‘Enormous implications’: SA’s ‘silent’ health epidemic

While the nation focuses on the COVID pandemic, a “silent” epidemic is afflicting South Australia – with huge implications for individuals and hospitals. In part one of an InDaily special report, Jemma Chapman examines the disturbing rise and impact of diabetes.

Sep 28, 2021, updated Sep 28, 2021
An insulin shot. Photo: AP/John Locher

An insulin shot. Photo: AP/John Locher

The figures are stark.

A concerning 6.4 per cent of South Australians are diagnosed with diabetes, compared to 5.3 per cent nationally – and in some regions it’s above 10 per cent – according to the latest figures from Diabetes Australia.

That’s more than 113,000 South Australians – a significant jump from 5.8 per cent of the population diagnosed just six years ago.

Most are afflicted with the largely-preventable, lifestyle-related Type 2 disease.

Diabetes is a leading cause of hospitalisation.

Over time, high glucose levels damage the body’s blood vessels and nerves, leading to a raft of serious health problems such as heart, kidney and eye disease, and even limb amputations from ulcers.

What frustrates health professionals is it doesn’t have to be this way, yet South Australia continues to top the nation in its prevalence of the disease.

And there are warnings the actual rate – including in those who don’t yet know they have it – is up to twice the recorded level.

Researchers and doctors say younger people are increasingly affected by this chronic condition because of sedentary lifestyles and poor diets.

They’re calling for urgent and radical intervention, declaring the issue is much bigger than the already disturbing official figures show.

“It’s a serious underestimate of the real problem,” says Gary Wittert, Professor of Medicine at the University of Adelaide.

“So much of diabetes is not diagnosed.

“If you going looking for it – there’s an awful lot out there. It could be up to twice as much.”

While the Diabetes Australia figures include Type 1 diabetes (an auto-immune disease) and gestational diabetes (in pregnant women), the vast majority is Type 2 diabetes – with poor diet, lack of exercise and being overweight and obese key risk factors.

Wittert estimates that in some SA areas, nearly a quarter of the population could have the disease, with many unaware.

“It’s extremely concerning,” he says.

“And then if you look at the people who are at risk and likely to get diabetes in the next two, three, four, five years, that’s an even bigger number.

“This is a condition that has enormous implications for healthcare costs. It’s the most prevalent co-morbidity for people admitted to hospital.”

Wittert says we’re starting to see diabetes diagnosed in younger and younger patients.

“We’re seeing it in children,” he says.

“It used to be that Type 1 Diabetes was the major type of diabetes in young people but that’s not necessarily the case now.”

So much of diabetes is not diagnosed.

South Australia has the highest diabetes rate of any state, and is equal with the Northern Territory.

The hardest hit are the regions and lower socio-economic suburban areas north and south of Adelaide.

A local government area breakdown shows Port Pirie City and Districts has the highest rate in the state at 11.6 per cent, followed by Peterborough (10.2 per cent), Yorke Peninsula (10.0 per cent), Copper Coast (9.8 per cent), Port Augusta (9.6 per cent) and Whyalla (9.5%).

In the metropolitan area, Playford in the northern suburbs sits at the top at 8.1 per cent, followed by Salisbury (7.9 per cent), Gawler (6.9 per cent), Port Adelaide Enfield (6.7 per cent) and Onkaparinga (6.5%).

In contrast, the lowest rate in the state is in the Adelaide local government area – with just 3.2 per cent of the population diagnosed, followed by Adelaide Hills (4.1 per cent), Unley (4.1 per cent), Burnside (4.3 per cent) and Walkerville (4.3 per cent).

“The tragedy is that we now have unequivocal data that diabetes is a preventable disease,” Wittert says.

“When diagnosed early, with proper treatment, it’s reversible.”

Wittert says as well as the “misery” that diabetes causes individuals, it’s a huge burden on the hospital system.

“There is absolutely no question that if you prevent diabetes, you prevent hospitalisations. If you have shorter hospital stays, or you keep people with diabetes out of hospital, you save money.”

GP Dr Rod Pearce agrees the real rate of diabetes in SA is probably double what’s diagnosed which he describes as “the tip of the iceberg”.

His clinic in Glynde has a specialised diabetes educator who is usually fully booked.

“We’re dealing with it more and more,” he says.

“There’s a lot of demand for the services.

“You have to refer people for services and then the government funds them but there’s a limit to how many they’ll fund.”

Pearce says it’s “sad” and “disappointing” that SA is ahead of the national pack in rates of the disease.

He says it’s more prevalent in lower socio-economic areas because of “lifestyle, cheaper food and the usual things around good food costing more”.

“Junk food is easier to get,” he says.

“It’s easier to go and buy cheap rubbish than it is to get high-end quality food.

“Plus there’s often less activity, less opportunity to be active.”

Pearce says “premature ageing” is a major effect.

