Rowan Ramsey (Grey, Liberal Party) Share this | Link to this | Hansard source

I move:

That this House:

(1) notes that:

(a) 2021 marks 100 years since the discovery of insulin by Canadian surgeon Frederick Banting;

(b) Frederick Banting along with his colleagues Professor John McLeod, medical student Charles Best and researcher Dr James Collip, solved the problem of how extracted insulin could be used to treat a person with diabetes;

(c) insulin was first administered to a 14 year old boy, Leonard Thompson at the Toronto General Hospital—it was lifesaving for Leonard and for millions of others diagnosed with diabetes over the ensuing years; and

(d) for their discovery, Banting and McLeod won the Nobel Prize in Physiology and Medicine in 1923 and shared their prize money with Best and Collip;

(2) recognises that:

(a) diabetes is a serious and complex metabolic disease that affects the lives of many Australians;

(b) more than 1.4 million Australians currently have diabetes and are registered with the National Diabetes Services Scheme (NDSS); and

(c) Australians like Anna Moresby, who was diagnosed with type 1 diabetes as a child during World War 2, can live long and productive lives because of the discovery of insulin—Anna has just received a Kellion Victory Medal for living with diabetes for 80 years; and

(3) acknowledges that:

(a) the Government has a long-standing commitment to the NDSS, established in 1987, which assists people with diabetes to self-manage their diabetes through provision of subsidised insulin pen needles and pump consumables, glucose monitoring strips, continuous glucose monitors and flash monitors, and important information, resources, education and support programs and other services;

(b) there has been strong bi-partisan support for the NDSS; and

(c) since its inception the NDSS supports all people with diabetes all over Australia, including children with type 1 diabetes and families, young adults, women with diabetes in pregnancy and over 450,000 people who currently use insulin to help manage their diabetes.

In 1921, insulin was discovered by Canadian surgeon Frederick Banting and, along with Professor John Macleod, Charles Best and Dr James Collip, he shared in the Nobel Prize in 1923. Since that point in time, 100 years ago, insulin has saved hundreds of thousands, if not millions, of lives. It was one of the great scientific breakthroughs of its time. Despite that, diabetes is still with us today, in perhaps even greater numbers. In fact, the latest numbers I have seen show that the incidence of diabetes worldwide is still increasing, and that is of great concern.

I thank successive Australian governments for their support of the diabetes community. The current minister, Greg Hunt, has been a very passionate and helpful person in getting the requests of the diabetes community dealt with by government, certainly in the areas of the National Diabetes Services Scheme, the national plan, the insulin pumps, the constant glucose monitors, the FreeStyle Libre devices that are now being provided and the extension of services to rare forms of diabetes. I've told a story in this place before of meeting a young family with a baby that had diabetes that did not qualify for a constant glucose monitor. I went to see the minister and basically, with the stroke of a pen, he fixed it for about 13 families around Australia. That's the kind of response I really appreciate and the diabetes community appreciates. There's been strong support from the government for medical trials, and that continues. The member for Moreton and I are the co-chairs of the 'parliamentary enemies of diabetes'. In the time we have been there, it has been a rewarding thing for us to do. We have been pleased with what governments have done for diabetes. We don't claim to be the sole authors of every success, but we're certainly there with our shoulders to the wheel.

The figures show that 1.4 million Australians are on the National Diabetes Service Scheme, and it is thought that there would be another maybe one million people who are undiagnosed at this stage. It is sad to report that it is seats like my seat of Grey, in outer regional Australia, where that incidence is the highest. I do not have the latest numbers, but a few years ago Grey had the highest instance of diabetes across the nation. It's certainly a frontline concern for me. Without doubt, it affects the Indigenous population, particularly in remote communities, even worse than it affects the mainstream population. About 30,000 people a year in Australia take insulin for the first time. Worldwide—and these are the figures I wanted to touch on—it's estimated that one in 11 adults have diabetes. That is 415 million people, and about half of those are undiagnosed. Half a million children in the world have type 1 diabetes. And it's worsening. The International Diabetes Federation estimates that, by 2040, 10 per cent of the world's population—one in 10—will have diabetes. This is diabolical. That's why we need to keep spending money on those medical trials. Certainly the medical trials are largely aimed at type 1 diabetes, and that is not the predominant number. It is type 2 diabetes which is causing the most havoc around the world.

