Key resources
Bibliography
Health promotion
Yarning places
message stick
Programs
Organisations
Conferences
Courses
Funding
Jobs
Key resources
Please select category from the dropdown list below.
There are several types of diabetes, of which the most frequently occuring are type 1, type 2 and gestational diabetes mellitus (GDM) [1]. Type 1 diabetes is relatively rare in the Indigenous population, but type 2 diabetes represents a serious health problem for Indigenous people, who tend to develop it at earlier ages than do other Australians, and often die from it at younger ages [2]; GDM, which can occur during pregnancy, is more common among Indigenous women than among non-Indigenous women [3].
Statistics on diabetes incidence, prevalence, hospitalisation, and mortality among the Indigenous population are often underestimated for several reasons, including under-identification of Indigenous status, and information only being collected routinely for types of diabetes that require insulin treatment [1]; self-reported diabetes data may underestimate the prevalence of diabetes by up to 50% [4].
Diabetes can lead to life-threatening health complications, some of which may develop within months of diagnosis while others may take years to develop [5]. Complications of diabetes include disease of the large blood vessels (macrovascular), which can cause heart disease and stroke, and disease of the small blood vessels (microvascular), which can cause eye disease and peripheral nerve disease. For many Indigenous people, diabetes is not diagnosed until after complications have developed; when diagnosis occurs in the presence of end-stage disease it results in higher death rates, a greater dependency on tertiary level care, and higher health care costs [6].
The most recent analysis of diabetes incidence in Australia was undertaken by the AIHW in 2009 using data from Australia’s National Diabetes Register (NDR), which applies to all Australians who have commenced using insulin for diabetes since 1999 [1]. Recording of Indigenous status was poor prior to 2005, so analysis of the data including Indigenous status is for 2005-2007 only. Only a small proportion of people with type 2 diabetes and GDM require insulin treatment, however, so the data presented in this report can only accurately measure incidence of type 1 diabetes.
In 2005-2007, new cases of insulin-treated diabetes occurring in Indigenous people 15 years or older accounted for 1.9% of new cases of type 1 diabetes, 2.6% of new cases of type 2 diabetes, and 2.2% of new cases of GDM [1]. Overall, 2.9% of people on the NDR in 2005-2007 were recorded as Indigenous, which is slightly higher than the proportion of Indigenous people in the total population percentage in 2006 (2.5%).
Self-reported prevalence of diabetes/high sugar levels was 6% for Indigenous people who participated in the 2004-2005 NATSIHS [7]. These problems were reported more frequently by Indigenous people living in remote areas (9%) than by those living in non-remote areas (5%). After adjusting for age differences between the two populations, Indigenous people were around 3.4 times more likely to report some form of diabetes than non-Indigenous people (12% compared with 4%).
The ratio between Indigenous and non-Indigenous females for self-reported diabetes/high sugar levels was higher than that between Indigenous and non-Indigenous males (4.1 compared with 2.9) [7].
A lower proportion of Torres Strait Islanders (5%) than Aboriginal people (6%) reported having diabetes/high sugar levels (the difference is not statistically significant), but the proportion was 11% for Torres Strait Islanders living in the Torres Strait area [7].
The prevalence of diabetes increased with age, with a pattern of onset very similar to that of hypertensive disease (high blood pressure) [7]. The increase occurred at much younger ages among Indigenous people: the prevalence reported by Indigenous people aged 25-34 years was almost seven times that of non-Indigenous people, and the prevalences reported by Indigenous people aged 35-44 and 45-54 years were more than five times those reported by non-Indigenous people in those age-groups (Table 16).
| Age group (years) | Indigenous people | Non-Indigenous people | Ratio |
|---|---|---|---|
| Source: ABS, 2006 [7] | |||
Notes:
|
|||
| 15-24 | 1.0 | 0.5 | 1.9 |
| 25-34 | 4.3 | 0.6 | 6.8 |
| 35-44 | 10.0 | 2.0 | 5.1 |
| 45-54 | 20.7 | 4.0 | 5.2 |
| 55+ | 32.1 | 11.6 | 2.8 |
Diabetes is known to have adverse effects on pregnant women and their babies, depending on maternal diabetes status [3]. Maternal outcomes that may be adversely affected include: duration of pregnancy; type of labour; caesarean section; hypertension; and length of stay in hospital. Infant outcomes that may be adversely affected include: gestational age; birthweight; Apgar score; level of resuscitation; admission to special care; and length of stay in hospital.
