• 21 Sep 2020
  • 16 min 41
  • 21 Sep 2020
  • 16 min 41

In this episode Steve Morris talks to Greg Johnson, CEO of Diabetes Australia, about the biggest challenges facing people with diabetes during the COVID-19 pandemic, why diabetes is a ‘pandemic within a pandemic’, feedback from consumers about telehealth, and the importance of addressing mental health.


Further reading

Diabetes Australia: www.diabetesaustralia.com.au

National Diabetes Services Scheme (NDSS): www.ndss.com.au

RACGP - Management of type 2 diabetes: A handbook for general practice: www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/diabetes/introduction

Heads up on diabetes – National Diabetes Week 2020: headsupdiabetes.com.au

Transcript

Voiceover:

Welcome to the NPS MedicineWise podcast, helping health professionals stay up-to-date with the latest news and evidence about medicines and medical tests.

Steve Morris:

Hi, I'm Steve Morris, CEO of NPS MedicineWise, and welcome to another podcast. Today I'd really like to welcome Professor Greg Johnson, CEO of Diabetes Australia. Welcome Greg.

Greg Johnson:

Hello, Steve. It's great to be here.

Steve Morris:

Yeah, thank you. Obviously, diabetes is such a significant condition in Australia. So we’d really like to ask you some key questions about the impact COVID-19 has had on individuals. So look, as has been said, many times, this has been a year like no other in terms of COVID-19 and its impact. It’s affected us all in different ways. But from your perspective, what have been some of the biggest challenges facing people with diabetes during this time?

Greg Johnson:

Well, there'd been many. In a key sense, COVID-19 has sort of added a whole other layer of concern and worry for people with diabetes.

And so in National Diabetes Week back in July, we launched a new national campaign addressing this called Heads Up on Diabetes. And we conducted a national survey of people with diabetes, and we found very high levels of anxiety and worry and concern in people with diabetes.

And there's probably three elements to it. The first was a lot of fear and worry that people were diabetes were at greater risk of catching the COVID virus, which isn't the case. There isn't evidence that people with diabetes are at greater risk of getting infected, if you like. However, there is a lot of evidence that people with diabetes are at much greater risk of a serious COVID illness. And the data in Australia shows that very clearly, and the data all around the world, that if people with diabetes do get this virus, then they are at greater risk of hospitalisation, much higher risk of needing intensive care and unfortunately a much higher risk of death.

So, that is a concern and caused worry. And of course there's been disruption, major disruption to people with diabetes and their access to care and services in all areas, which has caused a lot of concern and anxiety for people with diabetes.

So we're really concerned about the mental health and welfare of people with diabetes. And been really focusing on that and supporting people with diabetes and health professionals all over Australia to try and maintain access to regular diabetes services, maintain the diagnostic processes, the care processes, the support processes as best we can.

Steve Morris:

Yeah. It just may be worthwhile to reminder listeners, Greg, about the current prevalence and incidence of diabetes in terms of the size of the impact.

Greg Johnson:

The word pandemic's used a lot with COVID-19 and it's a pandemic, but unfortunately diabetes is a pandemic and an ongoing one all around the world. In Australia, over the last 12 months, we've seen over 100,000 people diagnosed with diabetes just in the past 12 months in Australia. There's now over 1.35 million people diagnosed and registered with the National Diabetes Services Scheme, which is an Australian government scheme that Diabetes Australia administers and maintains. And that's not everyone because we know there's people who aren't registered with that scheme. There's people out there with undiagnosed type two diabetes and problems.

So right now it's a very large number of Australians who live with diabetes every day. And it's really important that we don't oversimplify and dumb down this problem. So those numbers, I said over 1.35 million includes all type one diabetes, type two diabetes, gestational diabetes in women during pregnancy, which is the fastest growing type of diabetes. And indeed there's nearly 10,000 people with other types of diabetes that aren't type one diabetes or type two diabetes or gestational.

