Diabetes care in remote northern Australian Indigenous communities

Abstract

Objective: To assess primary care processes and clinical characteristics of adults with diabetes in remote northern Australian Indigenous communities. Design: Clinical audit from diabetes registers in 21 remote primary healthcare centres in the Torres Strait Health Service District (n = 921), three in Cape York, Queensland (n = 252), and three in the Northern Territory (n = 194), between September 2002 and February 2003. Participants and setting: Aboriginal and Torres Strait Islander adults with diabetes who were receiving their routine diabetes care in these 27 centres. Main outcome measures: Provision of regular checks for weight, blood pressure, glycaemia (HbA1c), proteinuria, lipid levels, renal function, eyes and feet, influenza and pneumococcal vaccination. Weight, blood pressure and glycaemic control. Results: Most routine diabetes checks were delivered according to recommended schedules, except for eye and foot checks in the NT. There were uniformly high rates of appropriate treatment for hypertension and albuminuria, but low rates of insulin treatment and self‐monitoring despite a high mean HbA1c level (8.9%). Vaccination rates were low in the NT. Torres Strait Islanders with diabetes were significantly heavier than Aboriginals, but had lower mean diastolic blood pressure (77.3 mmHg compared with 79.5 mmHg) and lower prevalence of albuminuria and smoking. Conclusion: A high proportion of Aboriginals and Torres Strait Islanders requiring treatment for high blood pressure and proteinuria are receiving it. However, there is dissonance between the relatively high rates of routine checks and apparent lack of therapeutic action on glycaemia. More intensive management of glycaemia, including improved nutrition, exercise and (probably) insulin, is required to reduce microvascular complications.

The prevalence and causes of visual impairment in indigenous Australians within central Australia: the Central Australian Ocular Health Study

“…As males are less likely to present to a health professional,21 almost twice as many females as males were recruited. This phenomenon has been observed in previous work involving non-indigenous populations,22 and there is evidence that it may translate over to the indigenous Australian population 17–19 23 24. However, vision loss was not associated with sex; therefore, this sex imbalance that decreased in older age groups should not have affected our results.…”

The prevalence of glaucoma in indigenous Australians within Central Australia: the Central Australian Ocular Health Study

“…As males are less likely to present to a health professional,29 almost twice as many females as males were recruited. This phenomenon has been observed in previous work involving non-indigenous populations,30 and there is evidence that it may translate to the indigenous Australian population 31 32. However, glaucoma was not associated with sex, so this gender imbalance that decreased in older age groups should not have affected our results.…”

Cardiovascular disease risk profile and microvascular complications of diabetes: comparison of Indigenous cohorts with diabetes in Australia and Canada

“…Although poor, the proportion of DRUID participants meeting glycemic therapeutic targets (HbA1c < 7%) was similar to that reported in secondary care settings in Australia [27,28], as well as in remote Northern Australian communities [29,30]. Possible contributory factors to the lower rate of achieving therapeutic targets for glycemic control (compared to good rates of blood pressure control) in the Indigenous populations of the current study include unmeasured factors such as psychosocial stress, socio-economic disadvantage and access to medical care, including access to diabetes education and support of self-management in the use of insulin.…”