 2000–01 to 17.9% in 2020–21. Caution should be taken when comparing rates over time as many factors, including new diagnostic guidelines, are likely to have had an impact on the number of females diagnosed with gestational diabetes in recent years.

Impact of diabetes

Burden of disease

Burden of disease refers to the quantified impact of living with and dying prematurely from a disease or injury and is measured using disability-adjusted life years (DALY). One DALY is equivalent to one year of healthy life lost.

In 2018, type 2 diabetes was responsible for 112,500 DALY in Australia – equating to 4.5 per 1,000 population. Type 2 diabetes was the 12th leading contributor to total burden. After accounting for differences in the age structure of a population, the overall burden from type 2 diabetes decreased slightly from 3.9 per 1,000 population in 2003 to 3.8 per 1,000 population in 2018. Type 1 diabetes was responsible for 17,000 DALY, equating to 0.3 per 1,000 population – this was similar to the contribution in 2003 (0.4 per 1,000 population) (AIHW 2021a).

In 2018, 4.3% 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 2021b).

See Burden of diabetes.

Expenditure

In 2018–19, an estimated $3.0 billion of expenditure in the Australian health system was attributed to diabetes, representing 2.3% of total disease expenditure. Of the $3.0 billion in expenditure:

  • type 2 diabetes represented 61%
  • type 1 diabetes 11%
  • gestational diabetes 2.0%
  • other diabetes 26% (AIHW 2021c).

See Health system expenditure.

Adverse effects in pregnancy

Based on data from the NHMD for 2020–21, mothers with pre-existing diabetes (and to a lesser extent, gestational diabetes) were more prone to complications during pregnancy and intervention in childbirth with higher rates of caesarean section, induced labour, pre-existing and gestational hypertension, and pre-eclampsia compared with mothers with no diabetes in pregnancy.

Babies of mothers living with diabetes in pregnancy are also at an increased risk of childhood metabolic syndrome, obesity, impaired glucose tolerance, and type 2 diabetes in later life (Clausen et al. 2007; Kim et al. 2012; Zhao et al. 2016).

See Pregnancy complications.

Deaths

According to the AIHW National Mortality Database, in 2020, diabetes was the underlying cause of around 5,100 deaths. However, it contributed to around 17,500 deaths (10.8% of all deaths) when associated causes are included. (AIHW 2021e).

See Life expectancy and causes of death.

Treatment and management of diabetes

What is HbA1c?

Glycated haemoglobin, haemoglobin A1c or HbA1c, is the main biomarker used to assess long-term glucose control in people living with diabetes. Haemoglobin is a protein in red blood cells which can bind with sugar to form HbA1c. It is directly related to blood glucose levels and strongly related with the development of long-term diabetes complications. Because red blood cells can live for up to 120 days, HbA1c gives an indication of blood glucose over a few months.

HbA1c was endorsed for the diagnosis of diabetes in 2010 by the Australian Medical Association. Diagnosis is confirmed using HbA1c levels ≥48 mmol/L or ≥6.5%. HbA1c targets for people living with diabetes depend on the type of diabetes, life expectancy, risk of hypoglycaemia and other comorbidities.

HbA1c testing

According to the National Prescribing Service (NPS) MedicineInsight general practice insights report (NPS MedicineWise, 2021) in 2019–20, 67% of general practice patients with a diagnosis of diabetes (20 years and older) had at least one test result for HbA1c levels. Among MedicineInsight patients without a diagnosis of diabetes, only 11% had received at least one test for HbA1c levels.

According to the Australian National Diabetes Audit–Australian Quality Clinical Audit (ANDA–AQCA) 2021, among all adult patients with recorded diabetes (n=4,262), the median HbA1c level was 63.0 mmol/mol. Median HbA1c was slightly higher among patients with type 1 diabetes (66.0 mmol/mol) and slightly lower in patients with type 2 diabetes (62.0 mmol/mol). Patients with gestational diabetes had significantly lower median HbA1c levels (34.0 mmol/mol) (ANDA 2021).

See Ongoing monitoring.

Medicines

In 2020–21, there were over 16.5 million prescriptions dispensed for diabetes medicines through Section 85 of the Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme, representing 5.3% of total prescriptions. Metformin, a glucose-lowering medication for patients with type 2 diabetes, was the seventh most dispensed medicine in 2020–21 (Department of Health 2021b).

According to the NDR, 30,800 people began using insulin to treat their diabetes in 2020. Of the people with diabetes who began using insulin, 52% had type 2 diabetes, 35% had gestational diabetes, 10% were newly diagnosed with type 1 diabetes and 2% had other forms of diabetes (AIHW 2022b).

See Medicines use.

Hospitalisations and procedures

Almost 1.3 million hospitalisations were associated with diabetes in 2020–21, with 4.7% recording diabetes as the principal diagnosis and around 95% recording diabetes as an additional diagnosis, according to the NHMD. This represents 11% of all hospitalisations in Australia (AIHW 2021d).

Of these, around 1.1 million recorded type 2 diabetes as the principal and/or additional diagnosis and 64,600 hospitalisations recorded type 1 diabetes as the principal and/or additional diagnosis.