In 2005-06 to 2007-08, almost 7% of Indigenous mothers in NSW, Vic, Qld, WA, SA and the NT had diabetes in pregnancy: 0.1% had pre-existing type 1 diabetes; 1.5% had pre-existing type 2 diabetes; and 5.0% had GDM [3]. Compared with non-Indigenous women who gave birth, Indigenous women were 3.2 times more likely to have pre-existing diabetes and 1.6 times more likely to have GDM. Indigenous mothers with pre-existing diabetes had higher rates of pre-term birth, delivery with no labour, caesarean section, hypertension, and longer stay in hospital than did Indigenous mothers with GDM or without diabetes. Indigenous mothers with GDM were more likely to have a pre-term birth, caesarean section, hypertension, and longer stay in hospital than were mothers without diabetes in pregnancy.
Adverse outcomes for babies, including high level resuscitation, admission to special care nursery or neonatal intensive care unit, low Apgar score, and longer hospital stays, were higher for those born to Indigenous mothers with pre-existing diabetes than for those born to Indigenous mothers with GDM or those without diabetes [3].
Hospitalisation rates are not necessarily an accurate reflection of the burden of diabetes in the community since, as with most chronic health conditions, the treatment of diabetes is well supported by primary health care from doctors, nurses, and allied health professionals. Between 2005-06 and 2009-10, diabetes problems were managed at a rate of 8 per 100 general practitioner (GP) encounters for Indigenous people, which is more than double the rate for non-Indigenous people [8].
In 2007-2009, around 2% of hospitalisations for Indigenous people were for diabetes [8]. Between 2002-03 and 2008-09, diabetes-related hospitalisation rates for Indigenous people increased by 23% in Qld, WA, SA and the NT. In the same period, the rate for other Australians increased by 33%, although from a smaller base.
Diabetes was recorded as the principal diagnosis in 1.4% of hospital separations for Indigenous people in NSW, Vic, Qld, WA, SA and the NT from July 2006 to June 2008, representing 4.8% of all hospitalisations for diabetes [9]. After adjusting for age, hospitalisation rates for diabetes among Indigenous males and females were 3.4 and 5.0 times the rates of other males and females. The largest difference in rate ratios was seen in males aged 35-44 years who were hospitalised at around nine times the rate of non-Indigenous males. The largest difference in rate ratios for females occurred in the 45-54 years age-group, for which ages Indigenous females were hospitalised at around 13 times the rate of non-Indigenous females. Type 2 diabetes was the most common form of diabetes, responsible for 84% of diabetes-related hospitalisations for Indigenous people.
Hospitalisation rates in NSW, Vic, Qld, WA, SA and the NT from July 2007 to June 2009 were highest for Indigenous people living in remote (33 per 1,000), very remote (21 per 1,000) and outer regional areas (19 per 1,000) [9]. This compares with rates for non-Indigenous people of 2.8 per 1,000 (rate ratio 11.7), 8.6 per 1,000 (rate ratio 2.5), and 4.2 per 1,000 (rate ratio 4.4), respectively.
Complications from diabetes, including circulatory and ophthalmic conditions, but in particular renal complications, were the cause of high rates of hospitalisations. In NSW, Vic, Qld, WA, SA and the NT in 2008-09, hospitalisation rates for renal complications of diabetes were 11.2 times higher for Indigenous people than they were for non-Indigenous people [10]. The hospitalisation rate for complications associated with type 2 diabetes as a principal diagnosis increased by 19% for Indigenous people from 2004-05 to 2008-09 (from 11.3 per 1,000 people in 2004-05 to 13.5 per 1,000 people in 2008-09). Hospitalisation rates for multiple complications of diabetes were around 6.5 times higher for Indigenous people than for non-Indigenous people in 2008-09 (3.1 compared with 0.5 per 1,000).
There was an average yearly increase of 20% in the hospitalisation rate for diabetes among Indigenous males and females living in Qld, WA, SA and the NT from 2001-02 to 2007-08 (compared with a 45% increase in the hospitalisation rate for other Australians) [9]. This equates to a 23% decrease in the hospitalisation rate ratio between Indigenous and other Australians for diabetes over this time period (from 5.6 in 2001-02 to 4.7 in 2007-08). From 2004-05 to 2007-08, there was an average yearly increase of 17% in the hospitalisation rate for diabetes among Indigenous males and females in NSW, Vic, Qld, WA, SA and the NT, compared with a 15% increase in the rate for non-Indigenous people.
Diabetes causes more deaths among Indigenous people than it does among non-Indigenous people [9]. From 2004 to 2008, diabetes was responsible for 7.2% of Indigenous deaths compared with 2.5% of non-Indigenous deaths in NSW, Qld, WA, SA and the NT. After adjusting for differences in the two populations, the Indigenous rate is almost seven times the rate of other Australians. (It should be noted that death data on diabetes are probably an underestimate as the condition tends to be under-reported on death certificates or is not recorded as the underlying cause of death [11].)
Helping to 'close the gap' by providing the evidence base to inform practice and policy in Aboriginal and Torres Strait Islander health
Print