Position statements
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Diabetes Victoria’s position statements provide clear, evidence-based perspectives on key issues. These issues relate to diabetes care and management. These statements outline the organisation’s stance on various topics. They aim to inform the public, healthcare professionals, and policymakers. They are designed to ensure that people living with diabetes needs are prioritised in healthcare decisions.
Position statements
October 2021 - Diabetes Australia on ‘Our Language Matters’
Improving communication with and about people with diabetes
Let’s change the conversation Diabetes Australia started changing the conversation in 2011 when we published a world first position statement calling for “a new language for diabetes”. Since then, the International Diabetes Federation and diabetes organisations in the USA, UK, Italy, France, India, and Canada have published similar statements. In many countries around the world, people are engaging with the #LanguageMatters movement.
There has been some positive change to the words and language used about diabetes over the past decade – but we can all do better. The aim of this updated Position Statement is to increase our support for all people affected by diabetes. This document is a summary of the new statement. Full version can be found at diabetesaustralia.com.au.
October 2021 - Diabetes Australia on ‘Type 2 diabetes remission’
About this position statement
The aim of this position statement is to provide up-to-date, practical advice and information to people with diabetes and the community about possible remission of type 2 diabetes. It is not intended to be a scientific or fully detailed report for health professionals.
Introduction Type 2 diabetes is a condition in which the body becomes resistant to the effects of insulin and the pancreas loses the ability to produce enough insulin. Insulin helps turn glucose into energy for the body and this is essential to maintain health. The inability to process glucose is called glucose intolerance.
One measure for the diagnosis of type 2 diabetes is an HbA1c of 6.5% (48mmol/mol) or greater. HbA1c is a measure of average blood glucose levels over the past three months.
Glucose intolerance starts before type 2 diabetes develops. An estimated 2 million Australians have glucose intolerance, often called ‘prediabetes’. People with prediabetes are at high risk of developing type 2 diabetes.1
The development of type 2 diabetes (and prediabetes) is influenced by a mix of factors including genetics, age, lifestyle factors including food intake and physical activity, weight, use of some medicines, and other medical conditions. These are called risk factors. Some risk factors are modifiable, and some are not.
There is strong evidence that the risk of developing type 2 diabetes can be reduced by up to 58% in people who have prediabetes. This can be achieved through changes to diet and activity levels that result in sustained weight reduction.2, 3
Diabetes Australia recommends that all adults with prediabetes should have access to health behaviour change programs to support them to prevent type 2 diabetes from developing.
When a person is diagnosed with type 2 diabetes, the first line of treatment should always be healthy behaviour change modifications. Healthy eating (with attention to portion size and kilojoule intake) and regular physical activity are recommended for all people with diabetes. For many people, losing some weight can have a positive impact on glucose levels and other factors such as blood pressure. Even small amounts of weight loss can help.
Historically, type 2 diabetes has been understood as a progressive condition. However, several recent studies have challenged that view. We now understand that, in some cases, progression can be stopped or slowed. Progression generally follows the path of:
- ‘normal’ glucose tolerance to
- ‘prediabetes’ with glucose intolerance but not sufficient to be diagnosed as type 2 diabetes to
- type 2 diabetes.
New research has shown it is possible for some people with type 2 diabetes to reduce their average glucose level to achieve an HbA1c of under 6.5% (48mmol/mol) and sustain them at that level for a prolonged period of time (at least three months) – without the need for glucose lowering medication. This is referred to as type 2 diabetes ‘remission’. 4
August 2018 - Diabetes Australia on low carbohydrate eating for people with diabetes
Position Statement
Low carbohydrate eating for people with diabetes
August 2018
ABOUT THIS POSITION STATEMENT
This position statement draws on the latest evidence and provides practical advice and information for people with diabetes considering a low carbohydrate eating plan.
Diabetes Australia has developed this statement in response to enquiries from people with diabetes, health professionals and the general public.