Sadly, while there are no silver bullets in this game, a lot of the causes of type 2 diabetes are well-known: it's lifestyle, it's diet and it's exercise, and the solutions are within reach of those people who suffer. Getting that message out there and getting people to understand that they are in a powerful enough position to do something about it is the real challenge, and we shall have to keep at that work.

I'm going to end my comments on this motion by restating something I normally say when I speak about diabetes. Diabetes in Australia is the leading cause of coronary heart disease, it is the leading cause of blindness and it is the leading cause of amputation. It's a darn good thing to avoid, if you can, and, particularly in the case of type 2, a lot of people could. I ask them all to be in touch with their doctor, get screened, get their eye screenings, check out where their health is and do something about it.

Ian Goodenough (Moore, Liberal Party) Share this | Link to this | Hansard source

Is there a seconder for the motion?

Graham Perrett (Moreton, Australian Labor Party, Shadow Assistant Minister for Education) Share this | Link to this | Hansard source

I'm pleased to second the motion moved by the member for Grey and to speak in support of it. We are the co-chairs of the Parliamentary Friends of Diabetes, or should I say 'enemies of diabetes'. Since there's nobody listening and nobody taking a record, I would say that the member for Grey is a good bloke and very easy to work with, but hopefully no-one has taken that down!

The Diabetes Australia website refers to insulin as the holy grail of diabetes treatment, and it's not an overstatement. Insulin keeps more than one million Australians alive, and this year marks 100 years since insulin was discovered by Canadian researcher Frederick Banting and his colleagues Professor John McLeod, medical student Charles Best and researcher Dr James Collip. Together they received the Nobel Prize for their wonderful discovery, because it was a game changer for people living with diabetes.

Type 1 diabetes is not linked to modifiable lifestyle factors, and today—although hopefully one day—there is no cure for type 1 diabetes and it cannot be prevented. A healthy lifestyle can only help to manage type 1 diabetes. A new report by the Juvenile Diabetes Research Foundation, released yesterday, found that type 1 diabetes costs the Australian economy about $2.9 billion a year. They found that increased access to diabetes technology and treatments could reduce that cost significantly. Forty per cent of people with type 1 diabetes develop complications such as blindness, require amputations or suffer from cardiovascular disease, and 21,000 people are hospitalised every year due to hypoglycaemia or hyperglycaemia. The lifetime cost of type 1 diabetes with complications is about $738,000.

As well as being the co-chair, with the member for Grey, of Parliamentary Friends of Diabetes, I have a personal interest in promoting awareness of this chronic condition. My mum had type 2 diabetes. Just a few weeks ago it was a decade, amazingly, since Peggy passed away. A mother of 10 children, she is still missed by all of us. I often associate Canberra with Mum, because I used to call her a lot when I was here, rather than when I was busy with kids at home. I still miss her, and she inspired me to be a part of this group.

Type 2 diabetes represents around 85 to 90 per cent of all diabetes cases. There are some markers that make it more likely that you will develop type 2 diabetes: if you're over 45, if there's a family history of diabetes, if you are from one of certain ethnic backgrounds, if you suffer from high blood pressure, or if you're overweight or obese. Despite this checklist, many people who develop type 2 diabetes have no symptoms at all. For some, the first sign may be a complication, such as a heart attack, a vision problem or a foot ulcer, connected with diabetes. As I said, there's no cure for type 2 diabetes, so prevention is crucial, as outlined by the member for Grey. Thankfully, there is very strong evidence that we can prevent it in up to 60 per cent of cases, but we are not yet approaching this benchmark in Australia. People at risk of type 2 diabetes can delay or prevent its onset by maintaining a healthy weight—always a struggle for politicians—undertaking regular physical activity, making healthy food choices, managing their blood pressure, managing their cholesterol levels and giving up smoking.

