Australian National Diabetes Strategy 2021–2030

Objectives

The Australian National Diabetes Strategy 2021-2030 provides a national framework to prevent, detect and manage diabetes; coordinate health care and other resources across governments and sectors; reduce diabetes incidence, morbidity and mortality; and lessen the condition’s social and economic impact in Australia.[1][2]Its vision is to strengthen, integrate and coordinate all sectors to improve health outcomes and reduce diabetes-related social and economic impacts.[3][4]

• Prevent type 2 diabetes by addressing modifiable risks, including overweight and obesity, low physical activity, unhealthy diets and tobacco use, through population, community, workplace and targeted prevention action.[5][6]
• Promote public awareness and earlier detection of type 1 and type 2 diabetes, including symptom awareness, risk assessment, opportunistic screening and integration of testing with broader chronic disease checks.[7]
• Reduce the burden of diabetes and its complications, and improve quality of life, through high-quality, proactive, consumer-focused and team-based care.[8][7]
• Reduce the impact of pre-existing diabetes and gestational diabetes in pregnancy through equitable pre-pregnancy, pregnancy and post-pregnancy prevention, testing, treatment and follow-up.[8][9][10]
• Reduce diabetes-related inequities among Aboriginal and Torres Strait Islander peoples through culturally relevant prevention, education, primary health care, diabetes management, food security and early-years action.[8][11]
• Reduce the impact of diabetes among other priority groups, including culturally and linguistically diverse communities, older people, children and young people, rural and remote populations, people with mental health disorders and people with disability.[8][12][13]
• Strengthen prevention and care through research, evidence, linked data and improved access to medicines and technologies.[8][14][15]

Implementation is guided by person-centred care and self-management throughout life, reduction of health inequities, collaboration, and coordination and integration of care across services, settings, technology and sectors.[3][4]The Strategy also seeks to align existing efforts and investments with identified needs and use health-care resources efficiently.[2]

• Develop nationally agreed clinical guidelines, locally tailored care pathways and programmes to prevent and manage diabetes complications.[16][17]
• Improve access to structured self-management education, peer support, psychological care, affordable medicines, devices, monitoring technologies and multidisciplinary services.[17][18]
• Strengthen resilience of prevention and care during public health emergencies and other disruptions, including continuity arrangements for diabetes management, follow-up care and gestational diabetes services.[1][17][10]
• Advance a national research agenda spanning diabetes causes and treatment, implementation research, priority populations, technology, mental health, translational care and diabetes data systems.[15]

Implementation

The Strategy adopts a multisectoral, community-level delivery model led by governments and implemented with people with diabetes, families and carers, health professionals, non-government organisations, researchers, communities and industry.[1]The Commonwealth and state and territory governments are to work with the health sector and relevant organisations, supported by an Implementation Plan developed collaboratively and updated from the 2016-2020 plan.[1][3]

• Coordinate prevention and care across primary health, allied health, community, specialist and hospital services, with people with diabetes, carers and families involved in care design and self-management.[7][17]
• Use Primary Health Networks to improve local coordination among general practitioners, Aboriginal Community Controlled Health Organisations, other primary care providers, secondary care providers and hospitals.[16]
• Co-design culturally safe actions with Aboriginal communities and Aboriginal Community Controlled Health Organisations, and deliver services through community-controlled or culturally competent mainstream primary health care.[11]
• Strengthen the multidisciplinary workforce, including general practitioners, allied health professionals, diabetes specialists, credentialled diabetes educators, Aboriginal and Torres Strait Islander health practitioners and health workers.[4]
• Provide pregnancy-related care through coordinated primary, specialist and allied health services, including access to credentialled diabetes educators, accredited practising dietitians and/or exercise physiologists where diabetes is present.[10]
• Expand coordinated care in rural and remote areas through telehealth, online medical and mental health services, regional networks and partnerships between local clinicians and specialist diabetes centres.[19][20]
• Use My Health Record, connected diabetes management software, telehealth, remote monitoring, consumer education platforms and other digital tools to support information sharing, continuity and longitudinal care coordination.[17][18]Technologies that meet the definition of medical devices are subject to Therapeutic Goods Administration regulation.[16]
• Maintain access to subsidised medicines, devices and services through existing arrangements, including the National Diabetes Services Scheme, Pharmaceutical Benefits Scheme, Insulin Pump Program and Medicare.[2]

Leadership and governance, workforce capacity, information and research capacity, financing and infrastructure, partnerships and networks, and flexibility to respond to emerging challenges are identified as implementation enablers.[1][4]During Strategy development, the Australian Government Department of Health chaired time-limited Expert Advisory and Jurisdictional Advisory Groups, and Australian Health Ministers endorsed the Strategy.[1][21]

Progress is to be measured through goal-specific measures and updated indicators, building on indicators compiled by the Australian Institute of Health and Welfare for the previous Strategy.[1][3]The Strategy provides for review against the Implementation Plan throughout its duration and a mid-term review in 2025, or earlier if major changes in the evidence base require it.[3]

