Diabetes in Indigenous Australians

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Diabetes, in particular, non-insulin-dependent diabetes, is prevalent in the Aboriginal and Torres Strait Islander populations of Australia. [1] As many as 1 in 20 [2] Australians are said to suffer from diabetes. Aboriginal people are three times as likely to become diabetic in comparison to non-Aboriginal people. [3] In contrast with type 1 diabetes, which is a predisposed autoimmune condition, [4] type 2 diabetes or insulin-resistant diabetes, is a preventable disease, heavily influenced by a multitude of socioeconomic factors. [5] Sufferers of the disease are consequently more susceptible to chronic health issues, including heart disease and kidney failure. [6] Conclusively, this has contributed to the 17 year life expectancy gap between Aboriginal people and non-Aboriginal people and has led to health inequities between Aboriginal people and non-Aboriginal people. [6]

Contents

History

The history of Aboriginal Australians is said to have spanned some 60,000 years prior to colonization, [7] yet they were first cited by Europeans in 1606. [8] Further investigations of the land over the years leading to James Cook's arrival in 1769-70, suggested that the Aboriginal people were hunter-gatherers, who were described as "beasts who roamed the land". [8] Fully utilising the resources at their disposal, the diet of the early Aboriginal people was predominantly made up of land animals, fish and shellfish, as well as birds and plant foods. [7] (Note that some historians dispute this, such as Bill Gammage and Bruce Pascoe (in his Dark Emu ).)

Post-colonisation, the Aboriginal people experienced excessive disruptions to their socioeconomic circumstances, leading to a rapid decline in their health status. [9] Forced to assimilate into a Eurocentric society, Aboriginal people abandoned their traditional way of living and reluctantly adopted those of the colony. [9] Over time, this has seen the introduction of sugar and refined foods into the diet of Aboriginal Australians, initially to sever existing connections to the land. [9] Aboriginal people have since viewed sugar as an important cultural food, associated with family identities and reinforcing connections. [9] Subsequently, Aboriginal people have since become highly vulnerable to suffering from conditions such as diabetes.

Causes

European influence

The prevalence of type 2 diabetes, obesity, and the corresponding diseases that are associated with these conditions, are often attributed to European influences at the time of colonisation. [10] Sugar and refined foods were used at this time as a means of detaching Aboriginal people from the land and assimilating them into white society. Consequently, Aboriginal Australians have likened certain traditions and memories to the use of sugar. Thus, the ‘Westernisation’ of Aboriginal communities forced the neglect of a nutrient-dense diet and cemented a foundation for the development of type 2 diabetes.

Remoteness

The remoteness of Aboriginal communities and socioeconomic disparity have contributed to the prevalence of diabetes in Aboriginal Australians. Consequently, refined foods have seemingly replaced healthy alternatives, as communities are denied access to fresh and healthy foods due to limited resources. [11] Many Aboriginal people live in poverty, with unemployment and dependence on welfare being common in many communities. Energy dense, filling foods, which are often high in fats and sugar, are more common in the diets of people living in poverty. [12] There are direct correlations between the disparity of wealth, obesity, and subsequent morbidity. This is a main contributor to Aboriginal people and Torres Strait Islanders being 2-4 more times likely to suffer from this condition. [13]

Health inequalities

Health inequalities in society and lack of education can also contribute to the higher diagnosis of diabetes among Aboriginal and Torres Strait Islanders. [13]

Unutilised resources

Similarly, Aboriginal people are recognised as not utilising the health resources at their disposal. [11] Bush tucker, a dietary staple prior to European settlement that is low in natural sugars and free of refined sugars, is not being utilised even in remote communities due to the high dependence on Western diets. Australian Aboriginal people are said to be lacking in diabetes education, including proper monitoring of glucose levels, [13] making them more susceptible to diabetes-related problems.