The National Diabetes Services Scheme, the NDSS, established in 1987 by the Hawke Labor government, has ever since had bipartisan commitment from successive governments. The NDSS is administered with the assistance of Diabetes Australia and assists people with diabetes to self-manage their diabetes. It does that through the provision of subsidised insulin pen needles, insulin pump consumables, glucose monitoring strips, continuous glucose monitors and flash monitors, and lots and lots of very useful information.

Diabetes has a wider impact than just on those who suffer with the disease. It affects other family members, friends, teachers and employees, who all need to be aware of the support that sufferers need. We need a national type 2 diabetes prevention program to help prevent people developing type 2 diabetes. We need a prevention workforce of health professionals trained and certified in diabetes risk assessment and prevention in every state and territory. A range of suitable health professionals from fields including nursing, dietetics, physiotherapy, exercise physiology, pharmacy and psychology, as well as Aboriginal health workers, should be included. The goal of any program would be to slow the growth of the obesity epidemic—or tsunami—which is the main driver of type 2 diabetes, and we need to prevent low-risk individuals from moving into that high-risk category. That's the low-hanging fruit—healthy fruit, I'm talking about, obviously. If you develop type 2 diabetes, eating well and exercising are very important management tools. It's important to keep blood glucose levels in the target range to prevent short-term and long-term complications. As the member for Grey so clearly stated, diabetes is an epidemic not only in this country but across the whole world. We need to tackle diabetes head-on, for all our sakes.

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

I rise in support of this motion. Diabetes is a scourge of the modern world. It's been around for a long time but it's rising. I'd like to compliment both the previous speakers on their contributions.

For those Australians who aren't diabetics, I'll provide just a bit of explanation. Diabetes is when your sugar goes too high because either you have run out of insulin, which comes from your pancreas, or you have resistance to the effects of insulin—you might have hyperinsulinemia and resistance to it working. The latter is type 2 diabetes. The first condition, when there's no insulin, is an autoimmune condition. Juvenile onset diabetes is when your own immune system inflames and takes away the cells in your pancreas that make the insulin—so sugar goes up, insulin comes out and it comes down. There are other hormones in your gut and your body that help control that, there are incretin mimetics and there are wonderful drugs—insulin tablets that lower your blood sugar and reduce insulin resistance—but diabetes is a scourge on the health of everyone who gets it. The best prevention for that type 2 is to stay fit and healthy, and to eat good food. In my 35 years or so of practice, I always told patients about the three programs that will address the obesity problem in the Western world in particular. The first one is the ELF program—the eat-less-food program; the second program is the DME program—the do-more-exercise program; and the last, and the accessory program, is the DLG program—drink-less-grog! If you do that and do exercise you will be a lot healthier and will probably reduce your risk of getting diabetes as a result.

The other thing that we need to highlight is that in Australia we have the National Diabetes Services Scheme, which has been around since the late 1980s. It is federal government funded and a lot of the services are delivered by another jewel in Australia, and that is Diabetes Australia. Every state has a state based Diabetes Australia—for example, in New South Wales and the ACT. They offer oodles of support, help and practical knowledge to people who become diabetic. The National Diabetes Services Scheme is administered by them in some states and also delivered by pharmacies, where you can get things like free syringes, or you get reduced and subsidised prices for things like insulin pumps and continuous blood glucose monitoring.

The care that you get in Australia for diabetes, compared to that in some other nations, is exemplary. But that's because we have a wonderful, strong health system in this country. In the eight years that I've been here the coalition government has totally expanded the reach of our health system, nowhere better than with all the wonderful drugs that are available for diabetes. The incretin medics are an example of a class of drugs which are going to help weight loss. These try to get the natural got hormones which interact with the pancreas active. These can be via tablet or injection. There are breakthrough ones coming in the pipeline that will actually control this, with exercise and a sensible diet, with between 17 and 30 per cent weight loss. That's better than what all these gastric bypass operations are doing. That's in the pipeline.