People with diabetes may require procedures to manage their diabetes or treat the complications of diabetes. According to the NHMD, there were 4,500 weight loss procedures and 5,300 lower limb amputations undertaken for people with type 2 diabetes in 2020–21 (18 and 21 per 100,000 population, respectively).

See Hospitalisations.

Variation between population groups

The impact of diabetes varies between population groups. To account for differences in the age structures of these groups, the data presented below is based on age-standardised rates.

In recent years, the impact of diabetes has been higher among Aboriginal and Torres Strait Islander people, those living in lower socioeconomic areas and those living in remote areas (Figure 3). The diabetes prevalence rate was 2.9 times as high among Indigenous Australians as 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 1.9 times as high in Remote and very remote areas compared with Major cities, and 2.4 times as high in the lowest compared with the highest socioeconomic areas (Figure 3).

Figure 3: Variation in the impact of diabetes between selected population groups

The table shows the age-standardised rate ratios for all diabetes by selected population group. Rate ratios are presented for prevalence, hospitalisations, deaths and burden of disease. Overall, rates increased for each measure by increasing remoteness and socioeconomic disadvantage while rates were also higher among Indigenous people compared with non-Indigenous people.

Impact of COVID–19

The onset of the COVID–19 pandemic has significantly impacted the Australian health system, including mortality, hospitalisations, health services, disease management and surveillance. Diabetes is one of many conditions correlated with greater health consequences throughout the COVID-19 pandemic including increased risk of complication and mortality (Peric and Stulnig 2020).

Diabetes incidence

There is growing evidence of an increased risk of new-onset diabetes following COVID-19 (Sathish et al. 2021, Zhang et al. 2022). In the 12-month periods to September 2021 and September 2022, the NDSS recorded 119,800 and 117,600 new registrants, respectively. Registrations were higher in both periods than any previous 12 months recorded. These new registrations were an increase of 16% and 14%, respectively, compared with the equivalent 12-month period prior to the pandemic (to September 2019). The largest increase in registration was found among people with gestational diabetes, with an increase of 19% between September 2019 and September 2022 (Diabetes Australia 2022).

However, these new registrations may be due, at least in part, to people who were previously diagnosed with diabetes only registering with the NDSS during the pandemic. The increase in registrations may also be influenced by changes to the NDSS to simplify the usual processes to register (Andrikopoulos and Johnson 2020). Further monitoring is required to assess the influence on diabetes diagnoses as the COVID–19 pandemic continues to evolve.

Mortality

According to ABS COVID-19 Mortality data from January 2020 to September 2022, pre-existing chronic conditions such as diabetes were reported on death certificates for 8,211 (79.9%) of the 10,279 deaths due to COVID-19. Diabetes was a pre-existing condition in 16.2% of the 8,211 deaths (ABS 2022).

COVID-19 hospitalisations

In 2020–21, there were over 4,700 hospitalisations in Australia that involved a COVID-19 diagnosis. Around 42% of hospitalisations with a diagnosis of COVID-19 had one or more diagnosed comorbid conditions, such as type 2 diabetes or cardiovascular disease, an increase from 25% in 2019–20. Of the 4,700 hospitalisations involving a COVID-19 diagnosis, the most common comorbid conditions associated with COVID-19 hospitalisations over this period were type 2 diabetes (20%) and cardiovascular disease (which includes coronary heart disease and a range of other heart, stroke and vascular diseases) (20%) (AIHW 2022a). 

Of those with a recorded comorbid diagnosis of type 2 diabetes:

  • 12% of hospitalisations involved time spent in an intensive care unit, compared with 7.0% of all COVID-19 hospitalisations.
  • 7.1% involved continuous ventilatory support, compared with 3.8% of all COVID-19 hospitalisations.
  • 19% had a separation mode indicating the patient died in hospital, compared with 10.3% of all COVID-19 hospitalisations.

Monitoring

According to NPS MedicineWise analysis of MedicineInsight, the rate of HbA1c testing over the 6-months from 1 March 2020 to 31 August 2020 fell significantly among regularly attending patients with a record of type 2 diabetes compared with all regularly attending patients. The rate of type 2 diabetes encounters remained similar in both time periods. In the pre-COVID period, the average monthly rate of HbA1c testing among patients with a record of type 2 diabetes was 126.1 per 1000 clinical encounters, which fell to 109.0 tests per 1,000 clinical encounters in the early COVID period (NPS MedicineWise 2020).

In April 2020, there was a significant decline in the rate of HbA1c tests performed. The rate of testing for patients with a record of type 2 diabetes fell from 120 tests per 1,000 clinical encounters in April 2019 to 77 tests per 1,000 clinical encounters in April 2020 (NPS MedicineWise 2020).

With the COVID–19 pandemic continuing to evolve, it is still too early to predict the long-term impacts on diabetes and other chronic conditions.

See Impact of COVID–19.

Where do I go for more information?

For more information on diabetes, see:

Visit Diabetes for more on this topic.