Queensland election priorities for 2020 24 September 2020 As Queensland heads to the next election, Diabetes Queensland has been talking to our politicians to highlight our priorities for diabetes prevention, diagnosis, and management. The election priorities for 2020 are the results of conversations we have had with our members, and based on their experiences and needs. We welcome your feedback on the following initiatives, please contact us at [email protected]. Diabetes in hospitals Prevention and My health for life Better diagnosis of type 2 diabetes Diabetic ketoacidosis Telehealth Prevention Discrimination Pathways Targeted interventions 1. Diabetes in hospitals We are asking Government to improve the management of diabetes in hospitals by ensuring diabetes is treated as a primary condition, even when it is not the primary reason for admission. Diabetes Queensland is urging the Government to do this by undertaking wider diabetes skilling programs across our health services. We need to ensure that any patient admitted to hospital who has diabetes, regardless of the reason for admission, has their needs for diabetes met. We have heard from our members who have experienced problems across a wide range of areas, including food quality and timing, medication administration and access, and timing of anaesthetics and other medical procedures without regard to insulin. Even if a person is admitted for another, even unrelated matter, it is essential that a person’s diabetes is treated as a primary condition. Mismanagement of diabetes during a hospital stay increases the amount of time someone spends in hospital, and increases the risk of complications. If you have any feedback on this issue, please let us know at [email protected]. 2. Prevention and My health for life Prevention, where possible, is an essential part of reducing the burden of diabetes. For those cases of type 2 diabetes that can be prevented, addressing the risk factors can help people to avoid a diagnosis, or to be diagnosed before the onset of complications. There are a few areas we are asking for government help in prevention. The first of these is to continue and expand the My health for life lifestyle behaviour change program to build upon its work in delivering health promotion and life style behaviour change to Queenslanders and reduce the impact of chronic conditions including type 2 diabetes. The funding of the My health for life program has seen tens of thousands of Queenslanders engage with their health, and have the opportunity to change lifestyle factors that are associated with chronic disease. Diabetes Queensland, and its partners in the Healthier Queensland Alliance, have broken new ground in preventive health across Queensland, providing the community with an evidence-based and accessible preventive health program that, when compared to activities world-wide, provides proof that Queensland is on par with the world’s best practice in prevention even at this early stage. So far, more than 210,000 people throughout Queensland have engaged in a conversation about their health by undertaking a chronic disease risk assessment, and more than 16,000 high risk Queenslanders have enrolled in the My health for life program. An average 65 participants per week completed the program, making changes to their lifestyles to improve their health and reduce their risk of disease. More than 95 community based healthcare organisations are actively involved in delivering the program in their community, and many workplaces, including government departments, are taking up the program. For more information on this program, visit www.myhealthforlife.com.au 3. Better diagnosis of type 2 diabetes Diabetes Queensland is calling on government to increase the timely diagnosis of type 2 diabetes by implementing a trial testing regimen in emergency departments. This would be a blood test to determine HbA1c levels along with other tests conducted on admission to an emergency department. This would minimise the complications and preventable hospitalisations caused by the progression of undiagnosed diabetes. A trial in Western Sydney provided startling results on the levels of undiagnosed cases of diabetes and levels of risk. The trial unearthed rates of undiagnosed type 2 diabetes as high as 17 per cent, with a further 28 per cent of those tested having pre-diabetes. Early intervention for these people would increase the chances of avoiding diabetes complications, preventable hospitalisations, and the progression from pre-diabetes to type 2 diabetes for up to seven years. Because type 2 diabetes is often diagnosed at the point of a major complication, such as loss or reduction of sight, amputation, stroke or cardiac failure, early intervention is a life- and cost- saving measure. Emergency Department admissions offer an accessible and practical opportunity for broad scale testing. Diabetes Queensland is working with PHNs to increase this testing. Diabetes Queensland believes a trial across at least three major hospital sites is essential to understanding and treating the true rates of type 2 diabetes in the State. If you have any feedback on this issue, please let us know at [email protected]. 4. Diabetic ketoacidosis An important issue we need to address is the incidence of diabetic ketoacidosis (DKA). Diabetes Queensland is seeking to increase awareness of the symptoms of type 1 diabetes and its speed of diagnosis throughout the State, with a focus on skilling health staff in regional areas, to reduce life threatening DKA. For type 1 diabetes, a failure to diagnose the condition promptly leads to the life-threatening onset of DKA. Equipping Hospital and Health Services throughout the State, particularly in regional areas, with better knowledge to assist the diagnosis of type 1 diabetes earlier will reduce the risk of severe or fatal damage to a person awaiting a type 1 diabetes diagnosis. Hospitalisation rates for children with DKA have increased nationwide by 14 per cent in five years. Approximately 45 per cent of Queensland children diagnosed with type 1 diabetes present with DKA. In addition to equipping hospitals and health services local and state based campaigns alerting people to the symptoms of type 1 diabetes, particularly in childhood, are essential. With many diagnoses occurring in early childhood, it is important that parents are aware of symptoms, especially in their children’s non-verbal years. Building on existing partnerships with selected Hospital and Health Services, a ‘4Ts’ campaign which highlights the main symptoms – Toilet, Thirsty, Tired, and Thinner – that is promoted through state and localised networks, will increase awareness and speed up diagnosis in many cases. Diabetes Queensland believes a health professional team in each region needs to be equipped with the resources and information to increase the recognition and awareness of DKA. Diabetes Queensland also seeks a supported campaign to raise awareness of type 1 diabetes symptoms to reduce the rate of DKA. 5. Telehealth The requirements for social distancing and isolation during Covid have changed the way that many services are delivered. Some of these changes are beneficial, regardless of their necessity during Covid, and can offer longer term benefits. One of these is the increase in the optional use of e-health and telehealth. Diabetes