Monday, 15 June 2020
Private Members' Business
That this House:
(1) notes that there are:
(a) 1.3 million Australians with diabetes registered on the National Diabetes Services Scheme, with over 280 new people diagnosed and registered each day and an estimated 500,000 Australians with type 2 diabetes which remain undiagnosed; and
(b) an estimated 2 million Australians with pre-diabetes and at high risk of developing type 2 diabetes in the next 5-10 years;
(a) diabetes is a complex metabolic disorder, which if not diagnosed early and treated well may lead to serious health complications such as blindness, limb amputation, heart disease and stroke, and kidney disease; and
(b) the Government's long standing commitment to improving the treatment and care of people with diabetes through establishing the Australian National Diabetes Strategy, the roll out of continuous glucose monitors and flash monitors to children, young adults, health care card holders and women with type 1 diabetes who are pregnant, while noting the need for all type 1 diabetics to have affordable access to this important technology, as well as the recently launched Diabetes in Schools program, the KeepSight program, and programs to prevent diabetes related amputations;
(3) congratulates Australian of the Year 2020, Dr James Muecke AM for his work as an ophthalmologist working in many poor and developing nations, and for raising public awareness of the need to prevent type 2 diabetes through encouraging healthier lifestyles and healthier environments; and
(4) calls on all state and federal governments to re-commit to a refreshed Australian National Diabetes Strategy and to fund and develop a national diabetes prevention program.
I am, as most people in this place would probably know, the co-chair of the 'parliamentary enemies of diabetes', along with the member for Moreton, who is across the chamber. It's a job we take very seriously and work very hard at. We call ourselves the enemies of diabetes because this place is full of friendship groups, and I don't want to be a friend of diabetes; I wish to be an enemy of diabetes. It is the leading cause of coronary heart disease. It is the leading cause of amputation. It is the leading cause of blindness in Australia. I will come back to the issue of eyesight in a moment or two. 1.3 million Australians have diabetes, and another two million are estimated to have pre-diabetes. It has gone from the stage of being endemic to being epidemic, and it's a serious health risk for Australia.
I have been planning for this motion for some time because part of it is recognising the Australian of the Year, Dr James Muecke, who is an ophthalmologist from Adelaide and who has spent a substantial part of his life working in developing nations, helping people keep their eyesight. In fact Dr Muecke has helped thousands of people. We had hoped that he would be in parliament when we did this motion, but the enemies of diabetes will be joining him online soon for a discussion.
The government continues to find ways of funding new treatments, and we are continuing to work towards a cure for diabetes. There have been some really good programs in the last few years. I guess continuous glucose monitors are top of the list, but we have invested in eyesight screening programs as well. I thank Greg Hunt, who is a very attentive minister in this area.
I'd also like to give a little bit of a shout-out to the people who work on the National Diabetes Strategy implementation reference group, especially the former member for Pearce, the Hon. Judi Moylan, who continues maybe not a lifetime's work in this area but half a lifetime's work in this area—she has been a wonderful ambassador and campaigner for diabetes—and Professor Paul Zimmet, who has spent a lifetime studying and working in this area. They are wonderful examples of people who are willing to keep giving and giving and giving for a very good cause.
I'd also like to give a bit of a shout-out to Dr Michael Stanford AM, who is the newly appointed President of Diabetes Australia. He brings a great deal of expertise and prestige to this area. I also want to recognise the outgoing president, Barry O'Farrell, who, in the member for Moreton's eyes and my eyes was probably not there long enough. Barry O'Farrell has gone off to become the High Commissioner to India. It's another job, but he's still serving his nation. We thank him for that and for the almost two years he served as the president of Diabetes Australia.
I often say that this is a way for people who have had a high-profile in public affairs to come back. They can pick an organisation like Diabetes Australia and really give something back. I congratulate Julia Gillard, for instance, on the way that she has become involved in and become the public face of Beyond Blue. It is a really good thing for people from high office to do. So, we on the friends of diabetes group will continue to work with Diabetes Australia.