There are so many things, but the practical help that people get out of the NDSS and through the organisations that deliver a lot of these services is exemplary. I don't know how it would have been to be diabetic before those two initiatives. I went to school with some colleagues who were diabetic, and it was a real nightmare for them. We always used to think: 'Oh my God! These poor guys have to stick needles in themselves twice a day!' Some of my friends at boarding school would freak out, seeing them inject themselves. It put them to the side a bit, 'Oh, he's one of those guys who sticks needles himself.' But now people understand that juvenile-onset diabetes or the autoimmune type isn't someone's fault; you just get it. It's just bad luck. Like many things in life, you get a disease because you run into a bad microbe or you didn't choose your grandparents or your genes very well, because you inherited it. Or it's just bad luck—you run into a bad microbe that does things.

So this is a thing to be celebrated. Thank God that we have Diabetes Australia and the National Diabetes Services Scheme! (Time expired)

Kate Thwaites (Jagajaga, Australian Labor Party) Share this | Link to this | Hansard source

[by video link] Thank you to all the previous speakers on this important motion. I thank the member for Gray for moving the motion and the member for Moreton for his work in this space.

We're facing a diabetes epidemic across Australia, and there is more work for us to do in both preventing and treating diabetes. There are more than 1.4 million Australians with diabetes, and 120,000 of those have type 1 diabetes. Some 280 Australians develop diabetes every day and there are a lot of Australians who have diabetes which are as yet undiagnosed—the estimate is about half a million—so we need to do much better at diagnosing it and telling people to get tested for diabetes. Since 2001, the prevalence of diabetes amongst Australians over 18 has almost doubled. It's clear that something is happening here. Diabetes is rising, so we do need to significantly increase awareness of diabetes in our health discussions, particularly so that we can do some of the prevention work for type 2 diabetes.

There was a particular reason that I wanted to speak on this private member's motion today: I have personal experience with diabetes. Last year I was diagnosed with gestational diabetes when I was pregnant with my son. Gestational diabetes is the fastest-growing type of diabetes in Australia, and it affects thousands of pregnant women. It usually occurs around the 24th to 28th week of pregnancy, and women who have had gestational diabetes have an increased risk of developing type 2 diabetes later in life. For me, being diagnosed with gestational diabetes was quite a surprising diagnosis. I've tended to have a fairly healthy diet and an active lifestyle, so I felt quite shocked and surprised. I do want to say to pregnant women out there who are diagnosed with gestational diabetes: this is not a personal judgement on you. I know it can be hard when you're pregnant and you feel like you need to be doing the absolute best for your unborn baby. It's not about you. There are underlying factors that put you at risk.

I got used to monitoring my glucose and managed my diabetes through some small changes to my diet, but other women do have a more difficult process. We do know that gestational diabetes can develop if you've had gestational diabetes in a previous pregnancy; if you're older, especially over 40 years of age; if you're from an Aboriginal or Torres Strait Islander background; if you're from a Melanesian, Polynesian, Indian subcontinent, Middle Eastern or Asian background; if you've had elevated blood glucose levels in the past; if you have a family history of type 2 diabetes; if you're above the healthy weight range; if you have polycystic ovary syndrome; if you have gained weight too rapidly in the first half of pregnancy; if you have had a large baby or complications in a previous pregnancy; or if you are taking some types of steroid medications. There are a wide range of risk factors, and that's probably why we are seeing the incidence of this type of diabetes rise so quickly.