What is low carb eating?
Low carbohydrate (low carb) eating refers to diets or eating patterns that restrict carbohydrate intake, principally in processed and packaged foods and drinks such as cakes, lollies, chocolate, chips, ice cream and sugary drinks; as well as breads, cereals, grains, potatoes, fruits and sugar. Usually, when restricting carbohydrates, people eat a higher proportion of protein and fats such as those found in meat, chicken, eggs, oily sh, avocados, nuts, oils and butter. Some people choose to bulk up meals with low carb vegetables, such as cauli ower and zucchini.
When it comes to low carb eating, there is no particular diet or standard approach.
The Australian Dietary Guidelines provide general healthy eating advice and are a good starting point for people wanting to improve their eating habits. However, there is no one-size- ts-all approach to living well with diabetes. Everybody is di erent.
In recent years, low carb eating has gained popularity within the general population. Some people have found it useful for achieving weight loss.
Low carb diets are popular because they are relatively easy to follow and heavily promoted in the media. Low carb eating has also gained interest for some people with diabetes as one option to help lose weight and to assist in managing their blood glucose levels.
Key points 1. For people with type 2 diabetes, there is reliable evidence that lower carb eating can be safe and useful in lowering average blood glucose levels in the short term (up to 6 months). It can also help reduce body weight and help manage heart disease risk factors such as raised cholesterol and raised blood pressure.
2. For people with type 1 diabetes, a number of recent studies are reporting bene ts of lower carb eating, however these studies are limited in their size and design and do not provide strong evidence of bene t. Diabetes Australia believes high quality, large scale, longerterm studies are necessary to further establish the e ectiveness and safety of low carb eating for people with type 1 diabetes.
3. All people with any type of diabetes who wish to follow a low carb diet should do so in consultation with their diabetes healthcare team.
4. People with diabetes who commence low carb eating should monitor their blood glucose levels and, if necessary, talk to their doctor about the need to adjust their diabetes medication to reduce the risk of hypoglycaemia (low blood glucose).
5. People with diabetes considering low carb eating are encouraged to seek personalised advice from an Accredited Practising Dietitian experienced in diabetes management. There are some practical considerations that need to be taken into account to ensure the eating plan is safe and enjoyable, provides adequate nutrition for general health, is culturally appropriate and ts into the person’s lifestyle.
6. People with diabetes considering low carb eating should be aware of possible side e ects (such as tiredness, headaches and nausea) and seek advice from their health care team if concerned.
7. Low carb eating may not be safe and is not recommended for children, pregnant or breastfeeding women, people at risk of malnutrition, people with kidney or liver failure, or those with a history of disordered eating or some rare metabolic conditions.
8. People with type 1 diabetes may experience sudden drops in blood glucose levels and be at a higher risk of hypoglycaemia when following a low carb eating plan. They should talk with their diabetes healthcare team before starting low carb eating.
9. All Australians, including people who choose to follow a low carb eating plan, should be encouraged to eat foods proven to be bene cial to good health. These include whole fruit and vegetables, wholegrains, dairy foods, nuts, legumes, seafood, fresh meat and eggs.
10. All Australians should be encouraged to limit their intake of foods that are high in energy, carbohydrate or salt, including processed foods such as sugary drinks, chips, cakes, biscuits, pastries and lollies.
August 2017 - Diabetes Australia on glucose self-monitoring in adults with type 1 diabetes or type 2 diabetes
Position Statement
Glucose self-monitoring in adults with type 1 diabetes or type 2 diabetes.
Key Points
Health Policy Context
1. Managing glucose levels is very important for preventing or delaying the complications of both type 1 diabetes and type 2 diabetes.
2. Glucose self-monitoring is a rapidly changing and confusing area, with new technologies becoming available, many devices to choose from, and changes to government subsidies.
3. Making new glucose self-monitoring technologies affordable and accessible is critical to improving the health and quality of life for the 1.2 million Australian adults currently living with type 1 diabetes and type 2 diabetes.