And we're talking about age ranges from diabetes affecting young kids, right through to many, many older Australians, hundreds of thousands of older Australians with diabetes. We've seen trends with younger and younger people getting type two diabetes. So, alarming growth rates of type two diabetes in young adults, very high numbers of women getting gestational diabetes.

So this pandemic continues to grow and develop in Australia and affect more and more people. The daily run rate, if you like, is about over 280 people every day in Australia, developing diabetes.

Steve Morris:

Thanks for that, Greg. That really illustrates the size of the problem. As you say, a pandemic within a pandemic.

You've touched a little bit about, obviously, the work you've done to identify consumer concerns. But from a healthcare professional perspective, what do you think have been some of the challenges in helping healthcare professionals manage diabetes during this time?

Greg Johnson:

Well, it's been a lot of challenges. I'll probably break it down into some categories. So firstly, there's been a lot of work that we've done working with the health professionals and services around simply maintaining the diagnostic process, if you like. So to step you through that, I mean, there was a lot of concern early on in the pandemic that the reduced access to hospital based services. And we should recognise that a lot of hospital based diabetes services have been shut down or repurposed or are much less accessible during the COVID pandemic. So there was a lot of concern that there'd be increased rates of diabetic ketoacidosis appearing. And that is delayed diagnosis of type one diabetes. There was a lot of concern about the disruption to the diagnosis of gestational diabetes in obstetric areas and maternity hospitals across Australia. And, indeed, a lot of concern about the generalised reduced access to primary care.

Now, the data what does it show? We've seen over the course of COVID about a 40% reduction in access to primary care services and to pathology by people with diabetes. So that's a big concern and that primary care access would primarily affect people with type two diabetes who are not seeing their GP, not having regular blood tests for diabetes, their HBA1C checks and other blood checks required to monitor their diabetes. And that could have a really serious impact in the longer term on their diabetes management and potentially higher risk of diabetes complications playing out in the future.

So that's been a big concern. We've worked closely with many organisations. So with the RACGP - the College of GPs, with the Pharmacy Guild in particular, with many primary care organisations. So Optometry Australia and optometrists in regard to eye care and eye checks for people with diabetes, with podiatry and the foot services for regard to foot checks and foot health for people with diabetes. So working lots in lots of spaces to help try to keep people with diabetes connected to the health professionals that they need to see, to make sure that people with diabetes are still accessing the care and the checks that they need to maintain good health.

Steve Morris:

Just to touch on that further, Greg, what about the impact of telehealth during this period in terms of still helping people with diabetes to manage their condition?

Greg Johnson:

Well, it's been great. I mean, I think it's been transformative. And our observation is it's been a wonderful thing that we've seen such rapid and expanded access to telehealth and that has helped a lot. And so that's a good thing. I mean, one of the big questions is will that be maintained now and what does that mean for the future? But certainly there's a big place, ongoing place for expanded access to telehealth. It just makes it easier for people with diabetes.

We've got to remember that diabetes is an enormous burden, an enormous challenge on each individual who has diabetes. This is not a simple condition. When you think about it, people with diabetes have hundreds of decisions they have to make every day about their diabetes just to maintain their health. They have so many aspects of their health that they have to be concerned about, their eyes and blindness, their kidney function and kidney failure, their foot problems with foot ulcers and risks of amputations, their cardiovascular health, and other aspects of their health. And then the day-to-day monitoring of their diabetes.

And if you think about the therapeutics of diabetes there's nearly 440,000 people now in Australia using insulin every day to manage their diabetes, massive numbers of people on insulin and on multiple medications. So it’s a big challenge, diabetes. And so we need to make it easier for people to access services regularly, and in a low cost way. And digital health, telehealth is a great way to do that.

Steve Morris:

Yeah. Have you had any direct feedback from consumers, Greg, around their experience of using telehealth?

Greg Johnson:

Oh, lots. Lots. We've had enormous contact with people with diabetes through the COVID pandemic. A lot of social media and other channels that we use to get feedback from people with diabetes on a day-to-day basis.