I do want to commend the work that is going into both diagnosing and treating this type of diabetes and helping pregnant women manage gestational diabetes through their pregnancy. It is obviously incredibly important that they do get access to some of the things that previous speakers have been talking about—the tools that help them manage their blood sugar levels and help them understand how diet and exercise may be part of this and how taking medication, if necessary, may be part of this. So it is entirely appropriate that today the House recognises the significance of it being 100 years since the discovery of insulin. This discovery by Frederick Banting all those years ago means that people in our community today can lead long and fulfilling lives with diabetes, and that is a wonderful thing. But, as previous speakers have said, we do have more work to do when it comes to both preventing, treating and supporting people with diabetes. That does include making sure that people have access to the support and technology they need. I commend the community campaign by Australians with type 1 diabetes to have continuous glucose monitoring technology included in the NDSS. That is a really important development.

We do need more focus on preventing type 2 diabetes. Unlike type 1 diabetes, there are factors that can be identified early. We need to really shift the discussion from treatment once diagnosed to understanding what causes type 2 diabetes and getting in early to prevent it. I hope that that's something that the people in this place can turn our attention to and that we can support health authorities and health systems across our country to make that shift to prevention so that we can treat this diabetes epidemic.

John Alexander (Bennelong, Liberal Party) Share this | Link to this | Hansard source

Diabetes is an epidemic in Australia. According to JDRF, 127,000 Australians are afflicted with type 1 diabetes. Around 25,000 Australians are in the early stages or are undiagnosed. JDRF believes diabetes cost the governments and individuals $2.1 billion in 2020 alone. These figures are staggering.

While the numbers are huge, it's pleasing to note that diabetes is treatable and, perhaps remarkably, has been for a century. Back in 1921 when the world was fighting the last global pandemic, Canadian surgeon Frederick Banting discovered insulin and worked out the important role it played in preventing diabetes. Banting and his colleagues won the Nobel Prize for the effort, and millions of people around the world would agree that they were incredibly worthy recipients. While this first breakthrough was incredible and comparatively trailblazing in our early understanding of medicine, the diabetes world has not stood still. Insulin has been synthesised, continuous glucose monitoring has come in, and we're starting to see the advent of continuous monitoring combined with automatic insulin pumps which will essentially function as artificial pancreases.

I'm happy to say that the technological boom which we have seen in recent years is centred in Macquarie Park in Bennelong. We're home to Abbott, who make their FreeStyle glucose monitors which are removing the constant finger prick blood tests which are the bane of diabetics' lives. We also have Medtronic, who make the first diabetes pump available in Australia. Johnson & Johnson, who make a variety of diabetes devices, is based in Bennelong. None of these devices are any good without insulin to deal with the condition, which is where our pharmaceutical companies come in. Again, Bennelong is home to some of the biggest players in this market. Sanofi is one of the largest global insulin manufactures, and Eli Lilly has been part of the synthetic insulin process since the very beginning.

Diabetes treatment is currently experiencing a technological revolution. Established therapies are changing the lives of people with diabetes. If anything, the speed of this revolution is creating problems, as our bureaucracy struggles to keep up with the huge pace of innovation. I have had representations from people seeking access to a Bluetooth enabled tube feed insulin pump, Omnipod, which was approved by the TGA over a decade ago but remains unavailable here in Australia. Until it is approved and on the prosthesis list, the only way to get the treatment is to travel to Dallas, Texas, after receiving special approval—a long, expensive and arduous journey both in the physical and bureaucratic sense. This is clearly not feasible for many people with this condition. This is an example but certainly not the only innovative medicine or treatment that is coming down the pipeline. We need to have a regulatory process that is transparent and more agile to ensure that Australians aren't continuing to miss out when life-changing treatments are made available.

That said, one of the great innovations in recent years has been continuous glucose monitoring, CGM. Continuous and flash glucose monitoring is clinically proven to reduce average blood glucose concentrations, helping patients maintain a healthy range and avoid hypo- and hyperglycaemic events. Better glucose control is associated with better health. JDRF suggests that every dollar spent on CGM provision comes back 1.5 times, which will also go a long way to making up the huge economic cost of diabetes in Australia. The CGM Initiative, which was introduced in 2017, provides fully subsidised CGM products to those people with highest clinical and financial need, with approximately half of all Australians with type 1 diabetes now eligible to receive these products completely free of charge.

