Diabetes

Diabetes prevalence is markedly higher in some population groups

• The prevalence of diabetes increased significantly with age, ranging from 0.2 percent in those aged 0–14 years to 18.7 percent in people aged 75 years and older.
• In 2024, diabetes prevalence varied more than three times by health district, ranging from 9.7 to 29.6 percent among people aged 65–74 years, and from 5.8 to 19.3 percent among those aged 45–64 years.
• Overall, the Pacific population had the highest estimated rate of diabetes at 12.6 percent, followed by the Indian population (8.7 percent) and the Māori population (7.2 percent). The European/other ethnic group had the lowest rate of diabetes at 5.8 percent.
• About 48.2 percent of Pacific peoples aged 65–74 years were estimated to have diabetes compared with 13.4 percent of European/other in the same age group.

More than two-thirds of people with diabetes regularly received hypoglycaemic medication

If haemoglobin A1c (HbA1c) in a person with diabetes does not meet an agreed target with dietary and lifestyle changes, drug therapy is recommended. Evidence suggests good glycaemic control benefits microvascular outcomes.[1]

Having comprehensive cardiovascular risk management for people with diabetes (such as blood pressure and lipid management) has been shown to improve macrovascular outcomes substantially while good glycaemic control has a smaller and very delayed effect.

Given both the lack of available data on clinical parameters and the inability to split data by diabetes type, medication indicators provide a high-level view. Wide variation may raise questions such as do health districts with lower-than-average rates of medication use have lower or higher rates of diabetes complications.

• About 67.3 percent of people with diabetes received any hypoglycaemic medication in 2024. Without HbA1c results available nationally it is not possible to infer appropriateness or otherwise, but age-specific variation may highlight areas for improvement.
• Use was highest for people aged 65–74 years (73.6 percent) and 0‒14 years (73.2 percent).
• Among people aged 65‒74 years with diabetes, rate varied more than 1.2 times by health district, between 67.8 to 82.8 percent.

Metformin dispensing has remained stable over time

Metformin remains the standard initial drug treatment for type 2 diabetes.

• In 2024, about 52.8 percent of people were regularly dispensed metformin; rates remained stable over time.
• Metformin dispensing increased with age: in 2024 11.5 percent of people aged 15‒24 compared with 61.2 percent of those aged 65–74 years.
• Males (56.6 percent) were more likely to regularly receive metformin than females (48.7 percent).

Vildagliptin dispensing has increased since 2019

• In 2024, 21.3 percent of people with diabetes received vildagliptin, a significant increase from 2019 (4.8 percent).
• Vildagliptin dispensing is highest among those aged 45–64 years (24.5 percent) and 65–74 years (23.9 percent).
• Rates varied by ethnic grouping, with Indian (29.5 percent) and Pacific (29.1 percent) aged 65–74 years more likely to regularly receive vildagliptin than other ethnic groups.
• Dispensing rates varied nearly two times by health district, ranging from 16.8 percent to 30.6 percent among people aged 45–64 years.

Dispensing sodium-glucose co-transporter 2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists varied significantly by health district

Newer medicines, including sodium-glucose co-transporter 2 (SGLT-2) inhibitors such as empagliflozin, have been available since February 2021. Glucagon-like peptide-1 (GLP-1) receptor agonists, such as dulaglutide, have been available since September 2021 and liraglutide since March 2023.

These medicines are fully funded for the treatment of people with poorly controlled type 2 diabetes (individuals with HbA1c levels > 53 mmol/mol) who are at high risk of, or have established cardiovascular disease, diabetic kidney disease or heart failure, or who are of Māori or Pacific ethnicity.

As these medicines are new and only funded for some people, interpret these rates with caution. Since we define regular dispensing as people receiving medication for three or four quarters in a year, it is possible to miss individuals who started these medicines later in the year.

• The regular dispensing of empagliflozin dispensing increased from 6.6 percent in 2021 to 18.2 percent in 2024.
• Rates were higher for people aged 65‒74 years (22.3 percent) followed by those aged 45‒64 years (21.6 percent).
• Dispensing rates were higher for males (21.6 percent) compared with females (14.5 percent).
• The regular dispensing of empagliflozin varied nearly two times by health district for those aged 45‒64 years, ranging from 14.6 percent to 26.3 percent.
• Dispensing GLP-1 agonists was 6.0 percent with a peak among people aged 45‒64 years (8.0 percent).
• Rates varied by ethnic groups. Māori aged 45‒64 years (13.2 percent) have higher rates compared with other ethnic groups (Pacific peoples at 6.4 percent, Indian population at 3.9 percent and European/other at 7.1 percent).
• Dispensing rates varied more than three times by health district, ranging from 4.8 percent to 14.9 percent among people aged 45‒64 years. 

