Continuing Disparities in Cardiovascular Risk Factors and Complications Between Aboriginal and Anglo-Celt Australians With Type 2 Diabetes

Abstract

OBJECTIVE To determine whether disparities in the nature and management of type 2 diabetes persist between Aboriginal and the majority Anglo-Celt patients in an urban Australian community. RESEARCH DESIGN AND METHODS Baseline data from the observational Fremantle Diabetes Study collected from 1993 to 1996 (phase I) and from 2008 to 2011 (phase II) were analyzed. Patients characterized as Aboriginal or Anglo-Celt by self-report and supporting data underwent comprehensive assessment, including questionnaires, examination, and biochemical testing in a single laboratory. Generalized linear modeling with age/sex adjustment was used to examine differences in changes in variables in the two groups between phases I and II. RESULTS The indigenous participants were younger at entry and at diabetes diagnosis than the Anglo-Celt participants in both phases. They were also less likely to be educated beyond primary level and were more likely to be smokers. HbA 1c decreased in both groups over time (Aboriginal median 9.6% [interquartile range 7.8–10.7%] to 8.4% [6.6–10.6%] vs. Anglo-Celt median 7.1% [6.2–8.4%] to 6.7% [6.2–7.5%]), but the gap persisted ( P = 0.65 for difference between phases I and II by ethnic group). Aboriginal patients were more likely to have microvascular disease in both phases. The prevalence of peripheral arterial disease (ankle-brachial index ≤0.90 or lower-extremity amputation) increased in Aboriginal but decreased in Anglo-Celt participants (15.8–29.7 vs. 30.7–21.5%; P = 0.055). CONCLUSIONS Diabetes management has improved for Aboriginal and Anglo-Celt Australian patients, but disparities in cardiovascular risk factors and complications persist.

Dementia onset, incidence and risk in type 2 diabetes: a matched cohort study with the Fremantle Diabetes Study Phase I

“…In several European countries, the number of people with dementia is stabilising despite an ageing population [8][9][10], possibly because of improvements in education, housing and cardiovascular health [10]. In diabetes, improvements in clinical care have been accompanied by reduced rates of complications and cardiovascular disease [11,12]. How these two phenomena might affect the incidence of dementia in type 2 diabetes is unknown, but possible scenarios include an increased risk if more individuals with type 2 survive into old age or a reduction in risk if there are further improvements in diabetes care.…”

Diabetes mellitus in the australian indigenous community

“…However, smoking is related to other diseases among Aborigines, such as cardiovascular disease [34]. In addition, the high prevalence of smoking in urban Indigenous is similar to remote Aboriginal communities [35].…”

The independent associations of HbA1c, C-reactive protein and birth weight with cardiovascular disease, diabetes mellitus and chronic kidney disease in a remote Indigenous Australian community: a prospective cohort study

“…Sixty seven (6%) had an HbA1c greater than or equal to 6.5% (48 mmol/mol), but had no record of diagnosis or management of diabetes, while 158 (13%) participants had a prior diagnosis of diabetes. A further 195 participants were identified as high risk for developing type 2 diabetes using the IEC (International Expert Committee) 6.0% (42 mmol/mol) cut-off and up to 568 (48%) participants by the ADA criteria of 5.7-6.4% (39)(40)(41)(42)(43)(44)(45)(46) mmol/mol). Participants with known diabetes had HbA1c levels at time of screening between 4.9% (30 mmol/mol) and 15.6% (147 mmol/mol).…”

“…Due to difference in population samples for each measurement analysed, sensitivity analysis was conducted using only participants with complete information for BW, WC and BMI. Due to the drastic changes in mortality rates by birth weight cohorts and reducing incidence of LBW over the past [40][41][42][43][44][45][46][47][48][49][50] years in this community the model adjusted for the decade the individual was born [155].…”

“…These include renal disease and albuminuria [26,27,41], hypertension [26,27], abnormal lipid profiles [42], increased BMI [43] and C-Reactive protein (CRP) [44]. Insulin resistance has also been shown to be positively associated with BMI, WHR, 2 hr fasting glucose, triglycerides, SBP & DBP [45][46][47][48][49][50]. High density lipoprotein (HDL) cholesterol has been shown to be negatively associated with insulin resistance in Aborigines [46,49].…”