Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
Please could you give a brief introduction to diabetes?
Diabetes is a serious condition that causes high levels of glucose (a type of sugar) in the blood. There are three main types of diabetes: type 1 and type 2 diabetes, which are lifelong conditions, and gestational diabetes, which only occurs in women during pregnancy.
Type 1 diabetes usually starts in childhood or adolescence but can begin at any age. One in 700 children in Australia has type 1 diabetes. It usually runs in families so if a close relative has it (a parent, brother or sister), you are more likely to develop it.
Type 2 diabetes is much more common and affects almost one million people in Australia. It usually first appears in middle-aged or older people although, unfortunately, it’s becoming more common in children and adolescents.
While you’re more likely to get type 2 diabetes if a close relative has it, your lifestyle is also a major factor. If you’re overweight, have high blood pressure, do little physical activity or have a high fat, high sugar diet, your chances of type 2 diabetes are greater.
What complications and health problems can diabetes cause?
People with diabetes have a greater chance of developing eye conditions including loss of vision, as well as kidney disease, heart disease and stroke, nerve problems and foot problems. Doing whatever you can to prevent these complications by making lifestyle changes, and where necessary using diabetes medicines, is important — and it’s never too late to make changes. Although it’s really hard to make changes sometimes, there are some great resources and supports to help you. Check out: www.nps.org.au/conditions/type2diabetes/whocanhelp
Whether complications develop, and how quickly they do, depends on how long you’ve had diabetes and how well your blood glucose levels have been controlled. It’s also just as important to control cholesterol and blood pressure and stop smoking as many complications are the result of blood vessel damage caused by these. Heavy alcohol intake can also mean complications develop sooner.
How do people with diabetes test their glucose levels?
People with diabetes can check their own blood glucose levels at home or elsewhere with a ‘finger prick’ test. This involves taking a pin-prick droplet of blood from a finger, applying the blood to a disposable 'test strip' then inserting it into a glucose meter. A health professional provides advice on if it is necessary for you to do this (not everyone needs it), how often blood glucose testing is needed and how to do this correctly.
HbA1c (glycated haemoglobin) levels are also tested by a health professional to check how well someone’s diabetes is being managed over a period of time. HbA1c is a substance in the blood made up of glucose attached to haemoglobin in red blood cells. Testing HbA1c gives you a measure of your average blood glucose level over the previous 3 months.
What has changed recently about how HbA1c is measured?
Until July 2011, HbA1c results were reported only as a percentage (%) in Australia. To bring us in line with international reporting units, results are now presented both as a percentage and as another unit called millimoles per mole (mmol/mol) and after July 2013, will only be reported in mmol/mol.
This change has been made to standardise the way HbA1c results are reported in all countries world-wide. The new way of reporting won’t change the way people with diabetes are tested, their HbA1c target, or how often they need to be tested. It is simply a different way of reporting the same HbA1c result.
If you are interested, NPS has developed an HbA1c unit converter to help you convert your old HbA1c result into the new mmol/mol unit. Find out more about what the unit change means for you and use the calculator to convert your old units into the new.
What other checks do people with diabetes need?
Blood pressure and cholesterol levels are also measured when you have diabetes, because managing these is just as vital for preventing complications as is managing blood glucose.
Your feet, weight, eyes, kidneys and teeth will be reviewed routinely too in order to check for any complications or health problems related to your diabetes.
About 10–50% of women who have gestational diabetes will go on to develop type 2 diabetes later in life. A doctor may test these women for diabetes 3 months after their baby is born, and every 1 or 2 years after that.
What medicines do people with diabetes need for blood glucose control?
Different types of medicines are used for diabetes and each type works in a different way.
Metformin, sulfonylureas and insulin are all medicines commonly prescribed for diabetes to control blood glucose levels. These medicines have all been used for many years and have been shown to reduce the complications of diabetes.
People with type 1 diabetes will always need to inject insulin. This is because the cells in their pancreas make little or no insulin, which leads to high blood glucose levels. A small number of women with gestational diabetes also need insulin injections during pregnancy.
People with type 2 diabetes may need a medicine to control their blood glucose if dietary changes and physical activity alone aren’t enough. People may be also prescribed medicines as soon as type 2 diabetes is diagnosed if their blood glucose levels are very high or they have severe diabetes symptoms.
Different types and doses of medicine are used according to their individual needs, but most people start with either metformin or a sulfonylurea.
People with diabetes may also need to take medicines for related conditions, such as medicines to lower fats (triglycerides) and cholesterol in the blood, blood pressure lowering medicines, and some people with heart and circulatory (cardiovascular) problems may need aspirin.
Do people with diabetes need to change their medicines over time?
