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Diabetes

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Diabetes

Diabetes is a group of disorders marked by high levels of glucose in the blood and caused by either or both of the following [1]:

There are several types of diabetes, of which the most frequently occurring are type 1, type 2 and gestational diabetes mellitus (GDM). Aboriginal and Torres Strait Islander people have a lower incidence of type 1 diabetes compared with non-Indigenous people [2]. Type 1 diabetes is most common form of diabetes in children and young people but can occur at any age [3]. Type 2 diabetes however, represents a serious health problem for many Aboriginal and Torres Strait Islander people who tend to develop it at earlier ages than other Australians, and often die from it at younger ages [3][4]. GDM develops in some women during pregnancy [5] and is more common among Aboriginal and Torres Strait Islander women than among non-Indigenous women [6].

Diabetes is recognised as one of the most important health problems currently facing Aboriginal and Torres Strait Islander people and can lead to life-threatening health complications [3]. These complications may occur within months of diagnosis while others may develop over several years [7]. Aboriginal and Torres Strait Islander people with diabetes may also show signs of other chronic conditions, including chronic kidney disease, cardiovascular disease, liver disease and anaemia [8].

Incidence and prevalence

In 2011-13, an estimated 5% of Aboriginal and Torres Strait Islander adults had impaired fasting glycemia (IFG) compared with 3% of non-Indigenous adults ([3]. Aboriginal and Torres Strait Islanders in the 18-44 years age-group had a higher prevalence of IFG (4.2%) compared with non-Indigenous adults in the same age-group (1%). There were no other significant differences between Aboriginal and Torres Strait Islander and non-Indigenous age-groups.

Results from the 2012-2013 National Aboriginal and Torres Strait Islander health measures survey (NATSIHMS) indicate that 13% of Aboriginal and Torres Strait Islander adults had diabetes, based on self-report and measured results [3]. About 2% of these adults did not self-report that they had diabetes, which may indicate that they were unaware they had the condition, however, 11% did self-report that they were aware of their diabetes. Of those with diabetes, there was a larger proportion of females (56%) than males (44%). Aboriginal and Torres Strait Islander adults were 3.5 times more likely to have diabetes than non-Indigenous adults. There was an increase with age for the prevalence of diabetes among Aboriginal and Torres Strait Islander adults, from 2% aged 18-34 years to 46% aged 65 years and over [3].

In remote areas, Aboriginal and Torres Strait Islander adults were twice as likely to have diabetes compared with those living in non-remote areas (28% and 15% respectively) [3]. The disparity in diabetes prevalence between Aboriginal and Torres Strait Islander adults (18 years and over) and non-Indigenous adults was greater in remote areas (six times greater) than in non-remote areas (three times greater) [3].

In 2014, according to the National (insulin treated) Diabetes Register (NDR), Aboriginal and Torres Strait Islander people accounted for 3% of new cases of type 1 diabetes and 3% of new cases of insulin treated type 2 diabetes [9]. For type 1 diabetes, there were 9 new cases per 100,000 for Aboriginal and Torres Strait Islander people compared with an incidence rate of 11 per 100,000 for non-Indigenous people. For type 2 diabetes, there were 121 new cases per 100,000 for Aboriginal and Torres Strait Islander people compared with 42 per 100,000 for non-Indigenous people. For type 1 diabetes, the incidence rate among Aboriginal and Torres Strait Islander adults was higher (7 cases per 100,000) than for non-Indigenous adults (5 per 100,000). For Aboriginal and Torres Strait Islander children (0-14 years) and young people (15-24 years), the incidence rates of type 1 diabetes were lower than for non-Indigenous children and young people, 15 per 100,000 and 24 cases per 100,000 children respectively and 11 per 100,000 and 15 cases per 100,000 young people respectively). However, estimates may be understated as Indigenous status may not be reported.

In 2011[1], the incidence rates for insulin treated GDM were similar for Aboriginal and Torres Strait Islander and non-Indigenous women (60 per 100,000 and 59 per 100,000 respectively) [10]. The most recent national estimates of the prevalence of GDM are for 2005-2007 when almost 7% of Aboriginal and Torres Strait Islander women who gave birth in NSW, Vic, Qld, WA, SA and the NT[2] had diabetes during pregnancy: 1.5% had pre-existing diabetes and 5.1% had GDM [6]. Aboriginal and Torres Strait Islander women who gave birth were 3.2 times more likely than their non-Indigenous counterparts to have pre-existing diabetes and 1.6 times more likely to have GDM.

There is growing concern regarding the emergence of type 2 diabetes in Aboriginal and Torres Strait Islander children and adolescents, although data are limited [11]. Between 2006 and 2011, 252 new cases of diabetes were reported among Aboriginal and Torres Strait Islander youth aged 10-19 years at diagnosis[3] [12]. Of these, 55% were type 2 and 43% were type 1 diabetes. The age-specific rates of type 2 diabetes for young Aboriginal and Torres Strait Islander people were much higher than for their non-Indigenous counterparts (8.3 times as high among 10-14 year-olds and 3.6 times as high for 15-19 year-olds).