One of the things I'm sad to say—unless the statistics have changed quite recently—is that the electorate of Grey, which covers 92.4 per cent of South Australia, has the highest diabetes rate in Australia. We are not absolutely sure why. We've got a high Indigenous population, and type II diabetes is an incredible affliction for these people, but that can't be the only reason. They are only about seven per cent of the population. There are a whole lot of other things in there that we need to understand. People have little choice with type I diabetes, but, although not 100 per cent foolproof, there are many things you can do about your lifestyle that will limit your chances of getting type II diabetes. That is a message we are still not getting through to the public on a regular enough basis.
I'm very pleased to speak in support of the motion moved by the member of Grey, my co-chair of the 'parliamentary enemies of diabetes' group. Whilst people outside often see the argy-bargy of politics, on matters like this it is good to see that we work closely together. The member for Grey is a hard man to have a problem with. I don't want to do him a disservice in his electorate, but he has been very strong on diabetes, and, because he has an electorate that has those challenges, he brings great analysis to the subject. As stated by the member for Grey, there are now almost 1.2 million Australians who have been diagnosed and are living with type II diabetes, but there are others in our community—likely to be around 500,000—with undiagnosed type II diabetes and still another two million Australians with pre-diabetes who are at high risk of developing type II diabetes. Type II diabetes is a very serious and progressive metabolic condition, with many serious complications including eye damage and blindness, foot problems and amputations, kidney damage and dialysis, heart attacks, heart failure and strokes. People with diabetes are three to four times more likely to have a heart attack or stroke, so it is a good disease to fight and a good disease to be an enemy of. Diabetes has a wider impact than just on those experiencing the disease. Their family members, friends, teachers and employers all need to be aware of the support needed by suffers. The economic cost, which has been a big motivation for me, is estimated to be nearly $15 billion annually.
As well as being co-chair of the parliamentary diabetes group, I came to this because my mother had type II diabetes. It's funny: my mum has been dead for quite a while, for a few years now, but I always associate with her with Canberra. I would often phone her when I was here, away from my family. Mum liked a bit of a chat. In fact, I've only ever stayed in Canberra on a weekend twice in my life: once with my mum and then the weekend just gone. So, I've been thinking of mum, so it's great to have this motion, and I thank the member for Grey for that.
While we do not know exactly what causes type II diabetes, the good news is that there is strong evidence that it's preventable. Obviously, it's a progressive condition. It develops over a long period of time, where the body becomes resistant to the normal effects of insulin. It causes the pancreas to produce greater and greater amounts of insulin, and eventually the pancreas loses the ability to produce enough to manage the blood glucose levels in the body. Then the cells in the pancreas are gradually destroyed. Type II diabetes represents 85 to 90 per cent of all cases of diabetes in Australia. There are some markers that determine that someone is more likely to develop type II diabetes: if they're over 45, if they have a family history of diabetes, if they are from some particular ethnic backgrounds, if they suffer from high blood pressure, or if they are overweight or obese.
Many people who have developed type II diabetes had no symptoms at all. For some, the first sign might be a complication such as a heart attack, vision problems, or a foot ulcer. There is no cure for type II diabetes, and that is why prevention is crucial. There is strong evidence that we could prevent it in up to 60 per cent of cases, which is something we are not achieving in Australia as yet. We do need a national type II diabetes prevention program to help prevent people developing type II diabetes. This would include risk assessment; evidence based lifestyle and behaviour change programs for those who are at higher risk; a whole-of-community change to promoting healthy eating, healthy physical activities and healthy weight, perhaps springboarding off our response to the pandemic; and public education campaigns and public policy initiatives, including reducing the marketing and promotion of unhealthy food to children, reducing sugary drink consumption, reducing added fat, salt and sugar in the food supply, and reducing the cost of healthy food options for the poor and disadvantaged. A prevention workforce of health professionals trained and certified in diabetes risk assessment and prevention should be developed in each state and territory. A range of suitable health officials from fields including nursing, dietetics, physiotherapy, exercise physiology, pharmacy, psychology, and Aboriginal health workers should be included.
The goal of any program would be to slow the growth of the obesity epidemic, the main driver of type 2 diabetes, and prevent low-risk individuals from moving into the higher-risk category. If you develop type 2 diabetes, eating well and exercise are very important management tools. It's important to keep the blood glucose levels in the target range to prevent short-term and long-term complications. Diabetes is an epidemic not only in this country but across the world. We need to tackle diabetes head on, for all our sakes. I look forward to working with the member for Grey to do so.