4. Government should subsidise the cost of glucose self-monitoring technologies where there is evidence it can improve outcomes and quality of life.
5. Age should not be the deciding factor in Government subsidies. Too often subsidies are limited to those aged under 21 despite the evidence of health benefit being equally strong for adults.
6. Government should regularly review its policies concerning subsidised access to glucose self-monitoring technologies and supplies to incorporate the latest evidence and to allow greater affordability and accessibility.
Adults with Diabetes and Healthcare Professionals
7. People with diabetes should have access to an informed and supportive health care team who understand the use and benefits of glucose self-monitoring to inform adjustments to the person’s
diabetes self-care (including food/drink, physical activity, and medications).
8. People with diabetes should be supported by their health care team and the National Diabetes Services Scheme (NDSS) to develop their knowledge and skills in glucose self-monitoring. Initial training should be undertaken soon after diabetes is diagnosed. Skills, devices, and use of monitoring should be reviewed by the health care team at least once every year to ensure the person is continuing to benefit from glucose self-monitoring.
9. People with diabetes should feel comfortable that any change to their glucose self-monitoring – whether it is changing from one type of glucose monitoring to another, if subsidised access is discontinued, or if glucose self-monitoring is stopped altogether – has been managed appropriately, with discussion, shared decision making, and support from their health care team.
April 2017 - Diabetes Australia on sugary drinks
Health levy on sugar-sweetened beverages
Summary of Diabetes Australia’s Position
Diabetes Australia recommends that the Australian Government introduce a health levy on sugar-sweetened beverages, as part of a comprehensive approach to decreasing rates of overweight and obesity, and reducing the impact of type 2 diabetes. Revenue generated should support public education campaigns and initiatives to prevent chronic conditions (including type 2 diabetes) and address childhood obesity. A health levy on sugar-sweetened beverages should not be viewed as the single solution to the obesity and/or type 2 diabetes epidemic in Australia. Rather, it should be one component of a comprehensive approach, including restrictions on children’s exposure to marketing of these products, restrictions on their sale in schools, other children’s settings and public institutions, effective public education campaigns, and diabetes prevention programs.
Key messages continued in article
September 2016 - Diabetes Australia’s updated language position statement
Summary
Diabetes is the fastest growing chronic condition in Australia, affecting 1.7 million Australians. It is a progressive condition, which can reduce both quantity and quality of life, and requires daily self-care. On average, people with diabetes have higher levels of emotional distress than those without diabetes. Distress can continue throughout life with diabetes.
The way language is used – both verbal and written – reflects and shapes our thoughts, beliefs and behaviours. Language has the power to persuade, change or reinforce beliefs, discourse and stereotypes – for better or for worse. Words do more than reflect people’s reality: they create reality.
Language needs to engage people with diabetes and support their daily self-care efforts. Importantly, language that de-motivates or induces fear, guilt or distress needs to be avoided and countered.
Diabetes Australia believes optimal communication increases the motivation, health and well-being of people with diabetes; furthermore, that careless or negative language can be de-motivating, is often inaccurate, and can be harmful.
The aim of this position statement is to encourage greater awareness of the language surrounding diabetes, and identify potential improvements.
“Words are, of course, the most powerful drug used by mankind”
–Rudyard Kipling
Continue reading the full position statement
Click here to download this document as a PDF
August 2015 - Diabetes Victoria’s on workplace testing
t has come to our attention that some workplaces are performing blood tests on their staff members to check for diabetes.
It is positive that companies are interested in their employee’s health and well- being however Diabetes Victoria does not support workplaces performing blood tests for diabetes screening.
Diabetes Victoria recommends the AUSDRISK Tool screening tool which is a completely safe, low risk and an acceptable way to assess diabetes risk. http://www.health.gov.au/internet/main/publishing.nsf/Content/chronic-diab- prev-aus/$File/austool5.pdf. A person who scores 12 or more should see their GP to organise a blood test to check if he/she has diabetes.