Medicines prescribed for type 2 diabetes may change depending on the severity of the diabetes, the person’s age and health, and the other medicines they’re taking.
A single medicine like metformin may control blood glucose levels initially. But as diabetes progresses, more than one medicine — for example, metformin and a sulfonylurea — may be necessary to control blood glucose levels adequately. For some people, insulin, or a combination of tablets and insulin, may be the best choice.
People with type 1 diabetes may also need to change the type, form and dose of insulin they use depending on their circumstances, for example, during pregnancy and illness, or before and after surgery.
Are non-medicine measures just as important for people with diabetes?
Yes they are – even if you are on a medicine! A healthy lifestyle is vital for everyone with diabetes including eating a healthy diet, being physically active, minimising alcohol intake and quitting smoking. It will help people with diabetes maintain a healthy weight, may improve blood glucose control and reduce the need for medicines, and helps to prevent some of the long-term complications of diabetes.
People with type 2 diabetes are usually started on a healthy, balanced diet and physical activity for 6 weeks or more, to see if this controls their diabetes without medicines. About 30 minutes of moderate intensity physical activity on 5 or more days per week is advised for most adults. Gestational diabetes can also be treated with diet and exercise, and will usually improve or disappear after the baby is born.
People who need medicines to control their diabetes, including those with type 1 diabetes, should continue to follow a healthy, balanced diet and be physically active. This will help slow down the progression of the diabetes and lessen the risk of developing complications.
What is the Annual Cycle of Care when it comes to diabetes?
The Diabetes Annual Cycle of Care provides access to free health checks that help people manage their diabetes and prevent diabetes-related complications, such as vision loss, heart disease or stroke. Free health checks include HbA1c, blood pressure, cholesterol and other fat levels, a comprehensive eye examination, testing of kidney function, a foot examination, and a review of a person’s medicines, diet and physical activity.
People with diabetes are encouraged to make an appointment with their health professional to plan their Diabetes Annual Cycle of Care. They can also use the NPS Diabetes Health Tracker that allows them to keep track of their medicines and health checks, and to show it to their health professionals and have it updated at each visit.
You can download or order the NPS Diabetes Health Tracker, or have a copy sent to you by calling NPS on (02) 8217 8700.
What is the Diabetes MedsCheck and who is eligible for one?
Diabetes MedsCheck provides an opportunity in a pharmacy to have a private face-to-face conversation with a pharmacist about medicines for diabetes and blood glucose control. This is different from the Government subsidised Home Medicines Review, which is organised by your doctor and carried out by a pharmacist in your home.
During the Diabetes MedsCheck, the pharmacist answers any questions a person may have about all their medicines, such as what each medicine is for and any problems they may have with their medicines or blood glucose control. The pharmacist also provides information about blood glucose monitoring devices and training in how to use them.
At the end of the consultation the pharmacist gives a printout listing all the medicines a person needs to take, what they are for and when to take them. Together they agree on an action plan of goals, and any follow-up visits that may be needed with a doctor and other healthcare providers.
People with type 2 diabetes may be eligible for a Diabetes MedsCheck if they:
have a valid Medicare or DVA card
are living at home in a community setting
haven’t had a pharmacy MedsCheck, Diabetes MedsCheck, Home Medicines Review or Residential Medication Management Review in the past 12 months
have been diagnosed with type 2 diabetes in the past 12 months.
People may also be eligible if they need help with managing their type 2 diabetes or they don’t have access to existing diabetes education or health services in their community.
How do you think the future of diabetes care will develop?
Whilst there is no cure for diabetes yet, there is a significant amount of research being undertaken in Australia and internationally looking at different aspects of diabetes – including causes, potential vaccinations to prevent type 1 diabetes, new medicines treatments and other aspects of diabetes (like the role of high cholesterol and triglycerides).
Further information is available on Australian research likely to change future diabetes care at:
Would you like to make any further comments?
Diabetes is best managed and treated with the help of a team of health professionals with a range of expertise. To find out more about the team of health professionals and other services available, visit www.nps.org.au/conditions/type2diabetes/whocanhelp.
It’s also a good idea to register with the National Diabetes Services Scheme (NDSS). NDSS can provide diabetes-related blood glucose monitoring equipment at subsidised prices, and provides information and support on a range of topics. Registration is free. Ring them on 1300 136 588 or visit www.ndss.com.au.
Where can readers find more information?
About Dr Danielle Stowasser
As part of being appointed as Clinical Advisor for NPS MedicineWise, and manager of program design, Danielle has drawn on over 20 years of clinical experience in therapeutics and change management experience from running medicines programs to improve the quality of their use.
Danielle was the inaugural director of Queensland’s first state-wide medication safety and quality unit and prior to this completed doctoral study in medication safety and the use of information technology in improving continuity of care for consumers.