Regular dispensing of sulfonylureas decreased over time

• In 2024, 8.8 percent of people with diabetes were dispensed sulfonylureas regularly, a significant decrease from 2019 (17.7 percent).
• Dispensing rates varied by age, with highest in the 65–74 years age group (10.5 percent).
• Among people aged 65–74 years, rates varied significantly by ethnic group. Indian (16.7 percent) and Pacific populations (15.7 percent) were significantly more likely to regularly receive sulfonylureas compared with Māori (9.5 percent) and European/Other (9.3 percent).
• Rates varied by health district, for example, among those aged 45–64 years, rates ranged from 4.7 percent to 14.5 percent.

Regular dispensing of insulin varied nearly two times by health districts

Insulin therapy is used for both type 1 and type 2 diabetes.

• There has been a gradual decline in regular dispensing of insulin since 2019.
• Overall, 18.2 percent of people with diabetes regularly received insulin in 2024, a decrease from 22.4 percent in 2019.
• Across all ages, European/other had the highest rate of insulin dispensing (19.8 percent) with the Indian ethnic group having the lowest (10.6 percent).
• Insulin dispensing was highest in the 0–14 and 15‒24-year age groups, with 69.3 and 50.1 percent respectively.
• Rates varied nearly two times by health district, ranging from 13.9 percent to 26.3 percent among those aged 65-74 years.

Intensive management of high blood pressure and microalbuminuria

Intensive management of blood pressure and microalbuminuria is recommended to prevent progression of renal disease in diabetes. ACEI and ARB medicines are first-line treatments. The younger the age at diagnosis, the greater the impact of diabetes on life expectancy; this highlights the importance of glycaemic control, blood pressure management and prevention of kidney disease in younger people with diabetes.

• In 2024, about 51.9 percent of people aged 25 years or above with diabetes regularly received angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB) medicines. This is a slight reduction from 53.6 percent in 2019.
• Overall, rates varied 1.2 times by health district (49.0‒59.1 percent).

Māori and Pacific peoples have higher rates of ACEI or ARB medicine use at a younger age (25-44 years); however, some data also shows these populations have significantly higher rates of end-stage renal disease. A recent publication from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) found that Māori and Pacific peoples in Aotearoa New Zealand are at a significantly heightened risk of succumbing to the impacts of diabetic kidney disease reaching kidney failure (Māori 65 percent, Pacific peoples 67 percent), a two-fold greater likelihood than non-Māori non-Pacific (29 percent).[2]

Complications – hospital admissions for diabetic ketoacidosis and hypoglycaemia varied by age

• Nationally, the highest rates for admission to hospital for diabetic ketoacidosis were among those aged 0–14 years (9.9 percent), followed by 15–24 years (4.7 percent).
• At all ages, Māori (0.63 percent) experienced higher admission rates followed by European/other (0.33 percent) and Pacific peoples (0.26 percent).
• The rates for admission to hospital due to hypoglycaemia was also highest in the youngest age group although the count of people was highest in those aged 75 years and over. There has been a reduction in admissions to hospital for hypoglycaemia in those aged 15–24 years since 2019. 

Complications – lower-limb amputations increased with age

• In 2024, nearly 1,200 lower-limb procedures were performed among those with diabetes. Although this is a rare complication affecting only 0.2 percent of the diabetes population in a year, in 2024, this meant 785 people lost part of a lower limb due to their diabetes, 199 of whom underwent major amputation and 586 underwent minor amputation. More detailed information on major and minor amputation levels is available elsewhere.[3]
• Lower-limb amputation rates increased significantly with age, with 92 percent occurring in those aged 45 years and over.
• In 2024, males (0.3 percent) were more likely to undergo lower-limb amputations than females (0.1 percent).

Note this indicator counts people with diabetes who had one or more amputations in a year. Our analyses excluded people who died during the year. Also, if someone had multiple amputations within the year, they are counted only once.

People with diabetes occupied more bed-days for any reason

This indicator measures the number and percentage of medical and surgical bed-days occupied by people with diabetes (for any reason), compared with total occupied medical and surgical bed-days.