In 2014 The American Diabetes Association (ADA) issued a statement explaining why community screening for diabetes is not recommended “
“Testing should be carried out within the health care setting because of the need for follow-up and discussion of abnormal results. Community screening outside a health care setting is not recommended because people with positive tests may not seek, or have access to, appropriate follow-up testing and care. Conversely, there may be failure to ensure appropriate repeat testing for individuals who test negative. Community screening may also be poorly targeted; i.e., it may fail to reach the groups most at risk and inappropriately test those at low risk or even those already diagnosed.” http://care.diabetesjournals.org/content/37/Supplement 1/S14.full.pdf+html
Diabetes Victoria is also concerned that when blood testing is performed in the work place by unqualified staff there is a risk of needle-stick injury and the issue of appropriate disposal of sharps and blood stained materials.
Diabetes Victoria
570 Elizabeth Street Melbourne 3000 Victoria Australia
Email mail@diabetesvic.org.au
Website diabetesvic.org.au
Fax 9667 1778
Helpline 1300 136 588
Facebook DiabetesAustraliaVic
Twitter @DiabetesVic
Patron – The Governor of Victoria: The Honourable Linda Dessau AM
September 2013 - Austroads Assessing Fitness to Drive guidelines
In March 2012, Austroads and the National Transport Commission released their updated Assessing Fitness to Drive: Medical standards for licensing and clinical management guidelines.
The inclusion of a new Medical Standard for Licensing which requires people with diabetes to have an HbA1c level of less than 9.0% to be assessed as having ‘satisfactory control of diabetes’ (Section 3.3.2) has created concern, confusion and distress amongst people with diabetes, and in the diabetes community.
Following advocacy action by Diabetes Australia, the Transport and Infrastructure Senior Officials’ Committee (TISOC) approved changes to Assessing Fitness to Drive, March 2012 at a meeting in March 2013. The changes clarify the section that provides guidance on what the satisfactory control of diabetes means for driver licensing purposes.
However, Diabetes Australia believes that the clarifying statement does not go far enough. The new medical standards may lead to unfair and adverse outcomes for many people with diabetes. Diabetes Australia has raised these concerns with Austroads on numerous occasions and requested further amendment.
The remaining issues are:
- The definition of satisfactory control of diabetes as being an HbA1c of 9.0% or lower threatens to confuse the much more important issue of low blood glucose levels. Strong evidence shows that low blood glucose levels (hypoglycaemia), an unexpected hypoglycaemic episode and/or impaired hypoglycaemic awareness represent a much more serious risk to road safety.
- The intention of the medical standards was to trigger a further medical review of diabetes management in people with HbA1c greater than 9.0%. Instead, some people have simply (administratively) been denied eligibility for a license.
- The evidence base for including the HbA1c upper level of 9.0% is not strong. Many experts and other national jurisdictions do not accept that there is an association between high average blood glucose levels and driving risk.
Further information about these changes can be accessed on the Austroads website
www.austroads.com.au/assessing-fitness-to-drive/.
The updated version of Assessing Fitness to Drive for commercial and private vehicle drivers is now available for download from the Austroads website
www.austroads.com.au/images/stories/assessing_fitness_to_drive_2013.pdf
diabetesaustralia.com.au
Level 1, 101 Northbourne Avenue, TURNER ACT 2612, Australia
GPO Box 3156, CANBERRA ACT 2601, Australia
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Patron – Her Excellency Ms Quentin Bryce AC Governor-General of the Commonwealth of Australia – turning diabetes around
awareness • prevention • detection • management • cure
December 2011 - Media Release and Case Studies
Managing Diabetes Through Weight Loss Surgery
Diabetes Australia has identified a need to present advice on the use of weight loss surgery, or bariatric surgery, as a method of managing diabetes. The position statement was developed by a group of multidisciplinary experts as a result of increased popularity and success of the procedures and the continual rise in Australians living with diabetes. Bariatric surgery refers to the variety of surgical weight loss procedures available including reducing the size of the stomach to restrict the amount of food that a person can consume.