The NDSS and CGM initiatives are underpinned by the Australian National Diabetes Strategy 2016-20, which was released on 13 November 2015. What is really required now is commitment and leadership to shift the standard of care from outdated technology to the new standard of care. The government is currently updating the strategy to ensure it remains current and adaptive to the changes in the health environment that have occurred since its release. It is anticipated the updated strategy will be available mid-2021— (Time expired)

Katie Allen (Higgins, Liberal Party) Share this | Link to this | Hansard source

The high quality of medical care we enjoy today is built on years of efforts of physicians, scientists, PhDs and other medical professionals investigating the causes of and potential treatments for disease. The tireless efforts of these professionals have changed diseases and conditions from life threatening to life changing, and one of these particular conditions is of course diabetes.

The story of the life-changing treatment for diabetes is really one of the extraordinary things we should celebrate in the history of medical research and, indeed, medicine. One hundred years ago it was very rare for someone with type 1 diabetes to live for more than one year, and I really welcome the member's motion with regard to raising awareness of this life-changing discovery for literally millions of people all around the world.

It was in 1921 that Canadian surgeon Frederick Banting, along with Professor John Macleod, medical student Charles Best and researcher Dr James Collip, discovered insulin. They were able to administer extracted insulin to Leonard, a 14-year-old boy at Toronto General Hospital, who lay dying from diabetes. Almost immediately, his condition dramatically improved. It must have been an incredibly extraordinary moment to see children almost rising from their beds. I understand that children were dying in Toronto hospital, and basically Banting, Best and Collip went from bed to bed of dying children, injecting the entire ward with insulin. Before they had reached the last child, some were literally awakening from comas. Every person in that room must have felt they were part of a miracle, a life-saving discovery for Leonard and for millions of others diagnosed with diabetes globally over the last century.

Banting and Macleod won the Nobel Prize in Physiology or Medicine in 1923, just two years later. It was an extraordinarily short period of time to be recognised for this extraordinary discovery. They shared their prize money with the student and researcher, Best and Collip, respectively, which is more than appropriate.

I will say as a paediatrician that, having seen the impact that diabetes can have on the lives of children, it is truly life-changing, and we must recognise that medical research has provided hope and life extension for this amazing condition that basically has changed from being one that kills children to one that completely supports them.

But of course diabetes is not just about type 1 diabetes, which is a condition that occurs early in life. We don't know why children develop type 1 diabetes. It's a very frightening condition. It has a very sudden onset and can become an emergency. Children can turn up in a coma in an emergency ward, and doctors have to work very quickly to save their lives. Of course, there's also another condition, which is called type 2 diabetes, and this is completely different. It has a later onset and is associated with increasing rates of obesity around the world. It is something that we can do more about preventing through actions taken to increase weight reduction and through other lifestyle factors such as improved exercise.

More than 1.4 million Australians suffer from diabetes, and that is why the government supports these Australians through the subsidy of essential medicines like insulin under the Pharmaceutical Benefits Scheme, and of other products through the National Diabetes Services Scheme, established in 1987. The NDSS, as it's known, provides reliable and affordable accession and products such as insulin, pen needles, pump consumables and glucose monitoring devices as well as education and support programs. The continuous glucose monitoring initiative was introduced in 2017 and provides fully subsidised continuous glucose monitoring products to those people so they don't have to test their blood with a finger prick. I can tell you that children love it. Finger pricks used to be the bane of families' lives, and to have this monitoring product really does bring comfort to millions of families with young children right around the world. I know so many families and friends affected by this.

The Australian government has invested over $300 million over four years in the CGM initiative for this life-changing product. We continue to improve our technologies, our devices and our approach to supporting diabetes because investing in health and medical research is a priority for the Morrison government. Research is a key pillar of our plan to help keep Australians safe. Just like Banting and Macleod, this investment continues to help millions of people around the world.

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

There being no further speakers, the debate is adjourned and resumption of the debate will be made an order of the day for the next sitting.