• Monitor prevention through incidence of type 2 diabetes and prediabetes, population risk factors, access to prevention programmes and progress towards National Preventive Health Strategy targets.[6]
• Track clinical outcomes including glycaemic, albuminuria, cholesterol and blood-pressure targets, complication testing, diabetes-related hospital admissions, renal disease, vision loss, foot amputations and mental health.[9][19]
• Strengthen linked, de-identified datasets, national surveys, diabetes registers and reporting to support evidence-based policy, service planning and population monitoring, subject to legislative and privacy requirements.[15]

Monitoring & Evaluation

The Strategy establishes a national measurement framework across prevention, detection, care, priority populations, research and data. Each of its seven goals has measures of progress, and implementation is guided by measurement of progress, data collection, analysis and reporting.[1][4]Progress is to be reviewed against the Implementation Plan throughout the Strategy period, with a mid-term review scheduled for 2025 or earlier if major changes to the evidence base require it.[3]

• Update indicators previously compiled by the Australian Institute of Health and Welfare to align the 2016-2020 measurement approach with the 2021-2030 Strategy.[1][4]
• Use existing national data frameworks, associated metrics, data sources and reporting responsibilities to support implementation monitoring.[4]
• Build on the Australian Institute of Health and Welfare baseline indicator report of October 2018 and updated indicators report of December 2020.[4][22]
• Monitor prevention outcomes, including incidence of type 2 diabetes and prediabetes, overweight and obesity, physical inactivity, access to prevention programmes, and progress against National Preventive Health Strategy targets.[6]
• Assess prevention programmes for cultural appropriateness, accessibility in regional and remote areas, suitability for disadvantaged groups and effectiveness.[6]
• Track early detection through diabetic ketoacidosis at type 1 diabetes diagnosis and assessment of type 2 diabetes risk.[7]
• Report clinical and outcome data against the Living Evidence for Diabetes Guidelines, while monitoring retinopathy, renal and foot complications, mental health, digital readiness, data linkage and the effectiveness and cost-effectiveness of technology-enabled care.[17][18]
• Measure clinical outcomes including glycaemic control, albuminuria, cholesterol, blood pressure, complication testing, hospital admissions, blindness, amputations, end-stage kidney disease and hospital-care quality.[9]
• Track pregnancy-related outcomes, including trimester HbA1c testing for women with pre-existing diabetes, perinatal and infant deaths, gestational diabetes testing, and postpartum testing and follow-up.[10]
• Use the National Gestational Diabetes Register reminder system to encourage healthy lifestyles, type 2 diabetes prevention and future diabetes testing after gestational diabetes mellitus.[10]
• Monitor equity indicators among Aboriginal and Torres Strait Islander peoples, including diabetes prevalence, complications, gestational diabetes, risk-factor targets, healthy-food affordability and participation in childhood education programmes.[19]
• Establish or support outcome databases for young people with diabetes, including glycaemic and complication outcomes, and benchmark results across paediatric diabetes centres.[20]
• Develop linked, de-identified datasets and conduct regular national biomedical health surveys, including an Aboriginal and Torres Strait Islander component, to improve policy, planning and population monitoring.[15]
• Use the National Diabetes Register, Australian Burden of Disease Study and health-service utilisation information for regular reporting on diabetes parameters.[15]

The Strategy identifies surveillance limitations, including under-reporting in self-reported data and variation between communities and remote areas, requiring careful interpretation of prevalence estimates.[23][24]Reporting schedules, indicator thresholds, evaluation methodologies and formal accountability assignments are not fully specified beyond the Implementation Plan reviews, indicator updates and identified data activities.[3][17][18]

Costing & Financing

Financing and infrastructure are recognised as core enablers of implementation, alongside aligning existing investments with identified needs and using health-care resources efficiently.[1][2]The Strategy maintains reliance on existing government-supported arrangements for affordable medicines, devices and services, including the National Diabetes Services Scheme, Pharmaceutical Benefits Scheme, Insulin Pump Program and Medicare.[2]

• Support coordinated care and service access through appropriate financial incentives and funding arrangements.[4]
• Develop assessment, evaluation and funding pathways for timely and equitable access to new diabetes treatments and devices.[18]
• Explore innovative funding mechanisms for people with greater need for health care, allied health and Aboriginal and Torres Strait Islander health services.[18][9]
• Assess the effectiveness and cost-effectiveness of technology-enabled diabetes support and care models.[17][18]
• Use scalable e-health and technology-enabled interventions that may have lower marginal costs than traditional face-to-face support, while recognising that longer-term evidence remains needed for dietary interventions intended to achieve type 2 diabetes remission.[16]
• Support research and reporting on diabetes costs to the community and health system through the Australian Institute of Health and Welfare Australian Burden of Disease Study expenditure database.[15]

Diabetes represented an estimated 2.3% of total Australian health-system disease expenditure in 2015, equivalent to Australian dollars 2.7 billion.[23]Including indirect costs such as lost productivity, absence from work, early retirement, premature death and bereavement, its total annual cost was estimated to be as high as Australian dollars 14 billion.[23]Annual direct costs in 2015 were Australian dollars 9,600 for people with diabetes complications, compared with Australian dollars 3,500 for those without complications.[23]

No total implementation budget, costed activity plan, dedicated allocation, funding source, quantified funding gap or numeric economic assumption is specified for the 2021-2030 Strategy.[2][3]