Aboriginal and Torres Strait Islander Health Performance Framework - 2010
Why is it important?:Diabetes is a long-term (chronic) condition in which blood glucose levels become too high because the body produces little or no insulin, or cannot use insulin properly. Over many years, high blood glucose levels can damage various parts of the body, especially the heart and blood vessels, eyes, kidneys and nerves, resulting in permanent disability, reduced quality of life and shortened life expectancy. High blood glucose levels can cause complications for both the mother and baby during pregnancy. Diabetes is responsible for 12% of the health gap between Indigenous and non-Indigenous Australians (Vos et al. 2007). Diabetes prevalence is higher for Indigenous Australians than non-Indigenous Australians in every socioeconomic status group, often by a considerable margin (Cunningham 2010:s21). Prevention, early detection and better management of diabetes will be important in closing the gap in life expectancy.
There are several forms of diabetes. The most common form is Type 2, which accounts for 85–90% of all people with diabetes and is more common in people who are physically inactive, have a poor diet, and are overweight or obese. Other factors such as smoking and excessive alcohol consumption, low birthweight and intra-uterine factors are also associated with increased risk of developing Type 2 diabetes. Type 2 diabetes is a significant contributor to morbidity and mortality for Aboriginal and Torres Strait Islander peoples. Type 1 diabetes, the most common form of diabetes in children, is generally thought to be rare among Aboriginal and Torres Strait Islander peoples although misclassification problems with Type 2 diabetes make this difficult to ascertain (AIHW 2002b).
Findings:Measuring population levels of diabetes is difficult given the high rate of undiagnosed diabetes. The 2011–13 Australian Health Survey will include blood tests for measuring estimated diabetes prevalence. For this report, indirect measures of diabetes prevalence are explored.
In 2004–05, 6% of Indigenous Australians reported diabetes or high sugar levels. Diabetes was almost twice as likely to be reported by Indigenous Australians in remote areas (9%) as non-remote areas (5%). After accounting for age differences between the two populations, Indigenous Australians were more than 3 times as likely as non-Indigenous Australians to report some form of diabetes. For Indigenous Australians, diabetes problems start in younger age groups with higher rates of self-reported diabetes emerging from 25 years onwards. Diabetes or high sugar levels were reported for 32% of Indigenous Australians aged 55 years and over compared with 12% of non-Indigenous Australians. Rates have increased since 1995. There was a statistically significant relationship between prevalence of diabetes and selected social determinants of health and risk factors such as weight and diet (see Tables 4 and 5).
Indigenous mothers were more likely to experience pre-existing diabetes affecting pregnancy (3 to 4 times the non-Indigenous rate) and Gestational Diabetes Mellitus (GDM) (twice the non-Indigenous rate). Indigenous mothers with pre-existing diabetes were more likely to deliver pre-term (32%), compared with Indigenous mothers with GDM (14%) and Indigenous mothers without diabetes (13%) (AIHW 2010c).
The prevalence of diabetes among Indigenous Australians in selected remote communities was 5 to 10 times as high as the general community (Hoy et al. 2007; Kondalsamy-Chennakesavan et al. 2008; Zhao et al. 2008). A New South Wales study of young people aged 10–18 years found incident rates for Indigenous children to be 6 times the rates for non-Indigenous children (Craig et al. 2007). An analysis of the Fremantle Diabetes Study found diabetes prevalence for Aboriginal people to be more than double the rate for non-Indigenous Australians, with average age at diagnosis 14 years younger (Davis et al. 2007).
Hospitalisation rates for principal diagnosis of diabetes are 4 times as high for Indigenous Australians as for other Australians, and are higher in all jurisdictions with adequate data quality. Around 84% of diabetes related hospitalisations for Indigenous Australians relate to Type 2 diabetes and 15% to Type 1 diabetes. An additional 1,554 hospitalisations for women were for gestational diabetes. Hospitalisation rates for diabetes have increased significantly in recent years for both Indigenous and non-Indigenous Australians and the gap has widened. Deaths due to diabetes were around 7 times higher for Indigenous Australians than other Australians. Diabetes is identified as a problem in around 6% of general practice encounters with Aboriginal and Torres Strait Islander people, which is over 3 times the rate of other patients.
Implications:Diabetes is more common among Indigenous Australians than other Australians, as measured by self-reported prevalence and GP consultations. Hospitalisations and death rates for diabetes are both high pointing to possible issues in secondary prevention. Challenges for decision makers include maintaining a policy emphasis on primary prevention (nutrition, physical activity, smoking, alcohol) whilst implementing strategies to achieve effective secondary prevention (primary care, blood sugar control) and appropriate acute care to treat serious complications as they arise. More research is required on the most effective mechanism for achieving early detection and ongoing management of the condition (see measures 3.03 and 3.04). Indigenous Australians do not constitute a homogenous group with respect to socioeconomic status or diabetes prevalence, and this diversity must be recognised in developing measures to redress Indigenous health disadvantage (Cunningham 2010). The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (COAG 2008c), sets priorities for preventive health measures designed to reduce the factors that contribute to chronic disease, and expanded access to and coordination of comprehensive primary health care to improve detection and management of chronic diseases. The Coordinated Care for Diabetes pilot will commence from 1 July 2011, as part of the National Health Reform. The pilot will fully road-test the initiative to confirm the reform’s practical design and make sure it achieves the best outcomes for people with diabetes. The National Partnership Agreement on Preventive Health (COAG 2008d) will introduce initiatives addressing lifestyle risks associated with chronic disease through healthy lifestyle programs in workplaces, communities, schools and early childhood settings. Programs will focus on increasing physical activity, improving nutrition, decreasing harmful alcohol intake and smoking cessation.
Table 14 – Percentage Aboriginal and Torres Strait Islander peoples reporting diabetes/high sugar levels, by remoteness, 1995, 2001 and 2004–05
Source: ABS & AIHW analysis of 1995 and 2001 National Health Surveys (Indigenous supplements) and 2004–05 National Aboriginal and Torres Strait Islander Health Survey
Figure 20 – Percentage of persons reporting diabetes/high sugar levels, by Indigenous status and age, 2004–05
(a) Total is age-standardised
Source: 2004–05 National Aboriginal and Torres Strait Islander Health Survey and 2004–05 National Health Survey
Text description of figure 20 (TXT 1KB)
Figure 21 – Age-standardised hospitalisation rates for a principal diagnosis of diabetes, by Indigenous status Qld, WA, SA and NT, age-standardised, 2001–02 to 2007–08; NSW, Vic. Qld, WA, SA, NT 2004–05 to 2007–08
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 21 (TXT 1KB)
Figure 22 – Age-specific hospitalisation rates for a principal diagnosis of diabetes, by Indigenous status, NSW, Vic., Qld, WA, SA and NT, July 2006 to June 2008
Source: AIHW analysis of National Hospital Morbidity Database
Text description of figure 22 (TXT 1KB)
Table 15 – Diabetes problems managed by GPs, by Indigenous status of patient, 2004–05 to 2008–09
Rate per 100 encounters (age adjusted)
|Total diabetes (excluding gestational)|
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