The fight against diabetes has gone backwards in crucial areas and a total revamp of official strategy is needed, ground-breaking analysis has found.
Alarming findings from 25 years of medical data will be presented tonight to a crisis summit of clinicians, health bosses and politicians.
"When people say, 'It's going to get worse', it's already got worse - we are now in the middle of the epidemic. On the wards it's a third of the patients. In some wards it would be more than a third. This is a huge number," said Professor David Simmons, an international diabetes expert who analysed the Auckland GP clinic data.
"In a world where we expect mortality to improve, over the last 25 years the improvements for people with diabetes have actually often gone the other way."
Tonight's summit in South Auckland is organised by the Diabetes Foundation Aotearoa and tag-lined, "an urgent call to action". Attendees include Associate Health Minister Peeni Henare.
Simmons, Professor of Medicine at the Western Sydney University Macarthur Clinical School, will deliver the keynote address. One particularly alarming finding from the data: a failure to have more diabetics keep blood sugar levels as close to normal as possible.
Over the long term, too much glucose in the blood ravages nerves, organs and tissue, risking heart attack, stroke, kidney failure, blindness and foot disease leading to amputation.
Controlling blood sugar levels greatly reduces the chance of those complications, and can slow or stop illness that's already taken hold. That can be done through medication, insulin injections, and by improving diet and exercise levels.
However, New Zealand has some of the worst range of funded diabetes drugs in the developed world.
"We can deal with the glucose a lot better, that's for sure," Simmons told the Herald. "We have new medicines now which reduce weight gain and can actually lead to weight loss. And we have medications that can reduce mortality in diabetes. But those drugs are not available in New Zealand."
Turning the tide on diabetes needed much wider action, Simmons said, as well as the political courage to spend more now to avoid astronomical hospitalisation costs later.
New Zealand's DHB structure was "fantastic" for allowing diabetes care to be easily organised across both primary and secondary levels, but better support was needed for that to happen.
"It's very complicated for diabetes, because there are so many people involved [in treatment]. But it is doable. It needs massive investment upfront to prevent hospitalisation. Someone has got to be bold and say, 'It will cost us upfront but we have to do this now'."
Diabetes causes close to 1000 amputations a year and blights the vision of about 60,000 New Zealanders. More than 300 diabetics went on to dialysis last year alone.
That growing toll has contributed to some services failing. In South Auckland, obesity and diabetes have led to a surge in the number of pregnancies needing more monitoring and care, and resourcing problems like not enough maternity staff or bedspace contributed to the recent death or stillbirth of three babies. An 11-year-old went blind in one eye because her follow-up care was lost amidst a backlog, partly fuelled by diabetes-related eye disease.
"South Auckland is the canary in the cage. It's on the frontline. The impact varies around the country, but the other [DHBs] will get there too," Simmons said. "New Zealand has the structures to oversee the changes required. It is feasible. But it's going to need leadership."
There are bright spots. A Herald investigation into diabetic amputations profiled work at Counties Manukau DHB that successfully prevented hundreds of amputations by having a podiatrist treat patients at the same time as they get dialysis.
A landmark Government diabetes strategy started in 2016 and set targets to be achieved by 2019, including reducing the amputation rate. Most of those will be missed, briefings to Health Minister David Clark show, and clinicians have urged the Government to greatly step-up prevention efforts criticised by one as "a counting exercise".
The Ministry of Health and Clark both say it's too early to judge the strategy's success. On the related issue of obesity, Clark has pointed to efforts to pressure the food and drink industry into making products healthier. He has repeatedly declined Herald requests for an interview on the subject.
• The South Auckland Diabetes Summit is open to those working in the field of diabetes, primary care, or have a general interest in the care provided to people with diabetes. Registration is required with more information available here.