Frequently asked questions
What do we know about diabetes among Indigenous people?
- What is diabetes? (November 2007)
- How is diabetes diagnosed? (November 2007)
- What do we know about the prevalence of diabetes among Indigenous people? (November 2007)
- What do we know about the mortality and hospitalisation of diabetes among Indigenous people? (November 2007)
- What do we know about the risk factors for diabetes among Indigenous people? (November 2007)
- What do we know about the impact of diabetes among Indigenous people? (November 2007)
For more detailed information about diabetes among Indigenous Australians view our Indigenous diabetes web resource
| Please reference this document as: Australian Indigenous HealthInfoNet (2007) Frequently asked questions: what do we know about diabetes among Indigenous people? Retrieved [access date] http://www.healthinfonet.ecu.edu.au/html/html_keyfacts/faq/faq_specific_health/diabetes.htm |
What do we know about diabetes among Indigenous people?
What is diabetes? (November 2007)
Diabetes mellitus is a condition where the body does not produce enough insulin. Since insulin is a hormone that helps glucose (the main source of fuel for the body) move from the blood into the cells, the cells cannot use the glucose and this causes the blood glucose level to rise [1].
Diabetes mellitus is classified into three main types - insulin-dependent diabetes mellitus (IDDM) or Type 1 diabetes; non insulin-dependent diabetes mellitus (NIDDM) or Type 2 diabetes; and gestational diabetes mellitus (GDM) [2, 3]. Some of these terms tend to be used interchangeably, but the most current usage of the terms are Type 1, Type 2 and GDM.
Type 1 diabetes is predominantly a childhood disease and is more common
in developed countries [3]. It is also known
as 'juvenile onset' diabetes. The onset of type 1 diabetes is rapid
and the characteristic symptoms are increased thirst and hunger, excessive
urination, dramatic weight loss, and overwhelming tiredness. Injections
are necessary to provide insulin to cells.
Type 2 diabetes is a 'late onset' diabetes, and develops more commonly
in people over 40 years of age [3]. Type 2 diabetes
is often the result of an individual being overweight for many years.
This leads to cells becoming insulin-resistant, as a result of increased
levels of sugar being stored as fat and processed. Complications are
common in people with type 2 diabetes, largely because of the longer
'latent period' of disease prior to diagnosis. The disease can go undetected
for a number of years, during which time mild symptoms develop - these
may become life-threatening. Type 2 diabetes is managed primarily through
diet and exercise, and people with type 2 diabetes are not usually dependent
on insulin injections. This is because impaired insulin secretion and
cell resistance to insulin causes the condition - it is not caused by
insulin shortage.
Gestational diabetes mellitus (GDM) is less common than the other two forms. It is first diagnosed during pregnancy, and is primarily a temporary intolerance to carbohydrate, which returns to normal after the birth [3]. More than 40% of women with GDM develop type 1 or type 2 diabetes in the following 10 years [4]. As well as having a greater risk of birth defects, babies of women with GDM are more likely to develop obesity and impaired glucose intolerance and/or diabetes in later life. (Diabetic women who become pregnant are not included in this category.)
How is diabetes diagnosed? (November 2007)
The diagnostic criterion for diabetes mellitus is a fasting blood sugar level of greater than 7.8 mmol/L [2]. An individual must exhibit this level on at least two tests. Random blood sugar levels of greater than 11.1 mmol/L are also indicative of the diabetic state.
Fasting blood sugar levels of between 6.1 and 7.0 mmol/L indicate impaired glucose tolerance (IGT), which is often the precursor to diabetes [2]. The detection of IGT is a primary signal that diabetes may develop if good health management is not attained. For most people with IGT, this involves following a low-fat diet and maintaining a healthy body weight.
A further test, the oral glucose tolerance test (OGTT), may be performed to assess whether the patient is diabetic or has IGT [2]. The OGTT consists of a glucose drink containing 75g of glucose. The patient's blood sugar level is measured at one and two hours following administration of the drink. Diabetes is indicated if the two-hour blood sugar level is greater than 11.1 mmol/L and IGT is indicated if the blood sugar level is between 7.8 and 11.1 mmol/L.
