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Diabetes among Indigenous Australians at crisis point

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 stop…

Many people die while waiting for dialysis, or after finding the daily visits to a dialysis unit impossible to manage. Michael Coghlan

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 stop this disease from creating a national disaster.

Complications of diabetes include heart, eye, foot and kidney disease – and the complication rates in the Indigenous population are amongst the highest in the world. Kidney failure is one of the most devastating and it’s associated with very high mortality rates.

The risk of kidney failure among Indigenous people with diabetes is ten times higher than in non-Indigenous people with the disease. The higher rate of diabetes in the Indigenous population results from genetics, poverty and the lack of education and resources within this population, particularly in remote communities.

Kidney dialysis is the only way to treat the failure of the organ and it requires patients to attend a dialysis unit on a regular basis. Alice Springs has the unenviable reputation of hosting the largest kidney dialysis unit in the southern hemisphere. There are also a few small dialysis units in remote towns in the Northern Territory, but the number of patients needing dialysis is on the rise.

Dialysis often requires displacement from family, particularly for those living remotely. And many die while waiting for dialysis, or after finding the daily visits to a dialysis unit impossible to manage.

It’s little wonder then that resourcing Indigenous health generally and that of people with diabetes in particular is emerging as one of Australia’s most urgent health concerns. Despite our best efforts, diabetes is still on the rise and we are seeing many new cases and complications at a younger age.

Of great concern is the nature of diabetes in this population – it appears to be more aggressive and more resistant to conventional therapies. Complex treatment regimes are often needed but even they are rarely successful. Compliance with regular medications, such as once or twice daily insulin injections, and multiple tablets is very challenging, particularly in remote communities.

Seemingly simple issues such as regular meals, storage of insulin and tablets, and disposal of needles are not simple in outreach communities where priorities are more focused on acute health problems and day-to-day social issues. Home monitoring of blood glucose is critical for patients requiring insulin and other complex treatments – but this is not possible for most.

In my travels to remote settlements, I have seen children as young as 12 with type 2 diabetes (usually this is called mature onset diabetes occurring in older age groups). More worrying is the age of patients developing early kidney complications. I know of one young man aged 16 who already has signs of significant kidney disease and will no doubt head towards dialysis and death in the next ten to 15 years.

I have seen a young mother in her 30s progress from normal kidney function to kidney failure in five years. She now faces the prospect of life on dialysis. Many of my patients live with blood glucose levels in the 20 to 30 range (compared to a normal range of four to six), continuously without feeling too unwell. The long-term personal, social and economic consequences of this are, of course, devastating.

There’s a tsunami of kidney failure and other complications heading our way with many people having signs of early kidney damage, eye damage and heart disease. All these are associated with very poor control of their diabetes.

We have now reached a crisis point for the devastating effects of diabetes on Indigenous health. And while treatment of chronic disease in remote communities is challenging and complex, we must not be deterred.

Tiny clinics in remote towns need staff devoted to the prevention and treatment of diabetes and its complications. And communities need assistance at every level with the day-to-day management of this very complex disease.

Education and health promotion are critical in the long term but their health benefits may take decades. Clearly, we don’t have that sort of time. An emphatic response, firmly grounded in equity, compassion and human rights is needed to turn the tide of what will soon become a national disaster.

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17 Comments sorted by

  1. Tony P Grant

    Neo-Mort

    The statistics are indeed...scary!

    In my 40 years of viewing and participating within the "indigenous issues" often with abuse (non-indigenous person) I still wonder why health plus other issues are getting worse when so many "educated/trained...dare I say middle-class" indigenous representatives are on the ground?

    Is it a case of the "horse to water"?

    Or is it a case of creating/supporting a wealthy sub-group (middle-class militants) in their well to do life styles?

    I loved being attacked by people on this issue, why...statistics and complaints continue to rise and as a old mate of mine (Noongah man WA) says the place is full of "Uncle Toms" Robert Eggington activist.

