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Introduction

Early studies of Indigenous people before the adoption of Western lifestyles showed no evidence of diabetes, but the condition, particularly type 2 diabetes is now recognised as a very important health problem for Indigenous peoples across Australia. It has become very common – over three times more likely to occur than in the non-Indigenous Australian population – and the consequences can be bad , as will be shown below [1 - 3].
(For general information about diabetes, see Background info.)

The effect that diabetes has on Indigenous people can be measured in three main ways:

  • The number of people who have diabetes
  • The number of people who go to hospital because of diabetes
  • The number of people who die because of diabetes

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How common is diabetes among Indigenous people?

 A recent major national survey, called the 2004-05 National Aboriginal and Torres Strait Islander Health Survey [4], found:

  • Diabetes/high sugar levels were reported by around 1 in 16 Indigenous people
  • Diabetes/high sugar levels were more common among Indigenous people living in remote areas (that is, communities/small towns) (around 1 in 11) than among those living in non-remote areas (that is, big towns/cities) (around 1 in 20)
  • Diabetes/high sugar levels were more than 3 times more common among Indigenous people than among non-Indigenous people
  • The difference of diabetes/high sugar levels between Indigenous and non-Indigenous females greater than the difference between Indigenous and non-Indigenous males
  • Indigenous people were more likely to get diabetes at younger ages than non-Indigenous people [4]

Table 1: Diabetes - percentages of people reporting diabetes/high sugar levels as a 'long-term health condition', by Indigenous status, and Indigenous:non-Indigenous ratios, Australia, 2004-2005 [4]

Age group (years) Indigenous people Non-Indigenous people Ratio
15-24 1.0 0.5 2.0
25-34 4.3 0.6 7.2
35-44 10.0 2.0 5.0
45-54 20.7 4.0 5.2
55+ 32.1 11.6 2.8

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How common are diabetes in pregnancy (gestational diabetes) and type 1 diabetes among Indigenous people?

Diabetes in pregnancy

There have not been many studies of diabetes in pregnancy, but one study from the Northern Territory found:

  • Around 1 in 16 Indigenous women developed gestational diabetes
  • Around 1 in 25 non-Indigenous women developed gestational diabetes

After taking account of the fact that Indigenous women tend to have babies at younger ages than non-Indigenous women, the level of gestational diabetes for Indigenous women was more than twice that of non-Indigenous women [12].

Type 1 diabetes

A study in New South Wales found that Indigenous and non-Indigenous children had similar levels of type 1 diabetes [13, 14].

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How many Indigenous people go to hospital because of diabetes?

When a person goes to hospital, the main reason for doing so is written down (recorded) -- for example, it may be because of a heart attack. Often diabetes is not recorded as the main reason because it is linked to other illnesses, such as heart disease, kidney troubles, stroke, and feet problems. So the number of people who go to hospital because of their diabetes is not really known. For example, diabetes was recorded as the reason an Indigenous person had to go to hospital in only 1 in 100 admissions in 2003-04, but we know it is linked with quite a lot of illnesses that require admission [15].

Despite this, the rate of Indigenous people going to hospital for diabetes was higher than the rate for non-Indigenous people - 8 times higher for Indigenous males than non-Indigenous males, and 10 times higher for Indigenous females than for non-Indigenous females [15].

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How many Indigenous people die because of diabetes?

Diabetes is the cause of many Indigenous deaths. For Indigenous people living in Qld, WA, SA and the NT in 1999-2003, diabetes caused around 1 in 12 deaths. Deaths caused by diabetes were 7.5 times more common for Indigenous males than for non-Indigenous males and deaths caused by diabetes were 10.5 times more common for Indigenous females than for non-Indigenous females. For people aged 35-54 years, Indigenous males died at a rate 21 times that of non-Indigenous males, and Indigenous females died at a rate 37 times that of non-Indigenous females. These alarming statistics show the seriousness of diabetes for Indigenous people [15].

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What causes so many Indigenous people to get diabetes?

There are many reasons why Indigenous people have higher rates of type 2 and gestational diabetes than non-Indigenous people:

  • Obesity is 1.5 times more common among Indigenous people than among non-Indigenous people [16 - 24]
  • More than 2 out of 5 Indigenous people surveyed reported taking no exercise, compared with 3 out of 10 non-Indigenous people [4]
  • Many Indigenous people eat too much fatty and sugary foods
  • Many Indigenous people live in poor housing and environments [4, 7, 25 - 30]

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What are the main problems faced by Indigenous people who live with diabetes?