Queensland is calling for increased access for people in regional and rural areas by embracing the telehealth and e-health changes that have been implemented to deal with Covid. The move to telehealth for allied health services, including credentialled diabetes educators, has been of significant advantage during the pandemic, but also illustrates a very effective and efficient way of delivering health services throughout regional and remote Queensland. The changes that were necessary to allow access to services can be harnessed by State health services to enhance health management options throughout the State by embedding telehealth more widely as a foundational method of health service delivery, rather than a backup or incidental process. Telehealth allows for real-time, supportive and individualised health management, irrespective of a person’s location or demographic. For diabetes management, which relies on constant and regular interactions with health professionals to reduce the risk of complications, telehealth provides a sensible and efficient way of encouraging continuing engagement with the health sector, and the ability to avert potentially preventable hospitalisations. If you have any feedback on this issue, please let us know at [email protected]. 6. Prevention We spoke about prevention as a priority with the My health for life program. There are other aspects to prevention that we are also asking government to concentrate on. Diabetes Queensland has supported the establishment of the Health and Wellbeing Queensland agency, as the opportunity to create a world class health promotion and prevention agency. With a focus on families and children, and targeted interventions, the agency has the ability to create a holistic response to prevention of chronic conditions, and garner valuable evidence on best practice strategies. The establishment of Health and Wellbeing Queensland was a significant step in the health promotion and prevention of chronic conditions in Queensland. Diabetes Queensland applauds the creation of the agency, and is fully supportive of its aims to target localised interventions built on evidence-based need. The agency’s focus on families and children can provide our younger generations with the ability to break the cycle that is making chronic conditions such a burden. The impact of obesity and overweight hits later in life, but its governing behaviours begin in childhood, and are often cyclical. A projection by the Australian Institute of Health and Welfare estimates that 14% of disease burden due to overweight and obesity could be avoided by the end of the decade if the at-risk-population at the beginning of the decade reduced their body mass index (BMI) by 1 and maintained that loss. Changing risky lifestyle behaviours can have a large impact on health, wellbeing, productivity, and the economy. Diabetes Queensland looks forward to seeing Health and Wellbeing Queensland deliver a prevention framework and policy positions for a healthier state. Diabetes Queensland is also eager to see further implementation of practical health promotion initiatives such as curbing junk food advertising. The Government recently indicated that junk food advertising would be removed from State Government owned sites. Advertising for these products is aimed at the age groups in which unhealthy food habits are embedded. Removing these ads from Government-owned sites such as transport corridors is a positive move. Diabetes Queensland also supports removing unhealthy food and beverage sponsorships for activities targeting children. We would love to hear your feedback on these initiatives at [email protected]. 7. Discrimination Many of the issues that we hear about from members are not one-off circumstances, but obstacles that are placed in the way of many people, because of their diabetes. A big one is discrimination, especially in workplaces. When an issue is repeatedly encountered by people living with diabetes, it indicates a systemic problem – something can be done on a broad scale to try to change these experiences. For people living with either type 1 or type 2 diabetes, encountering difficulties in the workplace based on insulin injections, medical issues, exclusion from activities, refusal for shift or break changes and other issues are too commonplace. Most of the issues are borne out of ignorance, but highlight the need for employers to be more aware of their responsibilities to employees with chronic conditions including diabetes. Diabetes Queensland looks to the State Government to provide an information campaign to employers on workplace discrimination for employees living with chronic conditions. If you have any feedback on this issue, please let us know at [email protected]. 8. Pathways For people who have recently been diagnosed with diabetes, there is a lot of information to process, and the experience can be overwhelming. Diabetes Queensland would like to see a Health Department focus on the pathways open to people who have been recently diagnosed with type 1, type 2 or gestational diabetes, to ensure they can access information, support and allied services, including mental health, at the beginning and throughout their journey. There is a lack of consistency in the engagement people have with the health system following a diagnosis of diabetes which leaves many people feeling overwhelmed and confused, or even dismissive of the condition. Diabetes Queensland urges the Government to fund a gateway to allow the transition from diagnosis to quick and effective access to services. Diabetes is a complex condition that covers many aspects of physical and mental health, and needs to be taken seriously from the outset. Connecting people with services in a streamlined way will help to make management of the condition less daunting and difficult, and help people to effectively self-manage more quickly. This gateway would also fill a vital gap for relevant patients discharged from hospital and avoid a possible readmission. Diabetes Queensland would like to partner with the Government to help to deliver this gateway. 9. Targeted interventions Particular groups of Queenslanders are disproportionately impacted by diabetes, including people of First Nations or some cultural backgrounds, regional and rural Queenslanders and people without ease of access to services. Diabetes Queensland is encouraging government to provide specific interventions to help those communities. First Nations people are 3.3 times more likely to have diabetes, and 40% less likely to be managing their diabetes. Australians born in South East Asia have 1.6 times the prevalence of type 2 diabetes, people born in the Pacific Islands and the Middle East have nearly twice the prevalence, and those born in North Africa 2.3 times the diagnosis rate. These statistics highlight the need for culturally appropriate and targeted interventions with a broad reach across these communities. Regional and rural Queenslanders are faced with increased difficulty in accessing health and allied health services. Regular engagement with these services are essential for best possible diabetes management. Innovations in regional delivery are required to increase the engagement of people living in more remote areas with health professionals. We would love to hear your feedback on these ideas at [email protected].