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There are several types of diabetes, of which the most frequently occurring are type 1, type 2 and gestational diabetes mellitus (GDM) . Type 1 diabetes is relatively uncommon in the Indigenous population. On the other hand, type 2 diabetes represents a serious health problem for many Indigenous people, who tend to develop it at earlier ages than do other Australians, and often die from it at younger ages . GDM, which can occur during pregnancy, is more common among Indigenous women than among non-Indigenous women .
Statistics on diabetes incidence, prevalence, hospitalisation, and mortality among Indigenous people 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 ; self-reported diabetes data may underestimate the prevalence of diabetes by up to 50% .
Diabetes can lead to life-threatening health complications, some of which may develop within months of diagnosis, while others may take years to develop . Complications of diabetes include disease of the large blood vessels (macrovascular disease), which can cause heart disease and stroke, and disease of the small blood vessels (microvascular disease), 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 .
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 . 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, 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 . Overall, 2.9% of people on the NDR in 2005-2007 were recorded as Indigenous, which is slightly higher than the estimated proportion of Indigenous people in the total population percentage in 2006 (2.5%).
The self-reported prevalence of diabetes/high sugar levels was 6% for Indigenous people who participated in the 2004-2005 NATSIHS . These problems were reported more frequently by Indigenous people living in remote areas (9%) than by those living in non-remote areas (5%). After age-adjustment, Indigenous people were around 3.4 times more likely than non-Indigenous people to report some form of diabetes. The ratio between Indigenous and non-Indigenous females for self-reported diabetes/high sugar levels (4.1) was higher than that between Indigenous and non-Indigenous males (2.9) in 2004-2005.
In 2004-2005, 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 .
The prevalence of diabetes increased with age in 2004-2005 . 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 (%)||Non-Indigenous (%)||Ratio|
|Source: ABS, 2006 |
Diabetes is known to have adverse effects on pregnant women and their babies . 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 . 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 an induced labour, a pre-term birth, caesarean section, hypertension, and longer stay in hospital than were mothers without diabetes in pregnancy.
Adverse outcomes for babies, including pre-term birth, high level resuscitation, admission to special care nursery or neonatal intensive care unit, low Apgar score, and longer hospital stays, were more common for those born to Indigenous mothers with pre-existing diabetes than for those born to Indigenous mothers with GDM or those without diabetes .
Hospitalisation rates are not necessarily an accurate reflection of the burden of diabetes in the community because, 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, more than double the rate for non-Indigenous people .
In the two-year period from July 2007 to June 2009, around 2% of hospitalisations among Indigenous people were for diabetes . 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%, but from a lower base.
Diabetes was recorded as the principal diagnosis in 1.4% of hospital separations for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT from July 2006 to June 2008, representing 4.8% of all hospitalisations for diabetes . After age-adjustment, hospitalisation rates for diabetes for Indigenous males and females were 3.4 and 5.0 times the rates for other males and females. The highest rate ratio for males was for the 35-44 years age-group: the rate for Indigenous males was around nine times that of non-Indigenous males. The highest rate ratio for females occurred in the 45-54 years age-group, with a rate for Indigenous females 13 times higher than that for non-Indigenous females. Around 84% of diabetes-related hospitalisations for Indigenous people were for type 2 diabetes.
After age-adjustment, diabetes hospitalisation rates in NSW, Vic, Qld, WA, SA and the NT in 2007-09 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) . 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, particularly renal complications, but also circulatory and ophthalmic conditions, were the cause of high rates of hospitalisations. Hospitalisation rates for renal complications of diabetes were 11.2 times higher for Indigenous people living in NSW, Vic, Qld, WA, SA and the NT in 2008-09 than they were for their non-Indigenous counterparts . 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 to 13.5 per 1,000). Hospitalisation rates for multiple complications of diabetes were 6.5 times higher for Indigenous people than for other Australians in 2008-09 (3.1 compared with 0.5 per 1,000).
Diabetes causes a higher proportion of deaths among Indigenous people than it does among non-Indigenous people . In the period 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 age-adjustment, the Indigenous rate (103.4 per 100,000) was 6.9 times the rate of non-Indigenous people. (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 .)