Diabetes Australia Chief Executive Officer Lewis Kaplan explains the purpose of the document. “This position statement is for people living with diabetes. It complements other statements which have been prepared for medical professionals” he said. Advice from Diabetes Australia highlights that weight loss through healthy diet, exercise and lifestyle change is an effective, safe and economical means to help prevent type 2 diabetes and improve control in established diabetes. However there are instances where lifestyle interventions and medical treatments are not successful and bariatric surgery may be considered.
Diabetes Australia advises that bariatric surgery is a viable weight loss treatment option for people with type 2 diabetes with a Body Mass Index (BMI) over 35, where lifestyle interventions and medical treatments for obesity or diabetes have not been successful. People who do not already have diabetes but are risk of developing the condition should only consider surgery if they are very obese (BMI over 40 or over 35 with an obesity-related medical condition).
“While bariatric surgery should always be considered as a last resort, more people have reached that position than ever before, so surgery is increasingly being viewed as a viable option – although not without dangers. A key issue is access for those most in need of the surgery, as public funding is much lower than demand” said Kaplan.
The risks, benefits, appropriateness of surgery and type of procedure must be assessed for each individual. Considerations include a person’s weight, medical history, social environment, lifestyle, expectations and readiness to change their eating and exercise habits. The success of bariatric surgery varies and carries some risk of complications. Access to an experienced, multidisciplinary care team and ongoing follow-up is vital for success and to minimise complications.
Sean Kelly is a person living with type 2 diabetes who has experienced positive lifestyle changes since bariatric surgery, after living at an unhealthy weight for most of his life. “I lived to eat from the moment I woke up in the morning until I went to sleep at night. Now I have virtually no interest in food at all. This is admittedly a loss, but it has saved my life” Kelly said. Kelly has lost 55kg since surgery, has said goodbye to insulin injections and his blood pressure is normal.
An estimated 1.7 million Australians have diabetes with an additional 275 Australians developing the condition every day. There are also an estimated 2 million Australians at risk of developing type 2 diabetes with 25% of Australians considered obese.
Diabetes Australia is the peak consumer body representing people affected by diabetes and those at risk.
December 2011 - Weight Loss Surgery and its Use in Treating Obesity or Treating and Preventing Diabetes
People with diabetes
- Losing excess weight will assist in the management of diabetes. Healthy eating and physical activity should be the initial approach to weight loss and is a priority in the ongoing management of diabetes.
- Bariatric surgery is a treatment option for people with type 2 diabetes with a Body Mass Index (BMI) over 35, where lifestyle interventions and medical treatments for obesity or diabetes have not been successful.
- Most people with type 2 diabetes experience improved blood glucose levels after bariatric surgery, which for some will return to normal without the need for medication. Medication may be reduced or ceased. Blood glucose should continue to be monitored.
- The success of bariatric surgery varies. All surgery carries some risk of complications. Access to an experienced, multidisciplinary care team and ongoing follow-up is vital for success and to minimise complications.
People at high risk of developing type 2 diabetes
An estimated 2 million Australians are currently at high risk of developing type 2 diabetes. People can assess their risk by using the national AUSDRISK test or with a blood glucose test.
Lifestyle interventions that achieve sustained weight loss can prevent or delay the onset of type 2 diabetes and should be the initial approach for all people at high risk.
Bariatric surgery should only be considered for adults who are very obese (BMI over 40 or over 35 with an obesity-related medical condition) and who have been unable to successfully maintain weight loss with lifestyle interventions and medical treatments.
Overweight and obesity
- Sixty-one percent of Australian adults are overweight or obese, including 25 per cent (one in four) who are obese (BMI over 30). Obesity is the major, modifiable risk factor for type 2 diabetes.
