Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012

Tier 1—Health conditions—1.09 Diabetes

The HPF was designed to measure the impact of the National Strategic Framework for Aboriginal and Torres Strait Islander Health (NSFATSIH) and will be an important tool for developing the new National Aboriginal and Torres Strait Islander Health Plan (NATSIHP).

Page last updated: 15 November 2012

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, mental health problems, reduced quality of life and shortened life expectancy (AIHW 2008c). 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). The prevalence of diabetes is higher among Indigenous Australians than non-Indigenous Australians in every socioeconomic status group, often by a considerable margin (Cunningham 2010). 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 accounted for 83% of all diabetes in Australia in 2004–05. It is more common in people who are physically inactive, have a poor diet, and are overweight or obese (AIHW 2008c). Type 2 diabetes is a significant contributor to morbidity and mortality for Aboriginal and Torres Strait Islander peoples. The Well Person’s Health Check study (1998–2000) demonstrated that more than one-third of Aboriginal and Torres Strait Islander peoples with diabetes did not eat enough serves of fruit, more than 55% did not do enough exercise and a high proportion of Aboriginal and Torres Strait Islander males (48%) and females (36%) with diabetes smoked tobacco (McCulloch et al. 2003). Other factors such as heredity, low birthweight, intra-uterine factors and excessive alcohol consumption are also associated with increased risk of developing Type 2 diabetes.Top of page

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 2012–13 Australian Health Survey will include blood tests for measuring diabetes prevalence. This information will be used in conjunction with self-reported data. 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 three times as likely as non-Indigenous Australians to report some form of diabetes. For Indigenous Australians, diabetes problems often 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. There was a statistically significant relationship between prevalence of diabetes and selected social determinants of health and risk factors such as unemployment, weight and diet.

In 2005–07, Aboriginal and Torres Strait Islander mothers were more likely to experience pre-existing diabetes affecting pregnancy (3 to 4 times the non-Indigenous rate) and to develop 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 2010d).Top of page

The prevalence of diabetes among Indigenous Australians in selected remote communities was five to 10 times as high as in the general community (Hoy et al. 2007; Kondalsamy-Chennakesavan et al. 2008; Zhao et al. 2008). A NSW study of young people aged 10–18 years found the incidence rate for Indigenous children to be 6 times the rate 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). An 11-year prospective cohort study of 686 Indigenous Australians in a remote NT Indigenous community found that half of Indigenous men and 70% of Indigenous women were at risk of developing diabetes by age 60 (Wang et al. 2010a).

BEACH survey data collected from April 2006 to March 2011 suggest that 5% of all problems managed by GPs among Aboriginal and Torres Strait Islander peoples were for diabetes. Approximately 96% of problems managed for diabetes among Indigenous Australians were for Type 2 diabetes. After adjusting for differences in the age structure of the two populations, GPs managed diabetes problems among Indigenous patients at 2.6 times the rate that they did for other Australian patients.

In the period 2008–10, hospitalisations with a principal diagnosis of diabetes were four times as high for Indigenous Australians as for other Australians. Around 84% of hospitalisations for diabetes among Indigenous Australians were for Type 2 diabetes, 15% for Type 1 diabetes and a further 13% for diabetes during pregnancy. Hospitalisation rates for diabetes have increased significantly for both Indigenous and non-Indigenous Australians. Hospitalisation rates were higher for those living in remote areas (22 per 1,000 in remote areas and 19 per 1,000 in very remote areas) than in major cities (9 per 1,000). Complications of diabetes such as lower limb amputations have been found to be more common among Indigenous Australians than non-Indigenous Australians (Health WA 2008).

During the period 2006–10 in NSW, Qld, WA, SA and the NT combined, approximately 8% of Indigenous deaths were due to diabetes, and death rates from diabetes were 7 times the non-Indigenous rate.Top of page

Implications:

Diabetes is more common among Aboriginal and Torres Strait Islander peoples 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 (such as primary care including allied health, and blood sugar control) and appropriate acute care to treat serious complications as they arise. Aboriginal and Torres Strait Islander peoples do not constitute a homogeneous 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). Family centred approaches that support the knowledge base for effective self management are recommended (Griew et al. 2007; NHMRC 2005).

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 Diabetes Care Project pilot commenced on 1 July 2011, as part of National Health Reform. The pilot will road-test revised care arrangements to confirm their practical design and make sure they achieve the best outcomes for people with diabetes. The National Partnership Agreement on Preventive Health (COAG 2008d) includes initiatives addressing lifestyle risks associated with chronic disease through healthy lifestyle programs in workplaces, communities, schools and early childhood settings. Programs focus on increasing physical activity, improving nutrition, decreasing harmful alcohol intake and smoking cessation.Top of page
Figure 35—Proportion of Indigenous Australians reporting diabetes/high sugar levels, by sex and remoteness, 2004–05
Figure 35—Proportion of Indigenous Australians reporting diabetes/high sugar levels, by sex and remoteness, 2004–05
Rates are age-standardised
Source: ABS and AIHW analysis of 2004–05 NATSIHS
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Figure 36—Proportion of persons reporting diabetes/high sugar levels, by Indigenous status and age, 2004–05
Figure 36—Proportion of persons reporting diabetes/high sugar levels, by Indigenous status and age, 2004–05
Source: 2004–05 NATSIHS and 2004–05 NHS
(a)Total is age-standardised
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Figure 37—Age-standardised hospitalisation rates for diabetes, by Indigenous status
Figure 37—Age-standardised hospitalisation rates for diabetes, by Indigenous status
Source: AIHW analysis of National Hospital Morbidity Database
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Figure 38—Age-specific hospitalisation rates for diabetes, by Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to June 2010
Figure 38—Age-specific hospitalisation rates for diabetes, by Indigenous status, NSW, Victoria, Qld, WA, SA and the NT, July 2008 to June 2010
Source: AIHW analysis of National Hospital Morbidity Database
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