I rise to support the member for Grey's motion about diabetes. This is such an important area. It affects so many millions of Australians. I want to start my remarks by commenting on the fact that the Australian of the Year this year is Dr James Muecke AM. James has decided to make prevention of diabetes one of his main topics because it is such an important area with regard to his background. He is an ophthalmologist by training, and he cares deeply about saving vision. We know that diabetes is the one of the leading causes of blindness, so it is wonderful to hear that the Australian of the Year this year, Dr James Muecke, is championing the issue of how we can prevent diabetes and save people's sight. I worked with James many years ago. I worked with him in Kenya 30 years ago, in Tumutumu. It is great to see him being elevated to this position of Australian of the Year. He is a very dedicated and passionate medical researcher and clinician, and he has really brought a great deal of passion to this area. Unfortunately for James, in the period of the pandemic it has been more difficult for him to amplify his message, so I'm delighted to stand here with the other members in this chamber to amplify what is a very, very important issue. That the issue of diabetes.
The public can sometimes conflate the issues of diabetes into one. But effectively diabetes is three conditions in one. The first is type 1 diabetes; the second is type 2 diabetes; and the third is gestational diabetes. Type 1 diabetes is in my field of paediatrics. It occurs in young children. We don't know why type 1 diabetes occurs. Basically, something attacks the pancreas and the pancreas can no longer produce insulin. Type 1 diabetes is a very frightening condition. It has a sudden onset, where children will start to drink masses of water and urinate very, very frequently. We're talking about three or four litres of water in a day, and going to the loo in enormous amounts. They can become quite distressed and lose their sense about themselves. It becomes an emergency. They can become so sick that they are rushed to hospital.
So type 1 diabetes can be a terrible emergency, resulting in ketosis and quite significant risk to the child. In fact, one of my staff members has a child with type 1 diabetes, and we see every day in our office how she has to live with juggling being a professional woman and having a family at home including a child with type 1 diabetes. To normalise his life he has to take insulin every day. There are periods where he becomes sick and his insulin requirements change, and that has a great impact on her ability to juggle the work-life balance. Sue Leidler is a wonderful supporter of mine, and I would like to name and honour her because she is someone living the life of having a child with diabetes. It is a difficult life for her, but she does it lovingly and supportingly for her son so that he can have a life that is not the life of a child who has diabetes, but a child who has a wonderful, fulfilled life.
Type 2 diabetes is a completely different kettle of fish. It is later in onset, where over a long period of time people become resistant to insulin because they develop antibodies. We know that there are lifestyle factors that contribute to the rise of type 2 diabetes. It is rising in prevalence because of problems such as obesity, high-sugar diets and poor exercise. Managing diabetes type 2 is something that we can all do to change our lives. Lower your sugar intake and make sure that you try to keep healthy and fit. Keeping your weight down is a great way to manage type 2 diabetes, and if you develop type 2 diabetes losing weight is one of the first steps to managing that.
At the political level it has been incredibly important to have the Australian National Diabetes Strategy, which was released in 2015 and is due for an update. I would encourage our government to make sure we include in this refresh the prevention strategy. I know that is in the works. Because of course prevention is better than cure. As a paediatrician I know that, but the taxpayer also knows that. If we prevent diabetes, we don't have to deal with the economic and health burden that diabetes creates in our community. It is very, very important that instead of having the ambulance at the bottom of the cliff, where patients fall down and the medical system is at the bottom of the cliff, we put it at the top of the cliff and prevent people going off in the cliff in the first instance. So I really commend the fact that the government is refreshing its diabetes strategy and that that is going to help our Indigenous population as well.
