Diabetes in New Zealand

We are pleased to present our first stop on our traveling with diabetes tour: New Zealand. We had the pleasure of meeting with the Diabetes New Zealand Waikato branch president, Murray Dear, and field officer, Angélica von Reitzenstein, a few weeks ago. They provided us with a window into what life is like with diabetes for New Zealanders.

What is Diabetes New Zealand and how do you help people with diabetes?

We are the support organization for people affected by diabetes in New Zealand. This includes people who have diabetes and their immediately family members and carers. We don’t provide any clinical support – we leave that to the professionals – but we are here to provide non-clinical support in the form of guidance, education, and advice. Specifically, our mission is to provide support to all New Zealanders with diabetes or at high risk of developing type 2 diabetes to live full and active lives.

Our office is a focal point for people to come and get information about diabetes, particularly the newly-diagnosed. We offer support groups, a magazine and we have small shop with diabetes-related products. We also help organize supermarket tours and advocate for people with diabetes. Angélica sees people via individual appointments and we also participate in diabetes research in conjunction with research institutions. At the moment, we’re just finishing November, which is our diabetes awareness month.

What outreach methods do you use?

Most people are self-referred, but some of them come referred by the nurses because our primary care practitioners know we are here. When they have patients that need more explanation, they send them to us. Most of the time, we help a lot of people with their diet.

Do you receive any private or public funding?

We don’t receive any public funding. In New Zealand, all of the money for diabetes goes to clinical funding. Not for support. Our national office gets some funding from the government to cover basic costs, but none of that trickles down to us.

We did receive a very small grant to help us with some costs for diabetes awareness month, but we basically rely on grants, donations, raffles, you name it. It’s always an effort. That funding also has to cover the costs of the annual camp we run for children with type 1 diabetes. That’s another fairly significant expense that we have to raise money for.

Could you briefly describe the panorama of diabetes and diabetic care in New Zealand?

At the moment, there are over 250,000 people diagnosed with diabetes in New Zealand and that has increased from 125,000 in the last ten years. There is also another 900,000 people that have been identified as being at risk of developing diabetes within the next ten years. And these are the people that have either pre-diabetes or some other metabolic disorder. So we have a big and “growing bigger” problem in New Zealand. Of those 250,000, 90% are type 2 and 10% are type 1. There is a small group with gestational diabetes and even though that usually clears up after pregnancy, these women are usually at higher risk of type 2 diabetes later in life as well. So our job is an uphill fight.

The standard of health care that we have in New Zealand is pretty good. The government funds all public health care. We do have private providers which people can see, but that is supplementary. The waiting time isn’t too bad. Our health care system is underfunded, but then again you could throw the whole gross domestic product at health and there still wouldn’t be enough money. But we do not have people dying on the streets from complications related to diabetes. They do not go unattended.

Everybody with diabetes is entitled to an annual diabetes review as well. It includes blood tests and a microfilament test on your feet, all free of charge. Everybody who has diabetes should also have their eyes screened at least every two years and that’s funded through the health system too.

Do patients pay for their insulin, glucose meter and other related diabetes care products?

All diabetes medications are partially subsidized by the government. If you needed to see your doctor, there would be a doctor’s fee, but that’s actually subsidized by the government too. When you get a script (prescription), there is a fee of $5 NZD per script, but that’s up to a maximum of 20 scripts in any one year. So $100 NZD is the maximum that you would pay. Anything over that is no charge. So if you’re on insulin, it doesn’t take long to reach your quota. While it’s not fully subsidized, the standard is pretty good compared to a lot of other countries.

The glucose meters are available for people with type 1 diabetes free of charge. Otherwise, there is a small cost. If you have insulin or if you are a type 2 taking sulphonylureas tablets, eg. Gliclazide you can have as many test strips as you want. If you have type 2 diabetes and need to take biguanides, eg. Metformin or on no meds, then you get one box of fifty strips every three months so there are some limits on how much you can have.

What could be improved about diabetes health care in New Zealand?

We have access to all established oral medications, but there are some new treatments like DPP-4 inhibitors or Januvia, for example, which are in New Zealand, but they’re not funded yet.

We also know that there are a lot of people who are pre-diabetic. They are at risk of developing diabetes and there is no government funding to undertake risk assessments and to follow-up with these pre-diabetics. And because it’s only prevention, their amount of time with a nurse is quite limited, so those are a lot of the ones who come through our doors. We have a pre-diabetes handbook and a know-your-risk factors guide, but we could be doing more.

Do you think the people of your country are well-informed about diabetes?

There is a large percentage of the New Zealand population that has little or no knowledge of diabetes. Our task is to keep the people who are diagnosed as well self-managed as possible. Over the last two years, we’ve run a diabetes action month where we go out and we give diabetes awareness a good push. But we have limited resources. So no, the average New Zealander is not well-informed about diabetes even though we try hard.

What specific resources do you offer to diabetics who would like to travel?

The national Diabetes New Zealand website provides information on how to transport and store your medications while traveling. If you speak with your doctor about your travel plans, there is a lot of flexibility and understanding. The maximum they can give you is a three months supply of medication, but they do write comprehensive letters about the treatment for diabetes and the concentration of the insulin required. You can get some things here, but for a longer journey, you get the insulin in the country where you go. You just need to go to the pharmacy in the country and ask. You would have to pay for the insulin in another country, but you can get it.

If a foreign person is traveling with diabetes in New Zealand, you can go to emergency services in the town where you are. You would pay a fee, around $40, and then you would be assisted and attended accordingly. If your insulin comes from another country, our endocrinologists are fully informed about making scripts to coincide with the concentration and type of insulin you need.

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