Behavioural innovation is key to improving the health of one million Australians living with type 2 diabetes

I appreciate Zimmet and colleagues’ letter on my Perspective.1 I commend their exemplary leadership of the development of the National Diabetes Strategy (NDS).2 The NDS is instrumental in ensuring that diabetes is on the national agenda, and enables us to hold the government accountable for prioritising and improving the health and quality of life of people with diabetes.

I thank Zimmet and colleagues for highlighting that the comprehensive advice of the NDS Advisory Group was cautiously edited, particularly in relation to recommendations. I note the detailed document is now available publically,3 but remain somewhat circumspect. For example, Goal 3 is to “reduce the occurrence of diabetes-related complications and improve quality of life among people with diabetes”. The key areas for action include “expand consumer engagement and self-management” and “provide mental health care for people with diabetes,” yet the potential person–level metrics for evaluating this goal refer only to the percentage of people receiving complication screening, the percentage of people achieving biomedical targets, and the incidence of complications; quality of life is not evident.

As I wrote in a previous article,4 “what gets measured gets done,” so I urge those currently considering the implementation of the NDS to think carefully about the metrics to be implemented. Quality of life is not just a buzz word, and HbA_1c levels and other biomedical indices are not proxy measures of quality of life. If we value quality of life but do not measure it, how will we know if it has improved or needs further improvement?