• Age had a significant effect on occupied bed-days: 1.8 percent among those aged 0–14 years with diabetes, increasing to 34.8 percent among those aged 65–74 years.
• Among all age groups, people with diabetes occupied 26.3 percent of total bed-days, despite a population prevalence of diabetes of 6.6 percent. Part of the difference is explained by the older age profile of people with diabetes and the strong link between age and bed-day use.
• Bed-day use exceeded prevalence among all ethnic groups: for example  among those aged 65–74 years, Indian (69.9 percent bed-days vs 45.3 percent prevalence), Pacific (67.0 percent bed-days vs 48.2 percent prevalence), Māori (45.8 percent bed-days vs 28.3 percent prevalence),  and European/Other (28.5 percent bed-days vs 13.4 percent prevalence).

Regular laboratory testing was lowest for screening renal disease (ACR)

The Laboratory Claims Collection includes tests performed in the community. The exclusion of hospital and point-of-care tests will under-count testing and may affect results more in some districts than in others. Some districts in the Laboratory Claims dataset also had incomplete data, with dramatically lower test volumes than expected. We excluded districts with a significant drop in data volumes for more than two months within the year, as this pattern indicates incomplete or unreliable data rather than genuine changes in service use.

We analysed rates for people with diabetes who received one or more laboratory tests in a year for HbA1c, albumin:creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR).

In 2024, 84.2 percent of people with diabetes received an HbA1c test, 62.8 percent an ACR test and 83 percent an eGFR test.

Rates differed by ethnic grouping for certain tests. For example, Māori (57.3 percent) and European/Other (61.9 percent) were significantly less likely to have undergone ACR testing, compared with those of Indian (69.3 percent) and Pacific populations (68.8 percent). From 2019 through to 2024 for all age groups, men were more likely to have regular ACR testing compared with women. 

Table 1 shows the percentage of people with diabetes receiving all three tests by age and ethnic group (2024).

Table 1: Percentage of people with diabetes receiving all three tests for HbA1c, ACR and eGFR, by age and ethnic group, New Zealand, 2024

Ethnic group	Age group (years) (%)
	25 - 44	45 - 64	65 - 74	75+	Total
Māori	44.2	58.2	61.9	57.5	55.1
Pacific peoples	55.3	72.2	74.3	65.5	67.5
Indian	54.7	74.5	76.4	66.8	67.7
European/other	48.4	62.3	65.6	58.1	59.8
Total (including those under 25 years)	50.1	64.3	66.9	59.0	60.9

Limitations

The Pharmaceutical Collection contains claim and payment information from community pharmacists for subsidised dispensing. This collection does not indicate whether a medicine was taken or whether the dose was effective. Over-the-counter medicines are not included. Note our definition of regular medication use only includes people receiving medication for three or more quarters in a year. It should be noted that we did not consider people who initiate medication later in the year. 

In selecting indicators for oral hypoglycaemic medication use, the expert advisory group for this Atlas domain decided to focus on medicines like metformin, sulfonylureas, vildagliptin, empagliflozin and GLP-1 agonists as the medicines for people with type 2 diabetes and insulin as the key medication for people with type 1 diabetes. 

There is no ideal rate of medicine use in people with diabetes because it depends on clinical need. However, wide variation between districts or ethnic groups raises questions as to why the rate of medicine use varies.

Analysis does not split by type of diabetes

There were some limitations as to what measures could be presented. It was not possible to reliably split people by type of diabetes; hence the indicators represent a combination of those with type 1 and type 2 diabetes. Generally, most people with diabetes aged 0–24 years will have type 1 diabetes, while around 90 percent and over of those aged 25 years and above will have type 2 diabetes.  

The method used in the VDR to identify people with diabetes is less accurate at identifying children than adults with diabetes. Local district data may be a better source for identifying prevalence in children. The National Diabetes Register is currently under development. Once it is live, it will be possible to split results by type 1 and type 2 diabetes.

Some important outcome indicators could not be includedSome important outcome indicators could not be included

Due to limitations in currently available data, we could not explore certain outcome indicators, including screening for diabetic retinopathy, retinopathy rates and end-stage renal failure. Outcome indicators, including myocardial infarction rates, stroke and other cardiovascular outcomes, are not included in this version of the diabetes Atlas domain, but are likely to be included in future updates. We encourage users to investigate local data in relation to these outcomes to promote improvement and equity initiatives at PHO and general practice level.