So, I sit down to research an article on diabetes and the first thing I find is an online test that offers to assess my risk of developing type 2 diabetes.
Well, I say to myself, I might as well do this to get a feel for the topic.
But I nearly fell off my chair when I got the results.
I’ve always been a fairly physically active person ‚ÄĒ I played basketball at school, lived on a farm, bushwalked, became addicted to salsa dancing, and have always loved riding my bike. I also consider myself a reasonably healthy eater too ‚ÄĒ by comparison to some.
But here I was, in my middle age, staring at a computer screen that said:
“You may have undiagnosed type 2 diabetes or be at high risk of developing type 2 diabetes ‚Ä¶ in the next 5 years ‚Ä¶ See your doctor‚Ä¶”
Gulp. This was not the kind of high score I relish getting.
I knew I had been a bit slack with exercise lately, and couldn’t fit into my jeans as easily as last year, but type 2 diabetes? Really?
I thought the condition only developed in people who spent all day on the couch eating pizza and watching Netflix.
The screening test I found on the federal Health Department’s website is the Australian type 2 diabetes risk assessment tool (AUSDRISK), and is held in high esteem by the experts I spoke to.
Before getting my shock results, I had planned to treat myself to some takeaway for dinner ‚ÄĒ as you are tempted to do after a long day at work.
Suffice to say, that was off the agenda!
I made an appointment to see the doctor, bypassed the fish-and-chip shop, and went home to start plotting my strategy to avoid developing diabetes.
According to Diabetes Australia, type 2 diabetes is Australia’s fastest growing chronic condition. It, along with other forms of diabetes, costs the country as much as $14 billion each year.
And waiting in the wings are millions of Australians who are at high risk of developing the disease, some of whom have “prediabetes” ‚ÄĒ metabolism changes that set the scene for type 2 diabetes.
Between 15 and 30 per cent of people with prediabetes are likely to develop type 2 diabetes in 5 years.
But there is good news: you can significantly reduce the chance of getting type 2 diabetes ‚ÄĒ and even reverse prediabetes, if you have it ‚ÄĒ by eating better, doing more exercise and losing weight.
According to the online screening test, I could reduce my chance of getting diabetes significantly by cutting a few centimetres off my waist and getting more exercise. As little as 5 per cent loss in weight can reduce your risk.
So I renewed my efforts to lose weight and get more active.
I started walking at night if I ran out of time to exercise during the day, put more veggies and less pasta on my plate, and stopped pigging out on cheese.
But like many others, I’d been here before.
There’s nothing like a shock to knock you off your sedentary perch, but how long would this new regime really last?
It’s hard making the time to cook fresh, healthy meals, or squeezing in exercise, after a long day at work, especially if it’s dark and cold and wet outside. And then there are all those extra things you just have to do when you get home.
It can be tempting to grab a glass of wine and some comfort food instead and fall asleep in front of your favourite drama.
So, was there any help at hand?
Enter: “lifestyle change programs” ‚ÄĒ specifically intended to stop people like me from developing type 2 diabetes.
They’re designed by expert health professionals who know sustained changes in lifestyle come from making incremental changes in the right direction that fit in with your specific circumstances.
We might manage with a few tricks like making soups to put in the freezer for the week, walking to a bus stop that is further away from the usual, cycling to the train station, walking up the stairs rather than taking the lift, and avoiding sitting for long periods.
Or we might need regular coaching and the support from a group of others facing the same challenge.
In the past two decades, the US government and health insurance industry decided funding lifestyle-change programs designed to prevent people from developing type 2 diabetes was a good investment.
The US Centres for Disease Control and Prevention coordinates the delivery of a year-long, evidence-based program they say cuts your risk of type 2 diabetes in half.
So I set out to see if we have a similar national scheme in Australia.
It turns out access to lifestyle-change programs designed for people at high risk for type 2 diabetes varies from state to state, and it’s tricky working out what’s available and where.
In Victoria, for instance, the free Life! program provides small group sessions and phone coaching to teach people about nutrition, physical activity, goal setting, sleep, stress and managing lapses.
You qualify if you have an elevated risk of type 2 diabetes ‚ÄĒ but you have to live in Victoria.
I live in New South Wales, where there doesn’t seem to be anything specifically aimed for people at high risk for type 2 diabetes. A bit of digging did reveal a phone-coaching, government-funded service called Get Healthy, which could be useful, although it’s not specifically focused on diabetes.
The Federal Government has a National Diabetes Strategy and has allocated many millions to initiatives aimed at getting Australians to eat better and become more active.
But experts say when it comes to programs specifically designed to prevent diabetes, it’s all a bit “ad hoc”.
Paul Zimmet from Monash University helped advise the Government on what it should do to tackle diabetes.
“At present, there is no coordinated approach to preventing type 2 diabetes in Australia,” Professor Zimmet said.
“You’ve got isolated things happening in the states.”
Gary Deed from the Royal Australian College of General Practitioners agreed.
