Working Towards Eye Health Equity for Indigenous Australians with Diabetes

Abstract

Type 2 diabetes mellitus (T2DM) poses significant challenges to individuals and broader society, much of which is borne by disadvantaged and marginalised population groups including Indigenous people. The increasing prevalence of T2DM among Indigenous people has meant that rates of diabetes-related complications such as blindness from end-stage diabetic retinopathy (DR) continue to be important health concerns. Australia, a high-income and resource-rich country, continues to struggle to adequately respond to the health needs of its Indigenous people living with T2DM. Trends among Indigenous Australians highlight that the prevalence of DR has almost doubled over two decades, and the prevalence of diabetes-related vision impairment is consistently reported to be higher among Indigenous Australians (5.2%-26.5%) compared to non-Indigenous Australians (1.7%). While Australia has collated reliable estimates of the eye health burden owing to T2DM in its Indigenous population, there is fragmentation of existing data and limited knowledge on the underlying risk factors. Taking a systems approach that investigates the social, environmental, clinical, biological and genetic risk factors, and-importantly-integrates these data, may give valuable insights into the most important determinants contributing to the development of diabetes-related blindness. This knowledge is a crucial initial step to reducing the human and societal impacts of blindness on Indigenous Australians, other priority populations and society at large.

Differences in retinopathy prevalence and progression between Anglo‐Celt and Aboriginal Australians: the Fremantle Diabetes Study Phase II

“…In addition, comparisons with non-indigenous DR rates are complicated by between-population differences in age distribution, DR risk factors and access to care. 10,11 Since recent census data suggest that 79% of the Australian indigenous population are urban dwelling, 12 it is important to characterise the contemporary determinants and burden of DR in indigenous people living in cities and to determine whether they are different to those in non-indigenous people from the same community. The aim of this study was to compare the prevalence of DR and the cumulative incidence of new or worsening DR between Aboriginal people (encompassing all indigenous groups) and Anglo-Celt Australians with Type 2 diabetes (T2D) participating in the population-based longitudinal Fremantle Diabetes Study Phase II (FDS2).…”

“…The reported rates of DR have ranged from 21% 8 up to 47%, 9 probably reflecting between‐study differences in variables such as study setting (urban vs rural/remote), recruitment methods (clinic vs community) and DR ascertainment (clinical examinationvs fundus photography). In addition, comparisons with non‐indigenous DR rates are complicated by between‐population differences in age distribution, DR risk factors and access to care 10,11 …”

Mixed diabetic retinopathy screening coverage results in Indigenous Australian primary care settings: A nurse‐led model of integrated diabetes care

“…Globally, Diabetic retinopathy (DR) is the leading cause of adult-onset blindness in working-age adults (Wong & Sabanayagam, 2020). The increasing prevalence of diabetes, which is predominantly Type 2 diabetes, among Indigenous Australians has also been associated with an increase in the rates of DR and vision impairment (Estevez et al, 2019). As DR is usually asymptomatic, particularly in the early stages, and refractive errors and cataracts are treatable diabetes-related vision loss is largely avoidable; hence eye screening of people with diabetes is an essential risk management strategy.…”

A model of culturally‐informed integrated diabetes education and eye screening in indigenous primary care services and specialist diabetes clinics: Study protocol

“…Diabetes and its chronic complications disproportionately affect populations in low‐ to middle‐income regions (Jennifer et al., 2019) racial and ethnic minority groups (Thornton et al., 2020), including Indigenous Australians (Australian Institute of Health & Welfare, 2020). A serious complication of diabetes is diabetic retinopathy (DR), which if left untreated, can lead to impaired vision or blindness (Estevez et al., 2019). As DR is usually asymptomatic, particularly in the early stages and DR‐related vision loss is largely avoidable, DR screening is an essential risk management strategy.…”