Type 2 diabetes has reached epidemic proportions in New Zealand and will get much worse unless action is taken now, according to a new report on the economic and social cost of the disease.
Author
Jim Mann
Professor of Medicine and Director, Healthier Lives National Science Challenge and the Edgar Diabetes and Obesity Research Centre, University of Otago
Already 228,000 New Zealanders (4.7% of the population) have type 2 diabetes. The estimated annual cost is NZ$2.1 billion - a staggering 0.67% of GDP.
The report projects that if nothing is done to change the current trajectory, the number of people with type 2 diabetes will increase by 70-90% (to 6.6%-7.4% of the population) in 20 years. Costs are expected to rise by 63% to $3.5 billion by 2040.
Hospital care is the biggest cost to the public purse but losses from tax revenue, personal income and unpaid labour contribute to overall economic losses. The human cost of lives cut short cannot be quantified. Māori, Pacific and Asian communities bear the brunt of the disease burden.
The scale of New Zealand's type 2 diabetes epidemic underscores the urgent need for prevention at a population level. It is a societal problem that needs a societal solution.
While individuals' lifestyles must change if their health is to improve, New Zealanders need a supportive environment to make changes that stick.
A public health approach
A range of approaches would help to reduce the risk of developing type 2 diabetes. Re-introducing a national healthy eating and activity policy for schools and young people would likely also benefit parents and carers. At school, children should be free from harmful drinks and foods which are packed with sugar, fat and salt. Our children must be protected from being bombarded by junk food advertising in their homes and neighbourhoods.
More effective food labelling would help consumers to better understand what they are putting in their supermarket trolleys, and encourage food producers to forge ahead with reformulating products so they contain less harmful ingredients.
Many other countries have introduced policies to protect their populations, including the UK's 2018 soft drinks industry levy regulations. It's time for New Zealand, which has among the highest rates of adult and childhood obesity in the western world, to catch up with our international peers.
We must not forget that in some parts of New Zealand, families experience food scarcity and insecurity and buy cheaper, less healthy foods. We must remedy this by tackling the root causes of poverty.
Cost-effective health programmes
In addition to public health measures, there are also things we can do immediately to improve the treatment and care of people who already have type 2 diabetes and to prevent people with pre-diabetes from progressing further.
The report recommends rolling out four cost-effective programmes which could help thousands of New Zealanders:
- lifestyle interventions that reduce the risk of progression from pre-diabetes to type 2 diabetes (sustained changes in diet and exercise)
- intensive lifestyle interventions to achieve remission of type 2 diabetes (clinical nutrition therapy)
- "gold standard" medications to better manage type 2 diabetes
- optimal foot screening and protection services.
Two new medications for managing type 2 diabetes have recently been funded by New Zealand's medicines-funding agency PHARMAC. This is a great start but we can do much more.
Pre-diabetes is being identified in many New Zealanders as part of screening for heart disease risk factors. Healthy lifestyle support programmes have been shown to halve the risk of progressing to type 2 diabetes. Culturally appropriate support should be made widely available to people with pre-diabetes.
International evidence has recently shown that it is possible to achieve remission of type 2 diabetes through clinical nutrition therapy. Investment in such services could save our hospital system from becoming overwhelmed by serious medical complications arising from type 2 diabetes, including kidney failure, heart attacks, stroke and blindness.
We could avoid around 600 diabetes-related amputations each year if all District Health Board foot screening and protection services were operating at an optimal level. Some are already close to achieving this.
Such measures, along with a public health approach to disease prevention, are essential if we are to prevent health costs from escalating out of control and our healthcare system from being overwhelmed.
Lessons from the COVID-19 response
New Zealand's response to the COVID-19 pandemic has shown us how effective a co-ordinated, government- and science-led approach can be in tackling a major health problem.
In New Zealand we have seen how aiming high - for elimination of an infectious disease - has saved lives and livelihoods. Excellent communication has been key to New Zealanders' enthusiasm for playing their part.
We need a similar approach and resolve to tackle the type 2 diabetes epidemic. This problem is too big to leave to individual district health boards, which are dealing with competing health problems on strained budgets.
We urgently need a national strategy for tackling type 2 diabetes to change the trajectory New Zealand is currently on. If we don't act now the scale of the problem in 20 years' time is almost unimaginable.
Jim Mann is Director of Healthier Lives - He Oranga Hauora National Science Challenge (funded by MBIE, hosted by the University of Otago), and Co-Director of the Edgar Diabetes and Obesity Research Centre at the University of Otago, and receives some research funding from the Riddet Institute.
