Why are Indigenous Australians at greater risk of diabetes? In Australia, the rising number of people affected by type 2 diabetes is most likely driven by increasing rates of obesity, decreased rates of physical activity, dietary changes and an ageing population.
Of three articles about diabetes in Indigenous Australians in this issue of the Journal, two provide evidence that the problem is escalating.
International studies indicate that, in people with impaired glucose tolerance, an intensive focus on diet and physical activity can substantially reduce progression to diabetes, and to an equal or greater extent than pharmacological interventions.
Preventing excessive weight gain in Indigenous communities, which are profoundly disadvantaged relative to mainstream Australia, is complicated by the strong link between poverty and obesity.
People living in poverty tend to maximise calories per dollar spent on food, 8 and energy-dense foods rich in fats, refined starches and sugars represent the lowest cost options. Healthy diets based on lean meats, whole grains, and fresh vegetables and fruits are much more costly.
Poverty in Indigenous communities is related to high unemployment and welfare dependency; living conditions are overcrowded, and community infrastructure is poor, with limited access to good quality foods.
A systematic approach to improving nutritional status of infants should be a priority — including the option controversial in some circles of providing subsidised food.
Improved maternal and child health could be an important and cost-effective contributor to diabetes prevention programs at the population level. Preventing and managing the complications of diabetes, such as cardiovascular risk factors, also involve lifestyle modification.
Through changes in food supply, increased opportunities for physical activity, and health promotion, Indigenous communities were able to achieve amelioration of dyslipidaemia, improved insulin action even in the absence of weight lossand increased in red cell folate and reduced homocysteine levels.
Metformin improves glycaemic control in diabetes, without weight gain. Yet, the gaps between the evidence and actual practice, in both Indigenous communities and the broader community, remain unacceptably large, and are limiting gains for those at risk of diabetes and for those who already have the disease and related conditions.
Such systems are integral to improving the quality and outcomes of clinical care. All three articles on diabetes in Indigenous people in this issue 3416 also address aspects of screening. Taken together, they support a critical role of coordinated health system approaches to diabetes identification and control.
The prevention and management of diabetes are critical to the future health of Indigenous as well as non-Indigenous Australians. But, there is no simple solution. The effectiveness of clinical and public health interventions is limited in Indigenous people, by the added burden of systematic historical and contemporary discrimination.
Getting it right will require better clinical treatment and action well beyond the health service sphere.Diabetes rates in Australia are high but its prevalence in the Indigenous population is between three and four times higher than the rest of the population.
And we are fast running out of time to. Diabetes 3 to 4-fold 11% incidence of type 2 diabetes in Indigenous Australians, 3% in non-Indigenous population.
18% of total indigenous deaths: Cot death 2 to 3-fold Over the period –, in Queensland, Western Australia, South . Diabetes (diabetes mellitus) is a disease that leads to high levels of glucose in the blood ref=Diabetes occurs when a person is no longer able to produce their own insulin (a hormone made by the pancreas) to control blood glucose levels or when the body is longer able use insulin effectively, or both.
Indigenous Australians with diabetes had high rates of micro- and macrovascular disease. 60% of Indigenous patients had an abnormal albumin to creatinine ratio compared to 33% of non-Indigenous patients (p.
Indigenous Australians are 3 times more likely to have type 2 diabetes compared to non-Indigenous Australians. This number of people with diabetes is even higher for those Indigenous Australians living in remote areas.
Diabetes in Indigenous Australians Type 2 diabetes is the fastest growing chronic disease in Australia. Aboriginal and Torres Strait Islander people are at higher risk of type 2 diabetes than the general population.