There's a hidden epidemic in New Zealand that's been burning away for 30 years, and right now a potential tsunami threatens to overwhelm our health system.
Type two diabetes is at staggering levels and is, I believe, the single biggest medical equity issue we have today.
It is now estimated that 11 per cent of the world's (and New Zealand's) total health budget is spent on diabetes, the majority related to type two diabetes – a disease that can be treated early with diet, exercise, and the use of medications.
In 2015 the International Diabetes Federation named diabetes one of three global threats next to terrorism and global warming.
There are two main types, unimaginatively named type one and type two.
Type one diabetes is an autoimmune condition that presents randomly, often as a child, but basically means the pancreas, which controls the liver, no longer makes insulin, and these patients need to inject it several times daily.
Although type two diabetes can have a genetic component, it is also associated with lifestyle, where food and exercise choices or options, and obesity, can increase the likelihood of it developing.
With type two the body loses the ability over time to control its blood sugar levels, and the pancreas begins to wind down.
Some experts lay the blame at the feet of the explosion of sugary soft drinks, or it could be that New Zealand is now the third most overweight nation on earth behind the United States and Mexico.
Either way, 220,000 people in New Zealand now have type two diabetes.
Years ago, type two diabetes was considered a disease of the elderly – "a bit of sugar" – but increasingly GPs are diagnosing younger patients.
At my practice, 10 to 15 years ago we very rarely diagnosed type two diabetes in anyone in their 20s, but it happens pretty much every week now. Our youngest type two diabetic is an adolescent.
The issue with younger people being diagnosed is that complications come in at around 20 years of the disease, so we're seeing people with complications in their 40s now whereas traditionally that would have been an aged care issue.
The health system is simply not set up to deal with the current population demands, particularly in high-needs areas.
If not taken seriously, type two diabetes can get nasty. It can damage the heart, kidneys, blood vessels, eyes, and nerves.
In New Zealand it is a leading cause of heart attacks, stroke, blindness, leg amputations and kidney disease.
In fact, in New Zealand, 54 per cent of renal dialysis unit patients (people with advanced kidney disease) are there because of diabetes.
Diabetics from our Māori and Pacific Island communities who are type two are seven to 12 times more likely to progress to end-stage renal failure than their European counterparts.
I believe New Zealand has a hospital-focused health system, and for type two diabetes that's too late. We need to be addressing it early and in the community.
For years, as a country, we have failed to resource general practice to deal early with issues like type two diabetes.
We have collectively stood back and watched this situation develop, hoping our hospital services will deal with the problem.
They can't. It's too big.
The Government and Ministry of Health need to make a commitment to adequately resource community medical services to tackle the epidemic early.
General practice can tackle the issue with the support of hospital-based services and adequate resourcing.
We need the new-generation diabetic medication that the rest of the world has access to.
The fact is that we have fallen 10 years behind the rest of the Western world in the provision of diabetic medication and need a serious rethink of where health system resources are spent to focus more on early intervention.
The only way to tackle type two diabetes is to focus on lifestyle at its source: the communities where people live.
That means better, equitable access to, and resourcing of, quality general practice in the
community, an integrated approach with GPs, nurses, dieticians, health improvement practitioners and podiatrists, and access to the new generation of diabetes medication.
- Dr Bryan Betty is medical director of the Royal New Zealand College of General Practitioners