Earlier in the COVID pandemic, there was a lot of panic. And so we saw some panic buying of medicines and diabetes management products. And there was some local shortages early on. Fortunately that's settled down and we haven't seen ongoing problems with supply of medicines or supply of diabetes management products. But we have seen local shortages we've been able to manage and support people through those things.

We have had a lot of feedback from people with diabetes that the telehealth arrangements have been really useful to them. And particularly that the messaging and the information supplied to people with diabetes has been really important to try to get accurate and reliable information to people so they don't worry unnecessarily. They don't panic and they are able to be a bit more confident in such an uncertain world and an uncertain environment to manage their diabetes.

Steve Morris:

Yeah. Greg, that confidence is critical, isn't it, particularly during this period? And just reflecting on, say, healthcare professionals that've been listening to this podcast. Can you tell us about what Diabetes Australia has been doing and what resources you might have available for health professionals in supporting their patients in the current environment?

Greg Johnson:

Yeah. Well, it's many things. So I mean, we did a lot of quick work with the college of GPS. So really basic things like seeing sick day management plans. And what that means is, as we all know, people with diabetes or who are at greater risk of diabetes management is more difficult if they get an intercurrent illness like the flu or some other infection, in this case COVID, adds to that. So just that planning and preparedness of what to do when a person with diabetes does get sick and not to panic and how to manage their diabetes is really important.

So we did a lot of work of getting those simple resources out to GPs and primary care settings. We've done a lot of work with the Australian Diabetes Educators Association and the Australian Diabetes Society with all of the specialists, endocrinologists, diabetes educators in making sure that people with diabetes are continuing to access that sort of diabetes, health specialist, health professional support.

As I said before, eye care. We run a new digital system of recalls and reminders for people with diabetes to get their eyes checked for diabetes eye problems, and that's called KeepSight. And we saw a major disruption to that during COVID where with optometry not being available and people not accessing optometry and eyecare.

So we've worked very hard to encourage people to maintain their access and get their eyes checked because we can't afford to have people missing out on important eye checks and missing the opportunity for early diagnosis of problems there.

And of course the pathology one that I mentioned before. So we've produced a lot of basic resources for health professionals and people with diabetes to encourage them to stay connected to all of those regular healthcare services.

Steve Morris:

Yeah. Thanks for that, Greg. And where can people easily find these resources?

Greg Johnson:

Well, a good place to start is the Diabetes Australia website. And the National Diabetes Services Scheme website, where there's lots of basic resources and information, including things like some sick day planning for people with diabetes. We've specifically developed a lot of resources for aged care, older people with diabetes. That's a particular concern in the COVID environment is the large numbers of older people with diabetes, many of them in aged care facilities. And so that's a particular concern and we've been targeting those resources to the aged care sector. And partnering with lots of organisations.

So there's resources available through pharmacy and the Pharmacy Guild, through the College of GPs. We recently launched with the College of GPs updated handbook for type two diabetes management and a simplified resource there for GPs and primary care practitioners.

So there's lots of information and lots of resources there. But I suppose one of the key things that I'd remind all health professionals is think about the mental health challenges of diabetes, as well as the physical health challenges of diabetes. And whenever you're seeing someone with diabetes or interacting with them ask them about how they're coping and how they're doing with their emotional health and well-being, as well as their physical health. Because these two things go together and there are very high levels of emotional burden of distress and anxiety related to diabetes ongoing, and particularly in the COVID environment.

Steve Morris:

That's really important, Greg. So I think it's a really important reminder to our listeners around the impacts on mental health for people with chronic conditions, including those with diabetes.

So, look, thank you for your time today, Greg.

Greg Johnson:

It's a pleasure. It's a pleasure. And I really encourage all health professionals who are listening to this podcast to talk to people with diabetes about how they're going with their diabetes and their self-management and support them. It's a very challenging condition.

Steve Morris:

Yeah. Okay. Thank you, Greg. And thanks for listening.

Voiceover:

For more information about the safe and wise use of medicines visit the NPS MedicineWise website at nps.org.au.