Low birth weights

Aboriginal infants are also said to have relatively lower birth weights than normal, which can also contribute to early incidences of type 2 diabetes. [13]

Lifestyle

Genetic predisposition is commonly found in early-onset diabetic patients. Diabetes is not a single gene disease, and rare gene variants and a common variant may be present in a single individual. Type 2 diabetes is also associated with obesity and other cardiovascular factors and lifestyle influences. [14] Those with high blood pressure, a poor diet, insufficient physical activity, obesity, and in the case of Aboriginal Australians, age higher than 35, are more susceptible to developing type 2 diabetes. [15]

Pregnancy

Gestational diabetes, diabetes diagnosed during pregnancy, is highly common among Aboriginal Australians. [16]

Complications

Type 2 diabetes is a detrimental condition commonly affecting Aboriginal Australians. It is closely associated with obesity and is often a precursor for subsequent preventable diseases, including cardiovascular and renal disease. Hence, diabetes is a major cause of the premature mortality of many Aboriginal Australians. [10]

Increased occurrence of renal complications among Aboriginal people is attributed to environmental and genetic factors, [17] as well as poor monitoring of glucose levels. [18] Low birth weight can cause lower renal volume, post-infectious renal damage, and other kidney conditions that are characteristically associated with chronic kidney disease and end stage kidney failure. [17] Consequently, Australian Aboriginal people are 8 times more likely to experience kidney failure than non-Aboriginal Australians. [19]

Cardiovascular disease is the single greatest contributor to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. [20] Obesity and increased waist circumference is an important risk factor, [20] along with other modifiable influences including smoking, high blood pressure, high cholesterol levels, low levels of physical activity. [20] All of these influences contribute to the incidence of diabetes and consequently, cardiovascular disease. Additionally, gestational diabetes can cause harm to pregnant women and also leads to complications in the fetus.

The prevalence of type 2 diabetes in Aboriginal Australians can lead to retinopathy, whereby blood vessels in the eye are damaged [21] as a direct result of this condition. Peripheral neuropathy is also common in diabetes patients and in some cases can lead to chronic foot problems and even amputations. [22]

Prevention

CSIRO ScienceImage 10461 A selection of fruit and vegetables.jpg

Health issues affecting Aboriginal Australians, including the incidence of type 2 diabetes, are often attributed to disparities in socioeconomic status. [22] Often, the greater the social and economic disadvantage, the greater the occurrence of diabetes and other associated conditions. [22] Improvements in the socioeconomic status of Aboriginal Australians and decreases in health inequities are instrumental if the incidence of diabetes and associated conditions are to be reduced.

Early detection programs and diabetes screenings are essential in reducing the frequency of diabetes and its long-term effects. [22] Additionally, regular weight assessments should be done. Promotion of healthy eating and physical activity, smoking cessation and the safe consumption of alcohol [23] are also vital to reduce and prevent type 2 diabetes. The Australian government has addressed the need for such intervention by implementing the National Prevention of Type 2 Diabetes program. Arguably,[ according to whom? ] such programs need to be supported by efforts to provide greater employment and educational opportunities for Aboriginal Australians and health programs tailored to their favoured holistic approach to health and wellbeing. [23]

Statistics

One in 20 Australian adults had diabetes in 2011–2012. [2]

Aboriginal people and Torres Strait Islander people are 2–4 times more likely to develop diabetes than their non-Indigenous counterparts. [13]

Diabetes among Aboriginal people is apparent as early as 25 years of age. Approximately 18% of Aboriginal and Torres Strait Islanders over the age of 25 report having diabetes or high blood sugar levels. Rates of diabetes range from 5% for those in the 25-34 age bracket to 39% for those aged 55 years and over. [24]

In 2012–2013, approximately 8% of Aboriginal and Torres Strait Islanders reported that they had diabetes or high blood sugar levels. Females were more likely than men to suffer from diabetes, with 10% claiming to be diabetic, in comparison to 7% of males. [24]

Related Research Articles

<span class="mw-page-title-main">Type 2 diabetes</span> Type of diabetes mellitus with high blood sugar and insulin resistance

Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, fatigue and unexplained weight loss. Symptoms may also include increased hunger, having a sensation of pins and needles, and sores (wounds) that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

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A diabetic diet is a diet that is used by people with diabetes mellitus or high blood sugar to minimize symptoms and dangerous complications of long-term elevations in blood sugar.