I would like to thank the member for Grey for his motion. I would also like to thank the member for Moreton and the member from Higgins for their contributions, and also the other speakers on this motion. Like the member for Higgins, I have had a long career caring for children with type 1 diabetes and, unfortunately in this day and age, also children with type 2 diabetes. We don't know why this is occurring, but the incidence of type 2 diabetes is increasing, and the incidence of type 2 diabetes is increasing exponentially, particularly in children and adolescents. The reasons for this are not really 100 per cent clear. We know that lifestyle has a big part to play, but there are other contributing factors. When I started in paediatric practice 40 years ago it was very rare to see a child with type 2 diabetes, but now, unfortunately, it is very, very common. I think there are many contributing factors. We've spoken about lifestyle, but also some of the foods that we have available now, some of the processed foods, contain compounds that are artificial that were never available years ago. Very interestingly, I recently had the opportunity to view some family moving pictures that were taken in the 1950s and 1960s by my father. It was very obvious that there was no obesity then. Everyone was thin. We had access to a very good diet. We certainly could afford as much food as we wanted, but, in those pictures, everyone was thin. If you took the same picture of my family today, you would be shocked by the difference. The reasons for that are not completely clear. There are, as I said, contributing factors with processed food, our lack of exercise et cetera, but there are other things at play as well.
In adults, one of my particular concerns has been the very common prescription of antidepressants, all of which can cause increased appetite and obesity, and I think this is a major concern that has not been explored. We certainly need to be looking further at why we are seeing the increased incidence of type 2 diabetes but also as to why we are seeing the increasing incidence of type 1 diabetes. It was quite rare when I started in practice in Campbelltown in 1983 to see a young child with diabetes, but, increasingly, it is common to see a child presenting, as the member for Higgins has explained, in extremists with type 1 diabetic ketoacidosis, which can be a life-threatening condition. It's now increasingly common. We don't know why. It's very important that we do really have a national diabetes program for both type 1 and type 2 diabetes that looks at the causes—not just the treatments. And it's not just lifestyle; there are other factors at play that we do not understand, and it's vitally important for the Australian population that we do find out why, because, once we do that, we can look at how we can prevent it. It is a real national tragedy. Both type 1 and type 2 diabetes can lead to side effects, and we're seeing increasingly young children with obesity, insulin resistance and type 2 diabetes.
There are 1.3 million Australians, as has already been mentioned, who are registered with the National Diabetes Services Scheme, and more people are registering every day. The national diabetes service has been a great addition to our fight against diabetes. And the government has acted, but they've missed the mark. Their commitment falls well short of supporting all Australians with type 1 diabetes and many Australians with type 2 diabetes requiring significant doses of insulin. We should get the government to say they're going to have a comprehensive program that covers every person in Australia with type 1 diabetes. This will be not only lifesaving; it will be money-saving for our health system, because type 1 diabetes, particularly the complications of type 1 diabetes, put an incredible strain on our health service.
I would like to congratulate Dr James Muecke AM for his Order of Australia and the work that he does to prevent eye complications from diabetes, but this is very expensive. It's far better to prevent rather than treat. I would like to say that diabetes is an incredibly serious condition. It's a blight on Australian society. We need to do much, much more.
Firstly, can I congratulate the member for Grey and his cosponsor, the member for Moreton, for this motion, and the member for Higgins and Macarthur, who never ever fail to remind us that they are doctors and know much more than we do. But I want to dedicate this speech to my dad who was diagnosed with type 2 diabetes several years ago, so this motion does really speak to me.
For decades the national rate of diabetes has increased to levels that are putting a strain on the national health system. Not only do those suffering from diabetes have a reduced standard of living but it can drastically affect the lives of those around them. In Australia, there are 1.3 million Australians registered on the National Diabetes Services Scheme. That is more than one in every 25 people. Every day, over 280 people are diagnosed in Australia with diabetes, with nearly half-a-million Australians suffering from type 2 diabetes who have not been diagnosed. This is a growing crisis that needs to be addressed urgently. Within the next five years, it is estimated that a possible two million Australians with prediabetes may develop type 2 diabetes.
Australia is known around the world for its high standards of living and active lifestyle, but, with such high numbers of people in this country suffering from this, it's not the case for so many other Australians. It is not a political issue but a pragmatic one that demands a long-term solution. Diabetes is not a simple illness and is frequently the cause of many other health complications. It makes sufferers of diabetes vulnerable, less productive and more reliant on the public health system and those around them.