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  2. Colin Bishop

    Manager

    How many times is this information going to be made known to the Health Departments and the governments - especially in Queensland?

    I will also raise the issue of water fluoridation and the additional health impact on all Australians.

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  3. rory robertson

    logged in via email @gmail.com

    Good morning Professor Cohen, and Happy World Diabetes Day.

    I agree that diabetes is a growing disaster for Indigenous health, and I think about the issues involved quite a bit. I do that I guess because I grew up with Aboriginal kids across country Australia, and my mum and sister spent decades as nurses in remote communities including Woorabinda, Baralaba, Katherine and Alice Springs (http://www.australianparadox.com/baralaba.htm ).

    Elevated rates of consumption of sugary foods and drinks…

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  4. Matt Stevens

    Senior Research Fellow/Statistician/PhD

    Sadly, many people in remote Aboriginal communities need assistance in so many ways, and sadly, too many are unable to assist themselves. Type 2 diabetes is a lifestyle disease in nearly all cases, and can be staved off, even reversed, with appropriate lifestyles that include a couple of hours of basic exercise a week and a good diet. One only needs to walk around Alice Springs to see the many obese Indigenous people, where in remote communities in central Australia, rates of adult diabetes are already up over 60%. Sure we need to treat those many Indigenous people who already now have serious Type 2 diabetes, but we really need to address the social determinants of health to stop this epidemic continuing.

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  5. Isabelle Skinner

    Professor of Rural and Regional Nursing at University of Tasmania

    Hi Neale,
    thanks for your call to action on World Diabetes day. Unfortunately many people living in remote communities have poor access to affordable nutritious food. They have poor access to a job with a future. They have poor access to refrigeration. Lastly, they have poor access to expert health care such as Endocrinologists, Diabetes Educators, Diabetologists, Health Psychologists.

    Having a renal dialysis service is terrific in Alice Springs but preventive health takes personal resources and access to expert advice in the early stages of disease. That they don't have. What can the Baker IDI do to improve acess to your wonderful resources for people living in remote and regional areas?

    Perhaps telehealth services from you to them could help.

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    1. Neale Cohen

      General Manager Diabetes Services, BakerIDI Heart and Diabetes Institute at Baker IDI Heart & Diabetes Institute

      In reply to Isabelle Skinner

      Hi Isabelle. Thanks for your comments. At the BakerIDI we have been involved in outreach services for 2 years and are learning the difficulties of remote and indigenous health. We are trying to provide continuity of care which I think is the key to chronic disease mangement. We have limited resources but are able to visit remote communities with endocrinologists, diabetes nurse educators including fly in fly out visits and telemedicine. What I think is missing and urgent is funding for these struggling clinics specifically for chronic disease mangement and staff devoted to this issue. in the long term this will not only be life saving but cost saving . Lets hope this message gets to some senior health advisors

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  6. Mike Parish

    Director

    Sugar and wheat need to be looked at closer.
    I went to a medical seminar recently, on preventative medicine. A well known doctor describe the current medical system- Where we have a cliff and when people drive over the cliff we have ambulances waiting at the bottom to run them off to get fixed, and the only way we seem to be improving things is to come up with faster ambulances!!!!
    Shouldn't our priority be to stop people driving over the cliff.
    I am a health researcher not scientific I just…

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    1. rory robertson

      logged in via email @gmail.com

      In reply to Mike Parish

      Mike, you make two very strong points. On the later, also try “Good Calories, Bad Calories”, by Gary Taubes. In my opinion, this could be the best book on nutrition science ever written, detailing a history spanning recent centuries. If you have the time, maybe start with Chapters 23 and 6. The pro-carbohydrate foundations of modern “nutrition science” – especially the hapless embrace of refined sugar and other refined carbohydrates as harmless - seem so poorly based that it’s not only fascinating and eye-opening but seriously disturbing.

