Prof Speight speaks about mental health at Parliament House, Canberra

The National Diabetes Policy Forum discussed implementation of the Australian National Diabetes Strategy: how are we doing and how do we know?

by Prof Jane Speight

It is almost 25 years since the first international guidelines were published about the emotional burden of diabetes and the role of health professionals in monitoring and reducing that burden. But the mental health of people with diabetes is far from being considered an ‘old issue’. Instead, at the National Diabetes Policy Forum held at Parliament House, Canberra on 15 October 2018, mental health was included on the agenda as an ‘emerging issue’.

The aim of the National Diabetes Policy Forum was clear: an opportunity to hold Government and ourselves (the diabetes community) accountable for the implementation of the Australian National Diabetes Strategy: 2016-2020 (ANDS) – that is, to ensure improved care and outcomes for those affected by, or at risk of, diabetes. There have been many successes for people with diabetes in recent years: e.g. continuous glucose monitoring, diabetes in schools program, national retinopathy screening program. However, as you can imagine, there were many issues on the agenda that are equally deserving of attention and investment. You can read more about the Forum in this article in The Limbic, which includes Prof Paul Zimmet’s 10 policy areas for implementation.

Many of these 10 policy areas and, indeed, the 7 goals of the ANDS, are complex and relate to a number of areas of importance. For example, goal 3 is ‘Reduce the occurrence of diabetes complications and improve quality of life’. Almost all aspects of diabetes clinical care can be included in this one goal, and it is important that mental health priorities are included within this goal. Arguably, they key objective listed here is to ‘routinely monitor people with diabetes for mental health issues’. However, this is rarely done in clinical practice and needs to become more widespread. We have written about this previously (e.g. here and here). Also, our work for the NDSS Mental Health and Diabetes national priority area has been instrumental in providing practical resources for health professionals to support the emotional health needs of people with diabetes. Note, there is also a NDSS webpage of resources specifically for people with diabetes here.

On 10 October 2018, the AIHW released an extensive list of Diabetes Indicators for the ANDS. This includes 18 indicators identified for goal 3 alone. However, not one of these relates to mental health. Furthermore, for the final indicator, related to ‘quality of life of people with diabetes’, the AIHW states that ‘we currently lack reliable national data relating to quality of life among people living with diabetes’. At the ACBRD, we take exception to that and will be contacting the AIHW to challenge this statement. I have previously raised my concern about the lack of QoL indicators in a letter published in the MJA last year. As I wrote five years ago in an MJA Perspective, the bottom line is that ‘what gets measured, gets done’. Prof Zimmet quite rightly calls for a 5-yearly national diabetes survey to hold us all accountable for the outcomes that matter to people with diabetes. Until we have national indicators related to the mental health and quality of life of people with diabetes, to which we are all held accountable, it may well be another 25 years before we see real action and improvements in these important areas.

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