Australian National Diabetes Strategy 2021–2030

Objectives

The Australian National Diabetes Strategy 2021–2030 is a ten-year national framework intended to coordinate health care and other resources across all levels of government, reduce diabetes incidence, morbidity, mortality and complications, improve health outcomes, and reduce diabetes’ social and economic impact in Australia.[1][2]Its vision is an integrated, coordinated, cross-sector response based on person-centred care, lifelong self-management, health equity, collaboration and continuity of care across services, settings, technologies and sectors.[2][3]

• Prevent type 2 diabetes by improving food environments, physical activity, active travel, healthy weight, maternal and child health, and culturally safe prevention for people at elevated risk and communities experiencing disadvantage.[4][5][6]
• Promote awareness and earlier detection of type 1 and type 2 diabetes through symptom recognition, risk assessment, opportunistic screening, population screening approaches and integration with checks for other chronic conditions.[4][7]
• Reduce diabetes burden and complications, and improve quality of life, through consumer-focused, proactive, multidisciplinary care, self-management support, clinical guidelines, local care pathways and complication-prevention programmes.[4][8][9]
• Reduce the impact of pre-existing and gestational diabetes before conception, during pregnancy and after birth, including equitable access to care and follow-up in rural and remote communities.[4][10][11]
• Reduce inequities affecting Aboriginal and Torres Strait Islander peoples and other priority groups, including culturally and linguistically diverse communities, older people, rural and remote populations, children and young people, people with disability, and people with mental health disorders.[4][12][13]
• Strengthen prevention and care through research, evidence, linked data, information sharing and a national research agenda addressing diabetes causes, treatment, complications, priority populations, technology, behavioural health and translation of research into practice.[4][14][15]

Implementation

Implementation is multisectoral, community-based and intended to be guided by an Implementation Plan developed jointly by the Commonwealth and state and territory governments with the health sector and relevant organisations.[1][2]Delivery involves people with diabetes, families and carers, health professionals, researchers, non-government organisations, communities, industry and all levels of government, supported by leadership and governance, workforce capacity, information and research, financing and infrastructure, partnerships, and preparedness for emerging public-health challenges.[1][3]

• Coordinate prevention through community, workplace, school, primary-care and active-travel settings; co-design programmes with affected communities; and tailor interventions for cultural safety, feasibility and accessibility in disadvantaged, regional and remote populations.[5][6]
• Deliver integrated multidisciplinary care through partnerships across primary, allied, community, specialist and hospital services, with Primary Health Networks supporting care coordination and locally appropriate pathways.[8][9]
• Maintain access to affordable medicines, devices and services through arrangements including the National Diabetes Services Scheme, Pharmaceutical Benefits Scheme, Insulin Pump Program and Medicare, while state and territory governments retain prevention and treatment responsibilities.[16]
• Expand consumer participation through structured self-management education, peer support, consumer engagement, culturally appropriate information and technology-enabled care, including My Health Record, telehealth, remote monitoring, connected software and digital education resources.[9][17]
• Build workforce capability across specialist, generalist, Aboriginal and Torres Strait Islander, paediatric, aged-care, disability and mental-health settings through training, competencies, referral models and evidence-based guidance.[17][12][18]
• Integrate mental-health assessment and support into diabetes care, including assessment at diagnosis and routine follow-up, and strengthen hospital handover, discharge planning and care transitions with primary care and residential aged care.[17][10][13]
• Partner with Aboriginal communities and Aboriginal Community Controlled Health Organisations to design prevention and management programmes, address cultural, linguistic, geographic and socioeconomic barriers, and improve culturally appropriate data collection and service access.[11][12]
• Support pregnancy-related care through pre-pregnancy programmes, coordinated primary and specialist services, gestational diabetes testing, post-pregnancy education, reminder systems through the National Gestational Diabetes Register and resilient service delivery during health-system disruptions.[11]
• Use regional care networks, outreach, telehealth, local clinician-specialist partnerships and paediatric referral pathways to improve access for rural and remote communities, children and young people, and people requiring specialist support.[12][19][20]
• Advance research and data capacity by coordinating funding streams, linking national health datasets, facilitating provider and consumer information sharing, producing de-identified aggregate data within privacy requirements, and using research findings for policy and service planning.[14][15]
• Measure progress against goal-specific indicators, with updates to measures previously compiled by the Australian Institute of Health and Welfare; review progress throughout the Strategy and undertake a mid-term review anticipated in 2025, or earlier if major changes in evidence warrant it.[1][2]