<span class="mw-page-title-main">Prediabetes</span> Predisease state of hyperglycemia with high risk for diabetes

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<span class="mw-page-title-main">Baker Heart and Diabetes Institute</span>

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<span class="mw-page-title-main">Diabetes in Australia</span>

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<span class="mw-page-title-main">Epidemiology of diabetes</span>

Globally, an estimated 537 million adults are living with diabetes, according to 2019 data from the International Diabetes Federation. Diabetes was the 9th-leading cause of mortality globally in 2020, attributing to over 2 million deaths annually due to diabetes directly, and to kidney disease due to diabetes. The primary causes of type 2 diabetes is diet and physical activity, which can contribute to increased BMI, poor nutrition, hypertension, alcohol use and smoking, while genetics is also a factor. Diabetes prevalence is increasing rapidly; previous 2019 estimates put the number at 463 million people living with diabetes, with the distributions being equal between both sexes icidence peaking around age 55 years old. The number is projected to 643 million by 2030, or 7079 individuals per 100,000, with all regions around the world continue to rise. Type 2 diabetes makes up about 85-90% of all cases. Increases in the overall diabetes prevalence rates largely reflect an increase in risk factors for type 2, notably greater longevity and being overweight or obese. The prevalence of African Americans with diabetes is estimated to triple by 2050, while the prevalence of whites is estimated to double. The overall prevalence increases with age, with the largest increase in people over 65 years of age. The prevalence of diabetes in America is estimated to increase to 48.3 million by 2050.

<span class="mw-page-title-main">Diabetes</span> Group of endocrine diseases characterized by high blood sugar levels

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<span class="mw-page-title-main">Indigenous health in Australia</span> Medical condition

Indigenous health in Australia examines health and wellbeing indicators of Indigenous Australians compared with the rest of the population. Statistics indicate that Aboriginal Australians and Torres Strait Islanders are much less healthy than other Australians. Various government strategies have been put into place to try to remediate the problem; there has been some improvement in several areas, but statistics between Indigenous Australians and the rest of the Australian population still show unacceptable levels of difference.

Nutrition is the intake of food, considered in relation to the body's dietary needs. Well-maintained nutrition includes a balanced diet as well as a regular exercise routine. Nutrition is an essential aspect of everyday life as it aids in supporting mental as well as physical body functioning. The National Health and Medical Research Council determines the Dietary Guidelines within Australia and it requires children to consume an adequate amount of food from each of the five food groups, which includes fruit, vegetables, meat and poultry, whole grains as well as dairy products. Nutrition is especially important for developing children as it influences every aspect of their growth and development. Nutrition allows children to maintain a stable BMI, reduces the risks of developing obesity, anemia and diabetes as well as minimises child susceptibility to mineral and vitamin deficiencies.

<span class="mw-page-title-main">Cardiovascular disease in Australia</span>

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<span class="mw-page-title-main">Dementia and Alzheimer's disease in Australia</span> Major health issue in Australia

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<span class="mw-page-title-main">Cerebrovascular diseases in Australia</span>

Cerebrovascular diseases in Australia are a major health issue. Cerebrovascular disease is a significant challenge to Australia due to it being a prominent cause of death in Australians and the difficulties it poses for carers and the health system in addition to individuals with cerebrovascular disease. Stroke is the deadliest cerebrovascular disease in Australia accounting for 84.24% of all deaths caused by cerebrovascular diseases. The death rate of cerebrovascular diseases is decreasing, with cerebrovascular disease in 2008-2018 falling from the third to fourth leading cause of death for men and second to third leading cause of death for women during this time period. In 2015, stroke was the tenth leading cause of burden of disease, accounting for 2.7% of the overall burden. This cause of disease burden has decreased from 2003-2015 with stroke falling from the second leading cause of disease burden to the tenth during this time period. Aboriginal and Torres Strait Islander people and people from low-socioeconomic areas experience higher rates of prevalence and mortality from stroke than non-Indigenous Australians.