“What we need is a coordinated, adequately funded national approach to diabetes prevention where there is a consistent and accredited prevention program available to at-risk communities, rather than the piecemeal and ad-hoc approach currently supported,” Dr Deed said.
Armed with my high AUSDRISK test results, I visited a GP.
But, even though I complained about having quite a few of the non-specific symptoms of diabetes, the doctor took one look at me and insisted I didn’t have anything to worry about.
I told her I was concerned about preventing diabetes, given my “high risk” ‚ÄĒ but she didn’t seem terribly aware of the AUSDRISK test.
She said my records showed I had never had an abnormal blood sugar reading and I didn’t fit the criteria for ordering any special tests.
I eventually convinced her to give me the fasting blood glucose test, recommended by my AUSDRISK assessment, which is one of the tests used to diagnose diabetes and prediabetes.
Doctors rely on a range of methods to assess diabetes risk, but according to University of Melbourne endocrinology researcher and Diabetes Society of Australia president Sof Andrikopoulos and Dr Deed, not all are up to speed on the AUSDRISK screening test.
So more GP education is needed.
While I waited for the results of my blood test, I took a closer look at the AUSDRISK test.
It appears the main reasons for my high-risk score were factors I couldn’t help: my age, family history and ethnic background.
One of the questions was:
10b. Are you of Asian or Aboriginal or Torres Strait Islander descent?
I am, sort of. My mother is Anglo-Australian and my father is Malay. I answered “yes” ‚ÄĒ and, in doing so, I increased my risk score.
Baker Heart and Diabetes Institute diabetes epidemiologist Jonathan Shaw, who helped develop the AUSDRISK test, told me, “Across most Asian populations, we see much higher prevalence of diabetes than we do in ‘white’ European populations”.
He said genes and environment are likely to be responsible for a predisposition in Asian people to depositing fat in unhealthy sites, such as within organs (like the liver) and muscle.
It seems people of Asian descent can’t get away with as much bulge around the waist than those of European origin. Dang!
Interestingly, my dad is pretty skinny but has type 2 diabetes.
So, if I had chosen to go with my mother’s European heritage and answered ‘no’ to the question, I might not be here telling you this story.
I asked Professor Shaw whether being half-Asian made a difference.
“Ethnicity is not an exact science,” he told me.
“Most studies show that mixed origin leads to mixed ‘effects’, but it’s impossible to cater for all the possible permutations, or to have enough data to accurately assign specific levels of risk to each different ethnic mixture.”
Meanwhile, my fasting blood glucose test results came back, and they were ‚ÄĒ ta-dah! ‚ÄĒ “normal”, although according to Professor Shaw, I wasn’t out of the woods yet.
He said there was some chance I could have “impaired glucose tolerance” or prediabetes, which could only be diagnosed by a different, more complicated ‚ÄĒ and less pleasant ‚ÄĒ test called a glucose tolerance test.
The GP told me if I wanted that test I would have to pay for it myself, at the cost of nearly $100. She was nervous about giving me a test that a Medicare audit might deem unnecessary.
It turns out using this test on people like me is a bit of a “grey area”.
And, according to Professor Shaw, my risk status would remain high, no matter what.
“A person may have risk factors for type 2 diabetes but currently have normal blood glucose levels,” he said.
“Their short-term risk of developing diabetes is low, but risk remains for the longer term [5-10 years].”
Back to sleuthing the best way forward.
Professor Shaw said studies dating back 15 years show lifestyle-change programs can prevent diabetes.
But while hundreds of thousands of Americans are enrolled in their national diabetes-prevention program, Australia is yet to go down this path.
Studies show the US prevention program cuts diabetes risk by 58 per cent over 3 years, but Professor Shaw and other experts said the long-term effectiveness of such programs would depend on how good people were at adhering to lifestyle changes.
And then there’s the thorny question of how much the Government is prepared to pay for such an approach.
While individuals who can afford it can access such programs (either paying directly or via private health insurance), this won’t be of any use to large numbers of poorer people who are at high risk of diabetes, Professor Shaw said.
He added that we also need policies that combat what some have termed the “obesogenic environment” we live in.
This includes taxing unhealthy foods. “The easiest target is sugar-sweetened beverages,” he said, as well as making it easier for people to walk or cycle.
Transport sociologist Claudine Moutou of the Institute for Sustainable Futures agreed “fat shaming” individuals into being more healthy was of limited use if our environment worked against it.
While I’m waiting for a nearby diabetes-prevention program to land, and for my surroundings to become more exercise-friendly, I ponder what to do next.
At least I’m starting to calm down from the initial shock of my high AUSDRISK score.
I’m reminded being at high risk of developing diabetes does not mean I will get it, just as someone with a low score is not immune from developing the disease.
It’s just a matter of numbers and chance. And I’ve decided that while there is plenty I can’t control in life, in this case there are a few things I can do to lower the odds.
Watch Catalyst’s Beating Diabetes on ABC iview.