Diabetes is a complex chronic disease associated with serious complications like cardiovascular disease, neuropathy, retinopathy, and kidney disease. Early and comprehensive care planning is essential. Clinical guidelines suggest that individuals who are newly diagnosed with type 2 diabetes receive multidisciplinary care, which involves general practitioners (GPs), nurses, and allied health professionals like dietitians, credentialed diabetes educators, and exercise physiologists. This model is supported by Medicare-funded Chronic Disease Management (CDM) services, which support GP management plans (GPMPs), team care arrangements (TCAs), and up to five allied health visits annually in Australia. The extent to which these services are used specifically in the early phase after diagnosis remains unclear. This study aimed to evaluate the use of CDM services among individuals with newly diagnosed diabetes and to detect factors influencing progression through multidisciplinary care pathways.
The study used data from the Sax Institute’s 45 and Up Study, a large cohort of over 267,000 adults aged 45 years and older in New South Wales, Australia. Participants were recruited from 2005 to 2009 and consented to long-term follow-up and linkage to administrative health records. Baseline survey data were linked to Medicare claims (MBS), prescription data (PBS), hospital admissions, and National Diabetes Services Scheme (NDSS) registrations for this analysis. The final sample included 12,694 community-dwelling individuals newly diagnosed with diabetes between 2011 and 2017, detected using a validated algorithm. The observation period covered 36 months (12 months before and 24 months after diagnosis). CDM service use was assessed in 3 stages: receipt of a GPMP, receipt of both GPMP and TCA, and use of allied health services. Sociodemographic and clinical characteristics were analyzed. Logistic regression models were used to identify factors linked to service use, with results reported as adjusted odds ratios (aOR) and 95% confidence intervals (CI).
The study population was balanced by sex (51.7% male), predominantly older (73.2% aged ≥60 years) and largely affected by overweight or obesity (76%). A substantial proportion were receiving medications for diabetes (63%), hypertension (74.1%), and high cholesterol (61.1%), which indicates a high burden of comorbidity. Although access to primary care was high, with 99.8% having at least one GP consultation, only 67.9% received a GPMP, and 61.0% progressed to both a GPMP and TCA within two years of diagnosis. Allied health service use was lower, with only 45.8% accessing at least one service. Among those with both a GPMP and TCA, 75.1% used allied health services; however, only 24.1% of the total sample had five or more visits. A total of 30,715 allied health claims were recorded, with 67% attributed to podiatry and physiotherapy. Podiatrists were the most frequently accessed providers (26.3%), followed by dietitians (16.9%), while credentialed diabetes educators were the least utilized (6.0%).
Regression analysis showed that women, individuals aged ≥75 years, English speakers, and those with obesity, comorbidities, or a family history of diabetes were more likely to receive GPMPs and progress by care pathway (aOR: 1.14-2.96). Socioeconomic disadvantage was linked to higher rates of GP care planning but did not consistently translate into greater allied health use. Individuals living in remote areas had significantly lower odds of accessing allied health services (aOR: 0.29), which highlights geographic inequities. These findings were consistent in sensitivity analyses.
Overall, there is substantial underutilization of Medicare-funded CDM services in individuals with newly diagnosed diabetes, specifically for allied health services that are critical for lifestyle and self-management support. Significant drop-offs occur at each stage of care, which indicate missed opportunities for early intervention. Disparities based on gender, geography, and patient characteristics underscore inequities in access. Addressing these gaps will need increased funding, improved referral practices, and enhanced accessibility, specifically in rural and remote areas.
Reference: Cox E, Gale J, Walker P, Meyerowitz-Katz G, Parr EB, Colagiuri S, Nassar N, Gibson AA. From referral to reality: utilisation of Medicare-funded allied health services among people with newly diagnosed diabetes. Aust J Prim Health. 2026;32:PY25240. doi:10.1071/PY25240