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  7. Tom Hennessy

    Retired

    Asian and Pacific Islanders have been shown to have the highest blood iron levels of any ethnic groups tested.
    Iron causes kidney disease and targeting iron has been shown to be efficacious in those with kidney disease.

    "Hemosiderosis and iron overload can lead to chronic kidney disease"

    "Iron is associated with the pathogenesis of chronic kidney disease (CKD)."

    "Iron can be significantly reduced or prevented from acting directly or indirectly on the kidney to injure the kidney,thereby causing kidney disease,
    which if left untreated (no iron chelator) would result in an increase in total urinary protein content and serum creatinine"

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  8. rory robertson

    logged in via email @gmail.com

    Readers, National Diabetes Week 2013 has just been and gone with not much happening. In an effort to counter the disturbing Australian and global trends to obesity and type 2 diabetes - especially amongst Indigenous peoples - I am calling for a ban on all sugary drinks in all schools globally: http://www.australianparadox.com/pdf/Sugary-Drinks-Ban.pdf

    If after assessing the facts you think this proposal has merit, please forward this piece to parents, students, teachers, principals, nurses, doctors, dentists and others involved in public health.

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  9. Josephine Vic

    Student

    Hi i was wondering the affect of diabetes in aborginal children is it amplified by the culture in which they live in and family history.

    Also why are there rising number is it because alot of children don't get the education as they don't go to school or that there is no edcation at school about this health issue

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    1. Neale Cohen

      General Manager Diabetes Services, BakerIDI Heart and Diabetes Institute at Baker IDI Heart & Diabetes Institute

      In reply to Josephine Vic

      Hi Josephine
      Indigenous groups are prone to getting diabetes like some other ethnic groups. There is definitely a genetic component to this although the exact genes are not known. Other factors include low education levels and dietary issues and these do amplify the problem as occurs in non indigenous groups. We know that diabetes and obesity rates are increased generally in lower socioeconomic groups .
      Having said that, it is very unusual to see type 2 diabetes in adolescents and children, and the indigenous population seem to be prone to a fairly aggressive type of diabetes

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    2. rory robertson

      logged in via email @gmail.com

      In reply to Josephine Vic

      Hi Josephine,

      My guess is that much more important than "the culture in which they live in and family history ["genes"]", the growing disaster of type 2 diabetes in Aboriginal communities is "amplified" by obviously unhealthy diets in part because of unreliable dietary information from entities like the Australian Diabetes Council.

      As noted above, outsized rates of sugar consumption – alongside alcohol and tobacco – are a major driver of the unacceptable “gap” in life expectancy between Indigenous…

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    3. Josephine Vic

      Student

      In reply to rory robertson

      Hi so for my year 12 health assignment that I am currently doing is anyone able to give me primary statistics to the following questions

      How many indigenous children are admitted to hospital?

      Is there any education about diabetes in the school?

      Has there been any mortalities of the disease over the last 10 years?

      Why are indigenous children affected a lot by diabetes when they exercises, running around at school?

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    4. Matt Stevens

      Senior Research Fellow/Statistician/PhD

      In reply to Josephine Vic

      Hi Josephine

      You will find hospital statistics in publications freely downloadable from the AIHW website. You will also find mortality, though often mortality associated with diabetes is circulatory. A search of google scholar with (Indigenous or aboriginal) and diabetes will bring up plenty of article for you to peruse and form your own opinion or view. Good luck with your assignment.

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    5. rory robertson

      logged in via email @gmail.com

      In reply to Josephine Vic

      Hi again Josephine,

      Matt's suggestion of the excellent AIHW website looks good for your questions one and three. My answer to your final question is "For many Indigenous children, elevated consumption of sugary softdrinks is a/the major driver of (eventual) type 2 diabetes". Here are three supporting references:

      1. http://care.diabetesjournals.org/content/33/11/2477.full.pdf ;
      2. http://www.youtube.com/watch?v=xDaYa0AB8TQ&feature=youtu.be
      3. http://www.rethinksugarydrink.org.au/facts

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