- Comprehensive population approaches are required to prevent overweight and obesity in children and adults, including public policy, regulation, marketing, and community based programs to promote a healthy lifestyle.
- Safe and effective options for treating obesity should be available for individuals.
- Funding to prevent and treat overweight and obesity should include population approaches, as well as individual lifestyle, medical and surgical interventions.
Introduction
Approximately twenty five per cent (25%) of Australian adults are obese. Based on current population trends, this will continue to increase in the future. Bariatric surgery is increasingly recommended as a treatment for obesity and for people with obesity-related medical conditions. This position statement is for people with type 2 diabetes and those at risk of developing diabetes to help them make decisions about bariatric surgery.
Obesity is a complex, chronic medical problem. There is a genetic basis to obesity, however, reduced physical activity and changes to the way food is prepared and consumed are largely responsible for the increase in body weight that has occurred in adults and children over the past 20 years.
In adults, weight is classified by body mass index (BMI), a measure based on weight in kilograms divided by height in metres squared (kg/m2). A BMI of 18.5 to 25 kg/m2 indicates a healthy weight for height. An adult with a BMI over 25 is classified as overweight and with a BMI over 30 is classified as obese.
Obesity is linked to a number of serious health conditions, including type 2 diabetes, cardiovascular disease, sleep apnoea and certain cancers. People who are obese are four times more likely to develop type 2 diabetes than those who are in the healthy weight range. Diabetes is associated with serious complications and reduced life expectancy. The personal and economic costs of diabetes and obesity are substantial, taking into account health and wellbeing, medical expenses and indirect costs from disability, reduced work and life expectancy. Prevention and management of obesity, type 2 diabetes and diabetesrelated complications is an important goal to improve individual and population health.
Weight loss reduces the risk of developing type 2 diabetes, improves cholesterol, blood glucose, and blood pressure. Weight loss by lifestyle change (dietary change and increased physical activity) is an effective, safe and economical means to prevent type 2 diabetes and improve control in established diabetes. In those who are very obese, weight loss is not easily achieved or maintained by dietary changes and exercise alone and bariatric surgery has been shown to be a more successful intervention for long term weight loss.
What is bariatric surgery?
Bariatric surgery includes a variety of surgical procedures to reduce weight and maintain weight loss. These procedures may result in weight loss by either:
- reducing the size of the stomach to restrict the amount of food that can be eaten;
- delaying digestion and absorption of food in the intestines;
- causing a feeling of fullness and satisfaction due to either stimulation of nerves in the stomach or changes in hormones that control hunger.
August 2008 - Diabetes Victoria on community based blood glucose screening
Diabetes Australia – Vic (DA–Vic) does not undertake nor advocate community-based random blood glucose testing such as finger prick tests as a screening method for diabetes. DA–Vic strongly recommends that these activities not be undertaken in the community as part of diabetes awareness programs.
RATIONALE
This position is supported by the Australian Diabetes Educators Association 1 and the American Diabetes Association 2, and is consistent with the National Health & Medical Research Council Guidelines 3
The position has been adopted by DA–Vic on the basis of the following:
- Community-based blood glucose screening is not diagnostic. Blood glucose readings obtained through random capillary sampling may be misinterpreted, and there is no opportunity for appropriate follow-up. Diagnosis can only be made on the basis of a plasma glucose test at a pathology laboratory or using point of care testing with an approved analyser with appropriate
quality assurance. A fasting sample is preferred. - Use of blood glucose meters for screening or diagnosis is not appropriate
- Outcomes of random community-based tests are influenced by a range of variables, such as operator skill, equipment used, type of food previously consumed, etc
- There is a risk of needle stick injury and transmission of blood-borne viruses
- Community blood glucose testing/screening is not cost-effective
- Blood glucose testing does not promote risk reduction
- It is inappropriate to test for diabetes, and for people to be informed of the outcome or its potential implications, in a public place.