For Indigenous people living in the Northern Territory:

  • The main cause of death among people with diabetes is kidney disease (sometimes called end-stage renal disease) (for non-Indigenous people with diabetes, the main cause of death is heart disease) [20, 33 - 37].
  • Infection is the second most common cause of death for people with diabetes. )More than 1-in-5 deaths of Indigenous people with diabetes in Australia in 1995 were caused by infection). [26, 35, 38].
  • Diabetes is a major cause of blindness. In the Northern Territory in 1994, almost 3-out-of-10 Indigenous people with diabetes had some form of eye damage [7, 12].
  • Almost one-in-five admissions to hospital of Indigenous people with diabetes are a result of cardiovascular (heart and blood system) complications [12].
  • More than nine-out-of-10 people with diabetes going to hospital for feet problems were Indigenous [39, 40].

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How can diabetes be looked after?

There is no way of curing diabetes, so it is important to keep it under control.

You can improve your diabetes by:

  • losing weight
  • eating healthier, more natural foods
  • eating a few smaller meals per day rather than one or two large ones
  • doing more exercise, including looking for ways to put more activity into your day (for example, walking to the shops instead of driving)
  • taking medicines that can lessen the amount of sugar in your blood (if prescribed by doctor)
  • stopping smoking
  • drinking less alcohol
  • having good hygiene (to reduce infections) [11]

You should also visit your health clinic often, so that:

  • your eyes can be checked
  • your feet can be checked
  • your kidneys can be checked
  • your blood pressure can be checked [11]

For many Indigenous people, controlling their diabetes can be hard since access to health services is far away, or they speak a different language, or do not understand the nurses/doctors (different culture). This can increase the harmful effects of diabetes on Indigenous people [31, 43].

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What is being done about diabetes in Indigenous communities?

Governments have made plans and put forward ideas of how to lessen the harmful effects of diabetes among Indigenous people. Some of these include:

  • The National Diabetes Strategy and Implementation Plan [32]
  • National Diabetes Strategy 2000–2004 [49]
  • Western Australian Diabetes Strategy 1999 [52]
  • Healthy lifestyles – A strategic framework for the primary prevention of diabetes and cardiovascular disease in Western Australia 2002-2007 [53]
  • NSW chronic disease prevention strategy 2003-2007 [55]

In view of its seriousness for Indigenous people, it appears that much more could be done to reduce and deal with diabetes.

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Summary

There is no doubt that diabetes is a big health problem for many Indigenous people, especially type 2 diabetes, which is four times more likely to affect Indigenous than non-Indigenous people. Many Indigenous people die from its effects.

Diabetes is caused by the way people live their lives, so there is a lot that people can do to stop themselves from getting it, and a lot that can be done to lessen its impact if they do get it. But, as with most other areas of Indigenous health, there is not enough being done to lessen the harmful effects of this sickness among Indigenous people [11].