Australia is a caring country, a compassionate nation, which is why we can do better when it comes to assisting those with this illness. We cannot afford for entire generations to fall ill at a time when the technology and expertise exist to prevent many from developing this sickness and to support those with diabetes to live a healthy and productive life.
This government has always had vulnerable Australians at the forefront of reforms to ensure that they are given the help they need. That is why we are delivering on our long-term commitment to assist Australians suffering from diabetes with the Australian National Diabetes Strategy. This is a far-reaching program that engages children and young adults as well as health card holders and pregnant women with access to affordable help.
This program is being launched in conjunction with a number of complementary initiatives, including the Diabetes in Schools program, the KeepSight program as well as a number of prevent-diabetes-related-amputations initiatives. This is the holistic approach we are taking to combat one of the most significant and long-term health issues that this country has faced over the past decade. Raising public awareness on this issue remains critical to encourage healthy habits and lifestyles and to give Australians the tools to take control of their own health. Empowering individuals has always been the policy of this government because there is no substitute for the power of the individual. Rather than blanket policies which replace individual choice with the Canberra bureaucrat, we are building a nation that empowers Australians to help themselves. Nowhere is that more crucial than in regard to a person's health because no two people are alike.
The 2020 Australian of the Year, Dr James Muecke AM, has been critical in his work as an ophthalmologist pioneering preventive type 2 diabetes approaches in many poor and developing nations. James has been instrumental in encouraging healthier lifestyles and healthier environments. His work continues to affect the lives of many, and his message is relevant all over this country. Recognition of his work is rightly deserved.
We have a long way to go, but it is because of the work of our health workers throughout the country that we are making a difference. There are many in my electorate who rely on the selfless acts of kindness that those in our healthcare sector display day after day. It is frequently a thankless task but one that could not be more important, and we thank them.
I am very pleased to speak about an issue that I've learnt more and more about in the last 10 years or so, and I want to thank the co-convenors of Parliamentary Friends of Diabetes for bringing this motion to parliament. Diabetes is a complex disorder. We all know that if it isn't diagnosed early and treated effectively it can lead to very serious health complications, such as blindness, limb amputation, heart disease, stroke and kidney disease. As someone who spent a number of years working within the Department of Health and other agencies up in the Northern Territory, I've seen firsthand some of the consequences for Aboriginal communities in the Territory of a failure to treat these sorts of conditions. It certainly tells us there is a lot more we could be doing.
I think most of us here would agree that there's a need for a national diabetes program, working with the states, and always more research and more support. An estimated two million Australians with prediabetes are at risk of developing type 2 diabetes in the next five to 10 years. I know that, as the daughter of someone with diabetes, I certainly carry higher risk factors. I note the government's announcement this year about subsidising flash glucose monitoring on the National Diabetes Services Scheme. I do think it was a shame that it came a year after it was actually promised. There had to be a massive community campaign by Australians with type 1 diabetes and by the opposition, and it included the tabling in parliament of a petition with 214,000 signatures. The minister had promised, as of 1 March 2019, that continuous glucose monitoring would be expanded and that flash glucose monitoring would be included in that expansion. We shouldn't be asking these groups of people, who struggle day to day to do the things they need to do to have a normal life, to be such fierce advocates in order to get very sensible changes to the health system to improve their quality of life. Because of the delay, because of that broken promise, thousands of Australians were forced to continue for a year a painful regime of finger-prick testing.
Why these flash monitors make such a difference was recently explained in comments by the chief of the division of endocrinology, diabetes and nutrition at L'Hopital Bichat - Claude-Bernard, in Paris. He said:
Use of flash glucose monitoring—with a sensor rather than with strips—is associated with a drop of the incidence of a major, potentially lethal, acute complication of diabetes in insulin-treated people …
He also said:
The magnitude of the protection potentially afforded by the device is huge.
That's the sort of thing we need to hear from places that have been using this for a lot longer than we have.
I've had a lot to do with children in my electorate with juvenile diabetes, from Kids in the House day, when we here are inundated with children who have type 1 diabetes—to make sure that we understand the impact it has on their lives and how we can help them with additional funding for research—through to local events in my own electorate. Last year, I was very proud to lead off, in both the Blue Mountains and the Hawkesbury, the JDRF One Walk. JDRF says it's the biggest type 1 fundraising event in the world, with walks right round the globe bringing together around a million people. I joined JDRF advocate families at the start of the walks, and each of those walks in the different parts of my electorate raised thousands of dollars for research into juvenile diabetes.
