Rigorously measured outcomes are scarce in local healthcare systems, especially for cost-effectiveness in prevention of common disorders.

A seminal paper by Crampton and colleagues (published in the 2 April 2004 issue of the NZMJ)1 is valuable—although it went largely unnoticed. It thoroughly canvassed important criteria for primary care indicators. Diabetes is used as an example. Diabetes also crosses into a secondary care prevention indicator of high-cost ‘open-ended’ hospital admissions being an objective international indicator.2

There are other compelling reasons why diabetes is New Zealand’s best performance indicator. For example, in USA a well as New Zealand, diabetes is ranked first because of its killing propensities.3 In addition, in a New Zealand survey, 210,000 diabetes patients and their families are involved with 14% of the overall hospital costs.

Prevention and better quality care could reduce these costly hospitalisations5,6 and half of the cases of kidney failure and dialysis could be prevented,4,5 by better use of diabetes performance indicators. The same applies for coronary disease, blindness, and amputations if there was more investment in moving upstream.3,7

Insulin resistance and pre-diabetes may be present for 20 years before a diabetes diagnosis is made—often itself delayed 12 years or more. Upstream screening of blood sugars thus becomes a key indicator in a common disorder.8

Eight percent of adults had undiagnosed diabetes in the Ausdiab Study; and unknown rates of diabetes will prove to be an unsustainable cost in New Zealand.9 Raised blood glucose is also a key indicator for morbidity, and all cause mortality as well as the earliest predictor of preventable cardiovascular diseases.10

New Zealand’s yearly ‘get checked’ programme (3 years’ stored results) yields a unique continuing data set. Those persons with diabetes want these 12 digitally transmissible items used.

Health systems should maintain wellness in the clash between financially imposed environments and our ‘hunter-gatherer’ genes. Diabetes can be used (via these health systems) as an ideal performance indicator of accomplishment spanning primary, secondary, and tertiary preventions—and to monitor social community and educational inputs to health preservation.

Murray Dear
President

Sarah Thomson
CEO