The ophthalmic sector has weighed in on a major government inquiry into the state of diabetes in Australia, drawing attention to “pervasive and persuasive” food marketing to children and barriers to accessing retinal imaging and intravitreal injections in diabetic retinopathy.
Optometry Australia (OA), RANZCO and ophthalmologist Dr James Muecke AM, the 2020 Australian of the Year, were among those who lodged submissions to the House of Representatives Standing Committee on Health, Aged Care and Sport report, The State of Diabetes Mellitus in Australia in 2024.
The review, that recently published 23 recommendations, is an in-depth look into diabetes mellitus in Australia in the face of 21st century healthcare needs that may see life expectancy decline due to “diseases of affluence”.
Diabetic retinopathy, and other diabetic eye diseases, are a complication of the disease. In fact, diabetes is reported to be the most common cause of preventable blindness in Australia. It’s a disease that may be asymptomatic, especially in its early stages.
OA told the committee that almost all people with Type 1 diabetes – and more than half of people with Type 2 diabetes – will be affected by diabetic retinopathy in their lifetime.
Esteemed Melbourne ophthalmologist Professor Hugh Taylor also explained everybody with diabetes will develop diabetic eye disease if they live long enough – with and 98% of that vision loss preventable if it’s detected and treated. But once the vision is lost from diabetes, it can’t be restored. And people can no longer look after themselves or their diabetes once they’ve lost the vision.
Importantly, the ophthalmic sector noted that diabetic retinopathy can be successfully managed with improved glycaemic control, eye injections and laser therapy.
To help people manage diabetes-related eye complications, the Department of Health and Aged Care is supporting KeepSight program, which was launched in 2019 and sends regular eye check reminders to people with diabetes and is generating positive results.
However, the committee heard that accessing screening and treatment for diabetic retinopathy is particularly challenging for many patients across Australia in both metropolitan and regional areas.
Mr Stephen Bali, MP for Blacktown in the NSW Legislative Assembly, noted that a key challenge for diabetic retinopathy patients in western Sydney was finding accessible treatment locations.
Dr Ashim Sinha, director of Diabetes and Endocrinology at Cairns Hospital and Health Service District, added: “There’s lack of screening availability. Not every place has fundus cameras, which are so easy to use, can be put into each of these communities and health workers can be easily trained to man. It is not rocket science.”
OA explained that patients often have to pay “substantial out-of-pocket” costs for intravitreal injections, which are administered in the private system with low rates of bulk billing. As a result, the necessary numbers of injections required for effective treatment are not always administered, the organisation stated.
OA said optometrists were well-positioned to play a role in diabetes prevention and inform patients about the impact of diabetes on eye health during routine examinations.
As such, it recommended optometrists should be considered part of the team care arrangement for all people diagnosed with diabetes, and that a national strategy be introduced to ensure people with diabetes receive eye examinations to enable early detection and treatment of diabetic retinopathy.
Tackling big industry
Among the recommendations stemming from the inquiry, many were focused on changes to the food industry.
They included:
- The National Health and Medical Research Council expedites a review of the Australian Dietary Guidelines, and ensures that the revised guidelines include adequate information for Australians living with diabetes.
- The government implements food labelling reforms targeting added sugar to allow consumers to clearly identify the content of added sugar from front-of-pack labelling.
- The government implements a levy on sugar-sweetened beverages, such that the price is modelled on international best practice and the anticipated improvement of health outcomes.
- The government considers regulating the marketing and advertising of unhealthy food to children
Dr Muecke has used his platform in recent years to draw attention to major issues within the food industry.
While acknowledging obesity was the greatest risk factor for Type 2 diabetes, he suggested it was not a root cause of diabetes, but rather a symptom of underlying issues.
He explained that, in his view, “obesity is only a marker for poor metabolic health”.
“Our poor diet,” Dr Muecke submitted, “is responsible for more disease and death than alcohol, tobacco and inactivity combined.”
The committee heard that Australians do not eat enough fruit or vegetables, with the Public Health Association of Australia (PHAA) noting that “less than 10% of adults and children eat the recommended amount” of these foods. In contrast, sugar, refined carbohydrates and unhealthy fats in ultra-processed foods are consumed in excess in Australia.
The committee also heard food marketing to children is “pervasive and persuasive”, and “ubiquitous in their daily lives – in their homes, schools, communities and gathering places”.
Dr Muecke also expressed concern at what he described as the food industry’s “relentless promotion of unhealthy food and drinks at checkouts and at the end of aisles within their supermarkets”. Furthermore, children are often further exposed to this marketing across various online platforms.
Other key recommendations included:
- The government explores the potential for effective national screening programs for all forms of diabetes, particularly Type 2 diabetes
- The government implements a national public health campaign to increase public awareness of the early signs of all forms of diabetes mellitus
- The government funds the development of education-based obesity screening information and resources
- That equitable access to health care for people living with all forms of diabetes be improved through: Longer appointments with a healthcare provider subsidised by the MBS; access to case conferencing models of healthcare, especially in rural and remote areas; access to telehealth services; increase in the number of item numbers for allied health consultation for those with diabetes for diabetes educators and dieticians and other allied health providers
- Access to diabetes educators, including in high-risk outer metropolitan, rural and remote communities.
- Subsidised access to Continuous Glucose Monitors (CGMs) is further expanded
- Explore expanding subsidised access to insulin pumps for all Australians with Type 1 diabetes.
- The government undertakes a review of the price and choice of insulin pumps in Australia.
- The government, subject to a positive recommendation from the Pharmaceutical Benefits Advisory Committee, expands the eligibility criteria for Glucagon-like Peptide-1 (GLP-1) receptor agonists, particularly for high-risk patients.
More reading
Specsavers reaches one million KeepSight appointment registrations
AI scan for diabetes has potential to save sight and money
Missed health checks for type 2 diabetes costing Australia billions