Diabetes care in remote northern Australian Indigenous communities

Robyn Anne McDermott · Fiona Tulip · Barbara Schmidt

57 citations0/0 files storedThe Medical Journal of Australia

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Indigenous Health, Education, and Rights Diabetes Management and Education Indigenous Health and Education

Abstract

OBJECTIVE: To assess primary care processes and clinical characteristics of adults with diabetes in remote northern Australian Indigenous communities. DESIGN: Clinical audit from diabetes registers in 21 remote primary healthcare centres in the Torres Strait Health Service District (n = 921), three in Cape York, Queensland (n = 252), and three in the Northern Territory (n = 194), between September 2002 and February 2003. PARTICIPANTS AND SETTING: Aboriginal and Torres Strait Islander adults with diabetes who were receiving their routine diabetes care in these 27 centres. MAIN OUTCOME MEASURES: Provision of regular checks for weight, blood pressure, glycaemia (HbA(1c)), proteinuria, lipid levels, renal function, eyes and feet, influenza and pneumococcal vaccination. Weight, blood pressure and glycaemic control. RESULTS: Most routine diabetes checks were delivered according to recommended schedules, except for eye and foot checks in the NT. There were uniformly high rates of appropriate treatment for hypertension and albuminuria, but low rates of insulin treatment and self-monitoring despite a high mean HbA(1c) level (8.9%). Vaccination rates were low in the NT. Torres Strait Islanders with diabetes were significantly heavier than Aboriginals, but had lower mean diastolic blood pressure (77.3 mmHg compared with 79.5 mmHg) and lower prevalence of albuminuria and smoking. CONCLUSION: A high proportion of Aboriginals and Torres Strait Islanders requiring treatment for high blood pressure and proteinuria are receiving it. However, there is dissonance between the relatively high rates of routine checks and apparent lack of therapeutic action on glycaemia. More intensive management of glycaemia, including improved nutrition, exercise and (probably) insulin, is required to reduce microvascular complications.

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References

1999The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples 1999

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2009Diabetes care and health status of First Nations individuals with type 2 diabetes in Alberta.2006Characteristics and outcome of type 2 diabetes in urban Aboriginal people: the Fremantle Diabetes Study 2005Toward health and wellbeing for indigenous Australians 2012Getting better at chronic care in remote communities: study protocol for a pragmatic cluster randomised controlled of community based management 2007Partnership approach to Indigenous primary health care and diabetes: a case study from regional New South Wales 2019Understanding lived experiences of Aboriginal people with type 2 diabetes living in remote Kimberley communities: diabetes, it don’t come and go, it stays!

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