“The usual rule of thumb is with poorly managed diabetes you’ll die 15 years earlier,” he says.

“The things you’ll die of are heart attacks, strokes, you’ll get blindness, poor circulation in the legs, amputations, infections.”

Professor Katina D’Onise, the executive director of prevention and population health in SA Health’s Wellbeing SA department, says Type 2 diabetes is a “kind of silent disease until it causes very serious problems”.

“Even a person with diabetes might not really have much in the way of symptoms for many years before they start running into problems like having deteriorating eyesight or reduced function of their kidneys or even having a heart attack,” she says.

“Often times it does have that silent period and it can kind of fool people into thinking that it’s not serious, when we know it is.”

Rick Parsons and his wife Michelle Jewels-Parsons, both 51, know how serious it is.

They've both been diagnosed, which has taken a toll on their physical and mental wellbeing.

Michelle Jewels-Parsons and Rick Parsons. Photo: Tony Lewis/InDaily

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Rick only discovered he had diabetes after suffering two heart attacks at just 39.

“I went to the doctor and the doctor basically called an ambulance and they took me into the hospital, did blood tests and said ‘So how do you treat your diabetes?’ I was like, ‘What diabetes?’”

Their full story can be read here.

Modbury North man Robert Ward, now 61, was also in his 30s when he was diagnosed with the disease.

He remembers having an "unquenchable thirst".

"I used to sit by my pool and dream of drinking the whole lot of water out the pool," he says.

"Your body tries to flush out the excess sugar.

"From my place in Modbury to the city, I had to take a drink with me because I couldn't go that time without one."

His GP suspected diabetes but an initial test came back negative.

It was during a subsequent visit to hospital that doctors again checked his blood sugar levels and told him "whatever you do, don't have any sugar", and his diabetes was confirmed.

In the years since, it's been a constant battle to stabilise his blood sugars.

"When I was first diagnosed and I got off the sugar, the first thing that went was my eyesight - I literally lost my sight," he says.

He was also bed-ridden at one point due to weak muscles.

With the right medication, diet and exercise, Robert's complications have improved but he still gets tingling fingers and toes "where the circulation has dropped", has high blood pressure and some kidney problems.

"I now feel a lot better than I did 10 years ago but I have had to work to get it to this position," he says.

Robert says having diabetes has also affected his mental health and he now lives a more isolated life.

When diagnosed early, with proper treatment, it’s reversible.

Experts say SA’s ageing population might be partly to blame for our high rates of diabetes but we’re also the fattest population in the country.

“There is a slightly higher rate of overweight and obesity in SA than other jurisdictions and that may well be the contributing factor,” D’Onise says.

Early markers include higher Body Mass Index and waist circumference.

“It is very strongly associated with being overweight or obese and a lack of physical activity, poor diet; that is a diet that is low in fruit and veg and whole foods and high in junk foods or discretionary foods,” she says.

“There’s also evidence that eating too much sugar in itself in addition to the ultra processed foods leads directly to diabetes as well.”

D’Onise says diabetes has been rising in prevalence not just in SA but across the nation for years “and that really does reflect the rise in overweight and obesity”.

Health Minister Stephen Wade points out that it’s not as simple as the number on the scales, though, that increases the risk.

“If somebody is obese but they’re maintaining healthy eating and more exercise they are less likely to develop diabetes,” he says.

D’Onise adds: “Obesity is a marker if you like of eating a poorer quality diet and low physical activity”.

“It does also have its own effects on developing diabetes but those can be mitigated by eating well and being physically active.”

Wade says diabetes was one of the conditions that most worried health authorities when the pandemic hit, because people were reluctant to visit their GP.

He says this delay in care is one of the “theories” as to why hospitals have been so overwhelmed in the past year, with poorly managed chronic conditions resulting in more emergency department presentations.

D’Onise says Type 2 diabetes in children is “rare” but as prevalence of the disease increases, “so will the age of onset of diabetes become younger”.

Country living is often associated with healthier lifestyles so Wade says he was curious about why diabetes rates were worst in the regions.

“When I went to the Barossa and asked this question, they said, ‘Well farming is very different nowadays, you spend a lot of time sitting in a tractor’,” he says.

“And then when you get home you watch telly. Living in the country doesn’t in and of itself imbibe health. You’ve got to use the environment.”

Genetics also plays a factor, putting some cultural groups at higher risk, including Aboriginal populations.

“There’s evidence that a healthy weight for an Aboriginal person is actually a lesser weight than for a non Aboriginal person,” D’Onise says.

“It’s equally the case for people of Southern European origin, Chinese people, some other Asian people.”

Wittert says there are also links between stress, depression and diabetes “and I don’t think that should be under-estimated”.

“Diabetes is an inflammatory disease, depression is an inflammatory disease in many cases, so they relate to each other,” he says.

Tomorrow, part two of our special report will look at some of the solutions proposed - and efforts already underway - to tackle the problem.

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