What do we know about the prevalence of diabetes among Indigenous people? (November 2007)
Non-insulin dependent diabetes mellitus (NIDDM) is a significant health problem for Indigenous people (view What is diabetes? for details of terms used here). The likely prevalence of NIDDM among Indigenous people is between 10-30% - around 2-4 times that among non-Indigenous Australians [4]. The disease also occurs at younger ages among Indigenous than non-Indigenous people.
What do we know about the mortality and hospitalisation of diabetes among Indigenous people? (November 2007)
Diabetes was responsible for more than 8% of deaths of Indigenous people living in Queensland, Western Australia, South Australia and the Northern Territory in 1999-2003 [5]. The numbers of deaths from ‘endocrine, nutritional and metabolic diseases’ (almost 90% of which were due to diabetes) were 7.5 times higher for Indigenous males than the number expected from rates for non-Indigenous males and 10.5 times higher than expected for Indigenous females. Among people aged 35-54 years, the death rate of Indigenous males was 23 times the rate of non-Indigenous males and the rate of Indigenous females 37 times that of non-Indigenous females [5].
Australia-wide in 2003-04, age-adjusted hospitalisation rates of Indigenous males and females for type 2 diabetes as the principal diagnosis were 8 and 10 times higher than those of non-Indigenous males and females [6].
What do we know about the risk factors for diabetes among Indigenous people? (November 2007)
Overall, Indigenous people have a high prevalence of risk factors known to be important in the development of NIDDM [5]. These include obesity, impaired glucose tolerance, hypertriglyceridaemia, hypertension and hyperinsulinaemia. Of importance also are the poor socioeconomic circumstances of many Indigenous people [7]. The effect of socioeconomic factors (such as low levels of education, high levels of unemployment, low incomes, and poor housing and related environmental conditions) are compounded through psychosocial pathways, involving stress, social support and social cohesion, social affiliations, early emotional development and social status [8, 9].
What do we know about the impact of diabetes among Indigenous people? (November 2007)
The impact of NIDDM in terms of deaths and hospitalisation is probably underestimated (view What do we know about the mortality and hospitalisation of diabetes among Indigenous people?), as the disease contributes greatly to cardiovascular disease (the major cause of death among Indigenous adults) and kidney disease [5]. NIDDM can also result in other complications, such as retinopathy (possibly leading to blindness) and peripheral neuropathy (possibly leading to amputation of lower limbs).
References
1. Commonwealth State Diabetes Forum (1999) Highlights
of government support for diabetes Australia 1999. Canberra: Commonwealth
of Australia.
2. World Health Organization (1999) Definition,
diagnosis and classification of diabetes mellitus and its complications.
Part 1: diagnosis and classification of diabetes mellitus. Geneva:
World Health Organization.
3. Expert Committee on the Diagnosis and
Classification of Diabetes Mellitus (1998) Report of the expert committee
on the diagnosis and classification of diabetes mellitus. Diabetes
Care;21(Suppl 1):S5-S19
4. de Courten M, Hodge A, Dowse G, King I, Vickery
J, Zimmet P (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.
5. 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
6. Australian Institute of Health and Welfare (2005) Australian hospital statistics 2003-04. (Health service series no. 23) Canberra: Australian Institute of Health and Welfare
7. Colagiuri S, Colagiuri R, Ward J (1998) National diabetes strategy and implementation plan. Canberra: Commonwealth Department of Health and Family Services.
8. Marmot M, Wilkinson RG (1999) Social determinants of health. Oxford: Oxford University Press.
9. Wilkinson RG (1999) Putting the picture
together: prosperity, redistribution, health and welfare. In: Marmot
M, Wilkinson RG, eds. Social determinants of health. Oxford: Oxford University Press:257
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