Burden of disease

Diabetes accounted for 4% of the total burden of disease among Aboriginal and Torres Strait Islander people in 2011 [13].

General practice attendances and hospitalisation

Survey results from the period April 2008-March 2013 of general practitioners (GPs) found that 5% of all problems managed by GPs among Aboriginal and Torres Strait Islander patients were for diabetes [14]. Type 2 diabetes accounted for 94% of all diabetes problems managed for Aboriginal and Torres Strait Islander people. After age-adjustment, diabetes was managed 2.8 times more frequently among Aboriginal and Torres Strait Islander patients than among other patients. This was due mainly to type 2 diabetes (77 per 1,000 encounters). For type 1 diabetes, encounters occurred less frequently than for type 2 diabetes (4.2 per 1,000 encounters) with a rate ratio of 1.8 after age-adjustment when compared with the non-Indigenous rate. GP encounters with Aboriginal and Torres Strait Islander women for GDM also occurred more frequently (1.1 per 1,000 encounters) than for non-Indigenous patients (rate ratio 2.7 after age-adjustment).

Hospital services are typically required to treat the advanced stages of complications of diabetes or acute episodes of poor glycaemic control [3][15]. In 2013-14, where the principal diagnosis was diabetes, there were 3,766 hospital separations for Aboriginal and Torres Strait Islanders in Australia, and they were more likely to have diabetes recorded as the principal cause of admission compared with the non-Indigenous admissions (7.2% and 4.7% respectively) [3]. Of these, 59%, were for type 2 diabetes, 17% for type 1 diabetes, 13%, for GDM and 11% for other unspecified diabetes related hospitalisations. For Aboriginal and Torres Strait Islanders where type 2 diabetes was the principle cause of admission to hospital or additional diagnosis, more females (27,607) than males (19,368) were hospitalised. Females were almost six times as likely as non-Indigenous females to be hospitalised for type 2 diabetes (136 per 1,000 compared with 24 per 1,000). Aboriginal and Torres Strait Islander males were three times as likely (113 per 1,000 compared with 35 per 1,000).

In 2013-14, rates of hospitalisations for type 2 diabetes increased with age for Aboriginal and Torres Strait Islanders; for all age-groups, they were hospitalised at higher rates than non-Indigenous people [3]. The gap between the two populations was larger at younger ages, 14 times higher for 25-34 years (24 per 1,000 and 1.7 per 1,000 respectively) and for 35-44 years (87 per 1,000 and 6.3 per 1,000 respectively), this declined to twice as high for age 75 years and over (398 per 1,000 compared with 202 per 1,000).

For type 1 diabetes in 2013–14, Aboriginal and Torre Strait Islander people were hospitalised at higher rates than non-Indigenous people across most ages [3]. The rates were three times higher in the 55-64 years age-group (9.5 per 1,000 compared with 3.0 per 1,000). Rates were similar in the under 25 years and 75 years and over age-groups. 

In 2013-14, the rate of hospitalisation for Type 2 diabetes in remote areas and very remote areas was more than twice as high (220 per 1,000) as that in major cities and inner and outer regional areas (both around 100 per 1,000) [3]. In major cities and in inner and outer regional areas, the rate of hospitalisation for Type 2 diabetes was three times higher for Aboriginal and Torres Strait Islanders than for non-Indigenous people. In remote and very remote areas, the rates were eight times higher for Aboriginal and Torres Strait Islander people than for non-Indigenous people (220 per 1,000 compared with 26 per 1,000).

In major cities and in the inner and outer regional areas, type 1 diabetes hospitalisation rates for Aboriginal and Torres Strait Islander people were similar [3]. When compared with the non-Indigenous population, in major cities and in inner and outer regional areas, Aboriginal and Torres Strait Islander people were more likely to be hospitalised for type 1 diabetes than non-Indigenous people (2.2 times higher in major cities and 1.9 times higher in inner and outer regional areas). Type 1 diabetes hospitalisation rates were similar for Aboriginal and Torres Strait Islander people living in remote and very remote areas compared with non-Indigenous people.

Hospitalisations for various chronic conditions, including complications of diabetes, are considered potentially preventable [16][17]. In 2014-15, diabetes complications accounted for 19% of potentially preventable hospitalisations for Aboriginal and Torres Strait Islander people, with an age-adjusted rate four times greater than the rate for non-Indigenous people. 

Mortality

In 2015, diabetes (underlying cause and/or associated cause) was the second leading cause of death among Aboriginal and Torres Strait Islander people, with an age-adjusted death rate 4.7 times higher than for non-Indigenous people [18]. Diabetes was responsible for 6.7% of deaths (194 deaths) among Aboriginal and Torres Strait Islander people living in NSW, Qld, WA, SA, and the NT. There were more deaths from diabetes among Aboriginal and Torres Strait Islander females (99 deaths) than among males (95 deaths). After age-adjustment, Aboriginal and Torres Strait Islander females and males were both more likely to die from diabetes than their non-Indigenous counterparts (six and four times respectively).