What's inspiring about these events is the determination of the children and their families to overcome this chronic, life-threatening disease. They can explain to you really patiently about pinpricks for blood-glucose testing and the difference continual glucose monitoring makes—how it changes their lives. It's also inspiring to see the adults who were diagnosed as children, who go along to these events to be role models and mentors to their younger selves.
I'm very pleased to see the announcement that a large population study, funded by JDRF Australia, will take place in Australia. JDRF describe it as 'a huge step forward for research' and say it will be the first in Australia—and one of only three in the world—to screen people from the general population without a family history of type 1 diabetes.
Labor, of course, has a strong track record in supporting juvenile diabetes research. We funded the establishment of the JDRF Type 1 Diabetes Clinical Research Network in 2010. We had planned to provide additional funding if we won the last election, and that funding would have allowed the clinical research network to enter a new phase, increasing the volume and impact of the type 1 diabetes clinical trials. (Time expired)
I don't think anyone in this place underestimates the impact of diabetes, particularly type 1 diabetes. There are over 1.3 million Australians registered on the National Diabetes Services Scheme, 280 new people diagnosed each day and 500,000 Australians with type 2 diabetes who remain undiagnosed. We also acknowledge the very serious risks associated with the disease if (a) it isn't diagnosed correctly or (b) it's not managed, monitored and medicated correctly.
I want to make the observation that the co-chairs of the 'parliamentary enemies of diabetes' network—my good friend and colleague Rowan Ramsey, from South Australia, and Mr Perrett, from Queensland—are doing fantastic work in this place. The group is continuously raising—not only with the parliament and the executive but also with the broader community—the importance of our campaign against this disease. Obviously, we have many friendship groups in this parliament, but I think this is one of the few that takes the title 'enemy group'. That in itself speaks to this issue.
Why is it important? It's obviously important on an individual level because the impact of this disease on individual lifestyles can be pronounced, particularly, as I said, if it goes undiagnosed for any period of time or, equally, if it's not properly treated. There is also a macroeconomic concern. The cost to the federal and state health budgets for people who haven't been correctly diagnosed or haven't been correctly medicated or treated is, to be honest, phenomenal. In a previous life before coming to this place, I worked as a solicitor for insurers, in terms of complex litigation. There were often personal injury catastrophe claims. I'd often go to dinner parties and people would ask, 'Why did that person receive an award of damages that ran into the tens of millions of dollars?' People would often think that was a gratuitous payment on account of the pain and suffering—things that someone might have suffered. I'd have to slowly step dinner party guests through it. The payment that was so large was effectively a payment for future care—that is, the costs associated with the necessary future care for someone who, for example, had both of their legs amputated or had lost their sight. In the context of diabetes, if the disease isn't properly diagnosed or diagnosed early enough or, indeed, isn't treated correctly, then ultimately the Commonwealth, or at least the Crown, if I can call it that, becomes the insurer and is required to meets the costs associated with that future care.
So, on the one hand, it's very important that we raise awareness and we continue to fund various programs, including the National Diabetes Strategy and, obviously, the review that is being undertaken. It's very important we do that work on a personal level because of the impact that this disease can have on individual livelihoods and the quality of someone's life when they are suffering from the disease. It is equally important, in terms of the public good, that we ensure these people receive proper diagnosis and treatment so their livelihood can be improved, and that we also ameliorate the future care costs if there's a failure.
In the time I have left, I concur with the comments made in this place about the FreeStyle Libre continuous monitoring device. It is an amazing invention. I have a constituent named Tyson Smith of Rendelsham. He is six foot tall, built like the proverbial and you would think nothing would stop the bloke, but, I can tell you, he got to the point where the continual monitoring of his glucose was a drain on him and his life. He's a typical knockabout farmer. How this device has changed his life and lifestyle is remarkable. On his behalf, I continue to advocate in this place and with the minister for an expansion of this program to other Australians.
A division having been called in the House of Representatives—
Sitting suspended from 12 : 18 to 12 : 30