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References

1. Basedow H (1932) Diseases of the Australian Aborigines. Journal of Tropical Medicine and Hygiene;35(12 & 13)
2. Plomley NJB (1989) Disease among the Tasmanian Aborigines. Medical Journal of Australia;151:665-669
3. Bastian P (1979) Coronary heart disease in tribal Aborigines - the West Kimberley Survey. Australian and New Zealand Journal of Medicine;9(3):284-92
4. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey, Australia 2004-05. (ABS Cat. no. 4715.0) Canberra: Australian Bureau of Statistics
View report
5. Australian Bureau of Statistics (1994) National Aboriginal and Torres Strait Islander Survey 1994: detailed findings. (ABS Catalogue No.4190.0) Canberra: Australian Bureau of Statistics.
6. Australian Bureau of Statistics (2002) National Health Survey: Aboriginal and Torres Strait Islander results. (ABS cat. no. 4715.0) Canberra: Australian Bureau of Statistics
View report
7. McCarty D, Zimmet P, Dalton A, Segal L, Welborn T (1996) The rise and rise of diabetes in Australia, 1996. A review of statistics, trends and costs. Canberra: Diabetes Australia
8. Dowse GK, Zimmet PZ, King H (1991) Relationship between prevalence of impaired glucose tolerance and NIDDM in a population. Diabetes Care;14(11):968-974
9. Leonard D, McDermott R, O'Dea K, Rowley KG, Pensio P, et al. (2002) Obesity, diabetes and associated cardiovascular risk factors among Torres Strait Islander people. Australian and New Zealand Journal of Public Health;26(2):144-149
10. de Courten M, Hodge A, Dowse G, King I, Vickery J, et al. (1998) Review of the epidemiology, aetiology, pathogenesis and preventability of diabetes in Aboriginal and Torres Strait Islander populations. Canberra: Commonwealth Department of Health and Family Services
11. Couzos S, O'Rourke S, Metcalf S, Murray R (2003) Diabetes. In: Couzos S, Murray R, eds. Aboriginal primary health care. 2nd ed. South Melbourne: Oxford University Press:348-410
12. Markey P, Weeramanthri T, Guthridge S (1996) Diabetes in the Northern Territory. Darwin: Diabetes Australia, Northern Territory
13. Verge C, Silink M, Howard N (1994) The incidence of childhood IDDM in New South Wales, Australia. Diabetes Care;17(1):693-696
14. Glatthaar C, Whittall DE, Welborn TA, Gibson MJ, Brooks BH, et al. (1988) Diabetes in Western Australian children: descriptive epidemiology. The Medical Journal of Australia;148(February 1):117-123
15. Australian Bureau of Statistics, Australian Institute of Health and Welfare (2005) The health and welfare of Australia's Aboriginal and Torres Strait Islander peoples 2005. (ABS catalogue no. 4704.0) Canberra: Australian Institute of Health and Welfare and the Australian Bureau of Statistics
View report
16. Braun B, Zimmerman M, Kretchmer N, Spargo R, Smith R, et al. (1996) Risk factors for diabetes and cardiovascular disease in young Australian Aborigines: a 5-year follow-up study. Diabetes Care;19(5):472-479
17. Daniel M, O'Dea K, Rowley KG, McDermott R, Kelly S (1999) Glycated hemoglobin as an indicator of social environmental stress among Indigenous versus westernized populations. Preventive Medicine;25(5):405-413
18. Gracey M, Spargo R, Smith P, Smith R, Burke V, et al. (1996) Risk factors for ill health in a remote desert-dwelling Aboriginal community in Western Australia. Australian and New Zealand Journal of Medicine;26:171-179
19. Guest CS, O'Dea K, Hopper JL, Nankervis AJ, Larkins RG (1992) The prevalence of glucose intolerance in Aborigines and Europids of south-eastern Australia. Diabetes Research and Clinical Practice;15:227-235
20. Hoy W (1997) Suggestions for a brief check-up for chronic noncommunicable 'lifestyle' diseases in Aboriginal adults and suggestions for diagnosis and management of renal disease at the community level [not published].
21. O'Dea K (1984) Marked improvement in carbohydrate and lipid metabolism in diabetic Australian Aborigines after temporary reversion to traditional lifestyle. Diabetes;33:596-603
22. O'Dea K, Patel M, Kubisch D, Hopper J, Traianedes K (1993) Obesity, diabetes and hyperlipidemia in central Australian Aboriginal community with a long history of acculturation. Diabetes Care;16(7): 1004-1010
23. O'Dea K (1982) The relationship between urbanisation and diabetes in Australian Aborigines. Proc Nutr Soc Aust;7:30-6
24. O'Dea K, Spargo RM, Akerman K (1980) The effect of transition from traditional to urban life-style on the insulin secretory response in Australian Aborigines. Diabetes Care;3(1):31-7
25. Australian Society for the Study of Obesity (1995) Healthy weight Australia - a national obesity strategy. Canberra: Australian Society for the Study of Obesity
26. Commonwealth Department of Health and Aged Care, Australian Institute of Health and Welfare (1999) National Health Priority Areas Report: diabetes mellitus. Canberra: Australian Institute of Health and Welfare
View report
27. Zimmet P (1992) Kelly West Lecture 1991. Challenges in diabetes epidemiology - from West to the rest. Diabetes Care;15(2):232-252
28. Australian Institute of Health and Welfare (2002) Australia's health 2002: the eighth biennial report of the Australian Institute of Health and Welfare. Canberra: Australian Institute of Health and Welfare
View report
29. National Health and Medical Research Council (2000) Nutrition in Aboriginal and Torres Strait Islander peoples. Canberra: National Health and Medical Research Council
View report