Monitoring & Evaluation

The Strategy establishes a monitoring approach centred on goal-specific measures of progress, an accompanying Implementation Plan, periodic review, and stronger use of linked data and research evidence. Indicators from the 2016–2020 Strategy, previously compiled by the Australian Institute of Health and Welfare, are intended to be updated for 2021–2030.[1]Progress against the Implementation Plan is to be reviewed throughout the Strategy period, with a mid-term review anticipated in 2025 or earlier if major changes in the evidence base warrant it.[2]

• Measure population prevention outcomes, including the number of people developing type 2 diabetes or prediabetes, prevalence of overweight and obesity, physical inactivity, access to prevention programmes, and progress against National Preventive Health Strategy targets.[6]
• Monitor awareness and early-detection outcomes, including type 1 diabetes presentations with diabetic ketoacidosis at diagnosis and the number of people assessed for type 2 diabetes risk.[7]
• Track clinical management and complications through target levels of glycated haemoglobin, albuminuria, cholesterol and blood pressure; medication-plan reviews; retinopathy, renal and foot assessments; hospital admissions; blindness; amputations; and end-stage kidney disease requiring dialysis.[10]
• Measure pregnancy-related outcomes, including glycated haemoglobin testing during each trimester for women with pre-existing diabetes, gestational diabetes testing, postpartum follow-up, and perinatal and infant deaths among children of mothers with diabetes.[11]
• Monitor equity-related outcomes, including diabetes prevalence, complications, gestational diabetes, health behaviours among pregnant Aboriginal and Torres Strait Islander women with diabetes, the affordability of a healthy food basket, and childhood programme participation.[19]
• Assess mental health and wellbeing, including depression, anxiety, distress, positive coping, and routine mental-health assessment at diagnosis and during ongoing diabetes care.[10]
• Strengthen quality improvement by monitoring implementation of the Living Evidence for Diabetes Guidelines, reporting against clinical guidelines and outcomes, and assessing digital readiness, effectiveness and cost-effectiveness of technology-enabled care.[9][17]
• Develop data infrastructure through national health-data linkage, information sharing between providers and people with diabetes, de-identified aggregate data, linked diabetes-relevant datasets, and regular national surveys and dataset reporting.[14][15]
• Support outcome monitoring for young people through databases covering glycaemic outcomes and complication assessments, benchmarking between paediatric diabetes centres, and shared expertise.[20]

Existing evidence sources include the National Diabetes Register, Australian Burden of Disease Study, health-system usage information, national surveys, and Australian Institute of Health and Welfare indicator reporting.[15]The Australian Institute of Health and Welfare issued a baseline indicator report in October 2018 and an updated report in December 2020 for the previous Strategy.[21]Specific indicator definitions, baselines, performance thresholds, reporting schedules, formal evaluation methods, surveillance governance and named accountability bodies are not fully specified in the supplied material.[7][11]

Costing & Financing

The Strategy identifies financing and infrastructure as core enablers for coordinated diabetes prevention and care, but the supplied material provides no overall Strategy budget, programme allocations, funding gap, resource-mobilisation target or quantified financing model.[3]Existing Australian Government support includes the National Diabetes Services Scheme, Pharmaceutical Benefits Scheme, Insulin Pump Program and Medicare funding, alongside other arrangements supporting access to medicines, devices and services.[16]

• Support research through channels including the National Health and Medical Research Council and Medical Research Future Fund, although no funding amounts or allocations are specified.[15]
• Develop efficient assessment and funding pathways for treatments and devices, with attention to geographic and socioeconomic barriers, and explore innovative funding for people requiring high levels of health-service use.[17]
• Assess technology-enabled diabetes support and electronic health interventions for effectiveness and cost-effectiveness; these may be scalable at a lower marginal cost than traditional face-to-face support.[8][17]
• Report the economic burden of diabetes using sources such as the Australian Institute of Health and Welfare Australian Burden of Disease Study expenditure database.[15]

In 2015, diabetes accounted for an estimated 2.3% of Australian health-system disease expenditure, or 2.7 billion Australian dollars.[22]Its estimated full annual cost, including indirect costs such as reduced productivity, work absence, early retirement, premature death and bereavement, was as high as 14 billion Australian dollars.[22]Annual direct costs were estimated at 9,600 Australian dollars for a person with diabetes complications, compared with 3,500 Australian dollars for a person without complications.[22]