Community can provide answers for diabetes
DIABETES presents huge challenges for doctors, policy makers and the wider community and healthcare system.
The current annual cost to the economy of type 2 diabetes is $6 billion, and projections 1 that the number of people over 25 with diabetes could rise to nearly three million by 2025 paint a grim picture of the serious system pressures ahead of us.
Any attempt to tackle this chronic disease behemoth must be comprehensive, measured and rigorous. And I would argue that building research capacity in diabetes is one area that holds particular promise if we are going to be strategic about the challenges we face.
Research can help us answer important questions about prevention and cure, but it can also help us understand lifestyle and health behaviours, what motivates people, and how they might respond to public health interventions.
It should be fundamental to our decisions on how to proceed; it should underpin policy making; and it must give us relevant, timely answers to the right questions so it is not seen as an ivory tower, academic exercise.
We’re all familiar with the barriers to timely and relevant research: the financial cost and logistical difficulty of patient recruitment; the length of time needed to conduct and analyse research; lead times to scientific publication; difficulty translating results directly into changes in clinical care and the time taken for results to filter into the policy world and the collective consciousness.
But we have the capacity to overcome some of these barriers if we pool our resources and take a collaborative approach.
This was the rationale behind the Sax Institute’s 45 and Up Study. Established seven years ago in collaboration with several partners, including major partner the Cancer Council NSW, the study recruited more than 265,000 participants aged 45 and over who agreed to share information about their health and lifestyle and have this linked to their Medicare and PBS data, GP and hospital use and other health-related databases. This number of participants constitutes over 10% of the NSW population in the target age group, so is a truly unique resource available for Australian researchers to better understand population health.
As we know, type 2 diabetes prevalence increases with age and more than 23,000 members of the 45 and Up Study reported having been diagnosed with diabetes, making the study an ideal home for projects in this area. Already, several diabetes research projects are making use of 45 and Up data.
A sub-study conducted within the 45 and Up Study of more than 50,000 women, published in Diabetes Care,2 showed that women who had had a child but did not breastfeed were 50% more likely than nulliparous women to develop type 2 diabetes in later life; childbearing women who breastfed had a risk similar to nulliparous women, showing that breastfeeding is a modifiable risk factor for diabetes.
And there are several more underway.
The value of this research resource will only grow over time. This year, we have begun our first large-scale follow up, and will resurvey our cohort in order to add to the already rich dataset we have established.
With the continued altruism of more than a quarter of a million study participants, we may find that the community itself will offer up many of the answers we are seeking to address the diabetes pandemic.
Professor Emily Banks
Scientific Director, 45 and Up Study, The Sax Institute
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