30. Australian Bureau of Statistics, National Centre for Culture and Recreation Statistics (2004) Aboriginal and Torres Strait Islander peoples: aspects of sport and recreation. Canberra: Australian Bureau of Statistics
View report
31. Nutbeam D, Thomas M, Wise M (1993) National Action Plan: diabetes to the Year 2000 and beyond. Canberra: The Australian Diabetes Society
32. Colagiuri S, Colagiuri R, Ward J (1998) National diabetes strategy and implementation plan. Canberra: Commonwealth Department of Health and Family Services
View report (PDF - 1.3MB - large file warning!)
33. Knuiman MW, Welborn TA, McCann VJ, Stanton KG, Constable IJ (1986) Prevalence of diabetic complications in relation to risk factors. Diabetes;35:1332-1339.
34. McCann V, Knuiman M, Stanton K, Winter M (1994) Mortality and coronary heart disease in diabetes mellitus. Australian Journal of Public Health;18:92-95
35. Phillips CB, Patel MS, Weeramanthri TS (1995) High mortality from renal disease and infection in Aboriginal central Australians with diabetes. Australian Journal of Public Health;19(5):482-486
36. Stanton KG, McCann V, Knuiman M, Constable IJ, Welborn T (1985) Diabetes in part-Aborigines of Western Australia. Diabetologia;28(1):16-21
37. Welborn T, Knuiman M, Bartholomew H, Whittall D (1995) 1989-90 National Health Survey: prevalence of self-reported diabetes in Australia. Medical Journal of Australia;163:129
38. Phillips C, Patel M, Weeramanthri T, Powers J (1993) Infections and the new epidemic of diabetes: mortality among Aboriginal central Australians [abstract]. Tropical Medicine at the Top End: Australasian College of Tropical Medicine
39. Ewald D, Hall G (2000) Trends in hospital separations of people with diabetes and those with foot complications in Central Australia, 1992-97. Alice Springs: Diabetes Australia Northern Territory and Territory Health Services
40. Ewald D, Patel M, Hall G (2001) Hospital separations indicate increasing need for prevention of diabetic foot complications in central Australia. Australian Journal of Rural Health;9(6):275-279
View report
41. National Health and Medical Research Council (1997) Diabetes in older people. Canberra: National Health and Medical Research Council
42. National Health and Medical Research Council (2003) The Australian immunisation handbook. 8th ed. Canberra: Commonwealth of Australia.
View handbook
43. Lee P, Rose V, Harris E, Bonney M (1999) National divisions diabetes program. Optional module 1. Part A: Aboriginal and Torres Strait Islander populations. Sydney: Centre for General Practice Integration Studies UNSW and Centre for Health Equity Training Research and Evaluation
44. Patel M, Phillips C, Cabaron Y (1991) Frequent hospital admissions for bacterial infections among Aboriginal people with diabetes in central Australia. Medical Journal of Australia;155:218-222
45. Couzos S, Metcalf S, Murray RB, O'Rourke S (1999) Diabetes. In: Couzos S, Murray R, eds. Aboriginal primary health care. An evidence-based approach. South Melbourne: Oxford University Press:123-211
46. Commonwealth Department of Health and Ageing (2006) Evidence based guidelines for diabetes. Retrieved 13 November 2006 from http://www.health.gov.au/internet/main/publishing.nsf/content/pq-diabetes-guide
47. Rowley KG, Daniel M, Skinner K, Skinner M, White GA, et al. (2000) Effectiveness of a community-directed 'healthy lifestyle' program in a remote Australian aboriginal community. Aust N Z J Public Health;24(2):136-44
48. Rowley KG, Gault A, McDermott R, Knight S, McLeay T, et al. (2000) Reduced prevalence of impaired glucose tolerance and no change in prevalence of diabetes despite increasing BMI among Aboriginal people from a group of remote homeland communities [see comments]. Diabetes Care;23(7):879-881
49. Commonwealth Department of Health and Aged Care (1999) National diabetes strategy 2000-2004 Canberra: Commonwealth of Australia.
View report (PDF - 62KB)
50. Commonwealth Department of Health and Ageing (2002) Diabetes initiatives: National Integrated Diabetes Program. Retrieved 17 February 2003 from http://www.health.gov.au/internet/main/publishing.nsf/Content/pq-diabetes-integ
51. Couzos S, Metcalf S, Murray R, O'Rourke S, (1998) Systematic review of existing evidence and primary care guidelines on the management of non-insulin-dependent diabetes in Aboriginal and Torres Strait Islander populations. Canberra: Office for Aboriginal and Torres Strait Islander Health Services, Commonwealth Department of Health and Family Services.
52. Department of Health Western Australia (2002) Western Australian Diabetes Strategy 1999. Perth: Western Australian Government
View publication
53. Department of Health Western Australia (2002) Healthy lifestyles. A strategic framework for the primary prevention of diabetes and cardiovascular disease in Western Australia 2002-2007. Perth: Western Australian Government
View publication
54. Commonwealth Department of Health and Ageing (2006) Health Priorities. Retrieved 13 November from http://www.aodgp.gov.au/internet/wcms/publishing.nsf/Content/Health+Priorities-1
55. New South Wales Health Department (2003) NSW chronic disease prevention strategy 2003-2007. North Sydney: NSW Department of Health
View publication
56. Brownson, R., Remington, P., Davis, J. (1998) Chronic Disease Epidemiology and Control 2nd Edition. Washington DC: American Public Health Association.

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Last updated: 18 October 2007