For 2011-2015, the age-specific death rates for diabetes for the 45-54 years age-group for Aboriginal and Torres Strait Islander people were 62 per 100,000 for males and 52 per 100,000 for females with rate ratios of 12.0 for males and 20.2 for females when compared with non-Indigenous males and females [18].

From 2010-2012, diabetes was the underlying or associated cause of death for 1,474 Aboriginal and Torres Strait Islander people (21% of all Aboriginal and Torres Strait Islander deaths compared with 10% among non-Indigenous people). For diabetes as the underlying cause of death, it was responsible for 564 deaths of Aboriginal and Torres Strait Islander people (8% of all Aboriginal and Torres Strait Islander deaths) in NSW, Qld, SA, WA and the NT [3]. Of these deaths, the underlying cause of death was recorded as: type 1 diabetes (5.0% of deaths); type 2 diabetes (46% of deaths); or the type of diabetes was unspecified (49% of deaths).

References

  1. Lalor E, Cass A, Chew D, Craig M, Davis W, Grenfell R, Hoy W, McGlynn L, Mathew T, Parker D, Shaw J, Tonkin A, Towler B (2014) Cardiovascular disease, diabetes and chronic kidney disease: Australian facts - mortality. Canberra: Australian Institute of Health and Welfare
  2. Australian Institute of Health and Welfare (2015) Incidence of type 1 diabetes in Australia 2000-2013. Canberra: Australian Institute of Health and Welfare
  3. Australian Institute of Health and Welfare (2015) Cardiovascular disease, diabetes and chronic kidney disease - Australian facts: Aboriginal and Torres Strait Islander people. Canberra: Australian Institute of Health and Welfare
  4. Australian Institute of Health and Welfare (2010) Australia's health 2010: the twelfth biennial report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
  5. Australian Institute of Health and Welfare (2009) Insulin-treated diabetes in Australia 2000–2007. Canberra: Australian Institute of Health and Welfare
  6. Australian Institute of Health and Welfare (2010) Diabetes in pregnancy: its impact on Australian women and their babies. Canberra: Australian Institute of Health and Welfare
  7. Australian Institute of Health and Welfare (2011) Prevalence of Type 1 diabetes in Australian children, 2008. Canberra: Australian Institute of Health and Welfare
  8. Australian Bureau of Statistics (2014) Australian Aboriginal and Torres Strait Islander health survey: biomedical results, 2012-13 - Australia: table 6.3 [data cube]. Retrieved 10 September 2014 from http://www.abs.gov.au/AUSSTATS/subscriber.nsf/log?openagent&4727.0.55.003_6.xls&4727.0.55.003&Data%20Cubes&F653985C855EA253CA257D4E00170316&0&2012-13&10.09.2014&Latest
  9. Bullock S, Pearce J, Byng K (2016) Incidence of insulin-treated diabetes in Australia 2014. Canberra: Australian Institute of Health and Welfare
  10. Australian Institute of Health and Welfare (2014) Incidence of insulin-treated diabetes in Australia 2000-2011. Canberra: Australian Institute of Health and Welfare
  11. Zimmet PZ, Magliano DJ, Herman WH, Shaw JE (2014) Diabetes: a 21st century challenge. The Lancet Diabetes & Endocrinology; 2(1): 56 - 64
  12. Australian Institute of Health and Welfare (2014) Type 2 diabetes in Australia’s children and young people: a working paper. Canberra: Australian Institute of Health and Welfare
  13. Australian Institute of Health and Welfare (2016) Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Canberra: Australian Institute of Health and Welfare
  14. Australian Institute of Health and Welfare (2015) Aboriginal and Torres Strait Islander health performance framework 2014 report: detailed analyses. Canberra: Australian Institute of Health and Welfare
  15. Australian Institute of Health and Welfare (2014) Cardiovascular disease, diabetes and chronic kidney disease: Australian facts: morbidity - hospital care. Canberra: Australian Institute of Health and Welfare
  16. Steering Committee for the Review of Government Service Provision (2016) Overcoming Indigenous disadvantage: key indicators 2016 report. Canberra: Productivity Commission
  17. Steering Committee for the Review of Government Service Provision (2014) Overcoming Indigenous disadvantage: key indicators 2014. Canberra: Productivity Commission
  18. Australian Bureau of Statistics (2016) Causes of Death, Australia, 2015. Retrieved 28 September 2016 from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2015~Main%20Features~Summary%20of%20findings~1

Footnotes

1. The 2014 Incidence of insulin-treated diabetes in Australia report excluded updated information due to concerns with data comparability [9].

2. Data from the NT are for public hospitals only [6].

3. Based on combined data from the National diabetes services scheme (NDSS) and the Australasian Paediatric Endocrine Group (APEG) [12].

 

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    Last updated: 15 March 2017
     
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