Treatment depends on where you live

Access to the latest and most effective drugs for Australians with diabetes can depend on where they live and how much they earn, new data shows.

People in remote and lower-socioeconomic areas are more likely to be using older and less-efficient medications than those in wealthier or urban areas, according to the Baker Heart and Diabetes Institute research.

The study tracked all 1.2 million Australians being treated for type 2 diabetes between 2007 and 2015.

It showed that two years after Australia’s newest diabetes medication came onto the market, people in remote areas were up to 62 per cent less likely to receive it than those in cities.

Co-author Jonathan Shaw said the older medications come with a higher risk of complications like heart and kidney disease.

“We’ve got a problem here, we’re not getting equal treatment to everybody across the country,” he said.

“It shouldn’t matter where you live, it shouldn’t matter how wealthy or otherwise your suburb is, everyone should be entitled to the same interventions and same medication.”

The report stopped short of concluding why there was a gap in diabetes healthcare in Australia, but Prof. Shaw said there were a few likely explanations.

The first is that information about the newest drugs takes longer to filter through to remote areas.

Second, he said diabetes care in remote areas was overwhelmingly provided by GPs struggling to cater to demand.

“We do see what some people call this postcode lottery and there are a number of reasons, one is it can be more difficult to access the best healthcare,” he said.

“We shouldn’t think healthcare in remote areas is poor or doctors are no good, they’ve got a big job to do and there aren’t as many healthcare professionals.

“There are time pressures, there are waiting rooms full of all sorts of people requiring urgent care.

“In that setting it can be a little bit more difficult to sit down and think what’s the absolute best that can be done, the newest that can be done.”

GPs caring for patients who can’t reach specialists

Konrad Kangru said regional areas lack the specialists who are often in better positions to prescribe new medication earlier than GPs.(Supplied: Angel Parsons)

Konrad Kangru, former president of Rural Doctors Association Queensland, said it was difficult for GPs to keep across new drugs hitting the market.

“We don’t have the specialists in the rural areas who are often the ones who are more confident in commencing these new medications or may have access to the additional supports these new medications might require,” he said.

Type 2 diabetes symptoms

Many people with type 2 diabetes display no symptoms. If they do, they are sometimes dismissed as signs of ‘getting older’. Symptoms include:

• • being excessively thirsty

• • passing more urine

• • feeling tired and lethargic

• • always feeling hungry

• • having cuts that heal slowly

• • blurred vision.

Source: Diabetes Australia

One of Dr Kangru’s patients is 71-year-old Gay Gillies, who lives in the far north Queensland coastal community of Dingo Beach.

Because her specialist is a two-hour drive away, she receives most of her care from Dr Kangru in his Proserpine rooms.

To control her blood sugar levels more effectively, she was recently placed on a new type of diabetes medication.

But learning that medication was available for other Australians much earlier has left a bitter taste in her mouth.

“[I’m] not very happy, it’s a bit daunting you know, they think, ‘Oh well we’re out there, don’t worry about us’,” she said.

“I have enough problems going to a specialist, it’s a two-hour drive and I can’t do that unless I’ve got my daughter to help me.”

More complications and amputations in regional Australia

People in regional Australia are already more likely to have diabetes.

On top of that, they are also more likely to have diabetes-related amputations than those in metropolitan areas, and more complications resulting from their condition.

That gap in care is a persistent problem, according to Renza Scibilia from Diabetes Australia.

“This study is important because it once again shows that this postcode lottery is real. It shows there are certainly differences depending on where people live,” she said.

“This highlights that we need to do better for people living with diabetes in rural and remote areas.”

Prof. Shaw said attracting more doctors to rural and regional areas and educating both patients and health professionals would help to narrow the gap in care.

“I think we need to have ongoing monitoring of this, we need to know what’s happening so we can react to it,” he said.

“It’s very much from my perspective a matter for government, for example, to make sure people in those areas get access and education is available.”

Professor Shaw said his research had particular implications for Indigenous Australians, who are more likely to have type 2 diabetes and live in remote areas.

“These newer drugs were interesting drugs with some advantages, but since 2015 we’ve further recognised they have even more advantages — particularly for preventing heart disease and also for preventing kidney disease.

“We have to make sure that particularly our Indigenous population who are so vulnerable to those sorts of complications are getting access to these medications.”

A spokesperson for Health Minister Greg Hunt said the government already provided considerable support to Australians with diabetes through subsidised medication and services.

“The Morrison government is committed to improving access to health services for all Australians, providing quality, safe and affordable healthcare no matter where they live, and provides considerable support to people with diabetes,” he said.

“It subsidises essential medicines, like insulin, under the Pharmaceutical Benefits Scheme (PBS) and diabetes-related products through the National Diabetes Services Scheme.”

He said improving the health of Indigenous Australians with diabetes was a key priority for the federal government, and that a national strategy was being developed which would partly look at the distribution of Australia’s medical workforce.