Type 2 Diabetes Becomes a Cultural Tale in Australia

Changing Landscape for T2D

A recent study by Magliano et al, in the Medical Journal of Australia, provides an in-depth examination of the changing epidemiological profile of type 2 diabetes (T2D) in Australia over a 15-year period. Using comprehensive data from the National Diabetes Services Scheme (NDSS), the study explores trends in T2D incidence across key socio-demographic dimensions, including age, sex, geographic remoteness, socio-economic status, and country of birth. The findings highlight not only the general decline in T2D incidence since 2010 but also the troubling rise in cases among certain ethnic and socio-economically disadvantaged groups.

As a chronic condition deeply intertwined with lifestyle, healthcare access, and demographic trends, T2D serves as both a marker and driver of public health inequities. The authors reveal that while the overall decline in incidence reflects progress in prevention and management, the increase in cases among individuals born in Asia, North Africa and the Middle East, and the Pacific Islands underscores the complexity of addressing this multifaceted condition.

Leveraging NDSS data, which captures 80–90% of diagnosed diabetes cases in Australia, the study disaggregates incidence trends across diverse populations. Such granularity illuminates the nuanced interplay of social, economic, and cultural factors driving diabetes risk, enabling more targeted and equitable public health strategies.

Given that over 30% of Australians were born overseas, the findings emphasise the critical need for culturally tailored prevention and intervention programs. By identifying both progress and disparities, this research bridges crucial gaps in diabetes prevention and management, offering actionable insights into fostering a more equitable and inclusive healthcare system.

A Call for Multidimensional Engagement

The observed decline in T2D incidence among Australian adults from 2010–2019 is a testament to public health initiatives and societal shifts. Age-standardised incidence rates decreased by 5.2% annually among men and 6.5% annually among women over this period. However, this decline masks significant variations among specific population subgroups, particularly individuals born in Asia, North Africa and the Middle East, and the Pacific Islands, who experienced rising incidence rates during the same period.

The disparity reflects systemic inequities and suggests that current prevention programs may inadequately address the unique needs of culturally and linguistically diverse (CALD) populations. For example, dietary acculturation, socio-economic barriers, and health literacy gaps may exacerbate diabetes risk among these groups. These trends echo global patterns, where rapid urbanisation and dietary transitions in low- and middle-income countries contribute to rising T2D incidence.

Socio-Economic and Geographic Disparities

The study highlights socio-economic disadvantage as a persistent determinant of T2D risk. Incidence rates were consistently highest among individuals in the lowest quintile of the Index of Relative Socioeconomic Disadvantage (IRSD), a trend observed across both sexes. Between 2010 and 2019, annual reductions in T2D incidence ranged from 5.6% to 6.8% for women and from 4.6% to 5.2% for men, with smaller declines observed in more disadvantaged groups. This disparity underscores the limitations of universal strategies in addressing the structural determinants of health, such as income inequality, food insecurity, and limited healthcare access.

Geographic remoteness presents an additional layer of complexity. Prior to 2015, T2D incidence was highest in inner regional areas, but after 2015, major cities exhibited the highest rates. This shift may reflect urbanisation trends and the concentration of socio-economic challenges in metropolitan regions, including the urbanisation of poverty and dietary changes associated with city living.

Data Gaps

A critical aspect of the study lies in its analysis of diagnostic trends. The increasing reliance on glycated hemoglobin (HbA1c) testing, a gold-standard diagnostic tool, aligns with international criteria but may influence observed trends. HbA1c testing, introduced as a diagnostic measure in Australia in 2012, identifies fewer cases than oral glucose tolerance tests, potentially contributing to underdiagnosis in certain populations. The shift from oral glucose tolerance testing to HbA1c assessment, particularly after 2014, warrants scrutiny to ensure accurate detection rates across diverse demographic groups.

The reliance on NDSS data, while robust, does not capture the estimated 20% of Australians with undiagnosed diabetes. Additionally, gaps in capturing country of birth for 14.8% of registrants and the exclusion of Indigenous Australians from the NDSS dataset limit the comprehensiveness of the findings. Enhanced data systems integrating non-NDSS participants, Indigenous populations, and alternative socio-demographic markers would provide a more accurate picture of T2D’s national burden.

Implications for Policy and Research

The findings call for urgent action to address inequities in T2D prevention and management. Public health campaigns must engage CALD populations through culturally tailored strategies, leveraging community leaders to deliver impactful health education that respects dietary and cultural practices. Furthermore, systemic barriers such as food deserts, limited healthcare access, and socio-economic disparities must be addressed through targeted policies, including fiscal measures like sugar taxes and expanded healthcare subsidies.

The underrepresentation of Aboriginal and Torres Strait Islander populations in this analysis points to a broader need for inclusive research frameworks. Indigenous Australians face disproportionately high rates of diabetes, and their exclusion from NDSS data due to reliance on alternative services necessitates dedicated studies and community-driven approaches.

Toward a Multidimensional Approach

Preventing T2D in a multicultural society requires a paradigm shift from universal strategies to multidimensional interventions that consider cultural, social, and economic contexts. Culturally responsive prevention programs, co-designed with CALD and Indigenous communities, can foster trust and align with specific dietary and lifestyle practices. Policies addressing systemic issues, such as the urbanisation of poverty and limited access to nutritious foods, must complement these efforts. Additionally, improved data collection methods are essential to capturing undiagnosed cases and socio-economic disparities, ensuring that prevention strategies are both inclusive and precise.

The evolving landscape of T2D in Australia reflects both progress and persistent challenges. While the overall decline in incidence signals advancements in public health, rising rates among specific ethnic and socio-economically disadvantaged populations highlight the need for targeted, equity-focused interventions. By fostering culturally responsive research, prioritising community engagement, and addressing structural inequities, Australia can not only reduce diabetes incidence but also establish a global benchmark for addressing health disparities in diverse societies. 

;Magliano, D.J., Chen, L., Morton, J.I., Buyadaa, O., Salim, A. and Shaw, J.E. (2024). Changes in the incidence of type 2 diabetes in Australia, 2005–2019, overall and by socio‐demographic characteristics: a population‐based study. Medical Journal of Australia. doi:https://doi.org/10.5694/mja2.52461.