References

  1. ↑ O'Dea, K. "Diabetes in aboriginal Australians". 37 (3): 25–8.{{cite journal}}: Cite journal requires |journal= (help)
  2. 1 2 "Diabetes (AIHW)". www.aihw.gov.au. Retrieved 3 September 2015.
  3. ↑ "4727.0.55.001 - Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-13". www.abs.gov.au. 27 November 2013. Retrieved 3 September 2015.
  4. ↑ "Type 1 diabetes". www.diabetesaustralia.com.au. Retrieved 3 September 2015.
  5. ↑ Rowley, K. G. & O'Dea, K. (2001). "Diabetes in australian aboriginal and torres strait islander peoples". Papua and New Guinea Medical Journal. 44 (3–4): 164–170. PMID   12422987.
  6. 1 2 Wang, Zhiqiang; Hoy, Wendy E.; Si, Damin (17 August 2010). "Incidence of type 2 diabetes in Aboriginal Australians: an 11-year prospective cohort study". BMC Public Health. 10 (1): 487. doi: 10.1186/1471-2458-10-487 . ISSN   1471-2458. PMC   2931471 . PMID   20712905.
  7. 1 2 Attenbrow, V (2010). "Sydney's Aboriginal Past". Investigating the Archaeological and Historical Records.: 152–153.
  8. 1 2 Broome, R (2014). "Doing Aboriginal History". Agora (2): 40–49.
  9. 1 2 3 4 Thompson, Samantha J; Gifford, Sandra M (16 November 2000). "Trying to keep a balance: the meaning of health and diabetes in an urban Aboriginal community". Social Science & Medicine. 51 (10): 1457–1472. doi:10.1016/S0277-9536(00)00046-0. PMID   11077950.
  10. 1 2 Daniel, M.; Rowley, K.G.; McDermott, R.; O'Dea, K. (1 January 2002). "Diabetes and impaired glucose tolerance in Aboriginal Australians: prevalence and risk". Diabetes Research and Clinical Practice. 57 (1): 23–33. doi:10.1016/s0168-8227(02)00006-2. PMID   12007727.
  11. 1 2 King, Merilyn (1 June 2001). "The diabetes health care of Aboriginal people in South Australia (Part 1)". Contemporary Nurse. 10 (3–4): 147–155. doi:10.5172/conu.10.3-4.147. ISSN   1037-6178. PMID   11855106. S2CID   21957339.
  12. ↑ Brown, A.; O'Dea, K.; Rowley, K.G. (2007). "Diabetes in Indigenous Australians: possible ways forward". The Medical Journal of Australia. 186 (10): 494–495. doi:10.5694/j.1326-5377.2007.tb01020.x. PMID   17516893. S2CID   8442635.
  13. 1 2 3 4 5 Davis, T. M. E.; McAullay, D.; Davis, W. A.; Bruce, D. G. (1 January 2007). "Characteristics and outcome of type 2 diabetes in urban Aboriginal people: the Fremantle Diabetes Study". Internal Medicine Journal. 37 (1): 59–63. doi:10.1111/j.1445-5994.2006.01247.x. ISSN   1445-5994. PMID   17199846. S2CID   42670424.
  14. ↑ Rosenberg M, Lawrence A. Review of primary prevention of type 2 diabetes in Western Australia. [cited 2006 March]. Available from URL: http://www.health.wa.gov.au/publications/documents/9755type2diabetesreview.pdf
  15. ↑ "Type 2 diabetes". www.diabetesaustralia.com.au. Retrieved 3 September 2015.
  16. ↑ Chamberlain, Catherine; Joshy, Grace; Li, Hang; Oats, Jeremy; Eades, Sandra; Banks, Emily (1 March 2015). "The prevalence of gestational diabetes mellitus among Aboriginal and Torres Strait Islander women in Australia: a systematic review and meta-analysis". Diabetes/Metabolism Research and Reviews. 31 (3): 234–247. doi:10.1002/dmrr.2570. ISSN   1520-7560. PMID   24912127. S2CID   13325428.
  17. 1 2 McDonald, S. (2014). "Placing aboriginal kidney disease in context". Canadian Medical Association Journal. 186 (2): 93–94. doi:10.1503/cmaj.131605. PMC   3903729 . PMID   24295866.
  18. ↑ "Prevalence of treated end-stage kidney disease (ESKD) (AIHW)". www.aihw.gov.au. Archived from the original on 3 September 2015. Retrieved 3 September 2015.
  19. ↑ Rix, Elizabeth F.; Barclay, Lesley; Stirling, Janelle; Tong, Allison; Wilson, Shawn (1 January 2015). "The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: A qualitative study". Hemodialysis International. 19 (1): 80–89. doi:10.1111/hdi.12201. ISSN   1542-4758. PMC   4309474 . PMID   25056441.
  20. 1 2 3 Burgess, Christopher P.; Bailie, Ross S.; Connors, Christine M.; Chenhall, Richard D.; McDermott, Robyn A.; O'Dea, Kerin; Gunabarra, Charlie; Matthews, Hellen L.; Esterman, Adrian J. (31 January 2011). "Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service". BMC Health Services Research. 11 (1): 24. doi: 10.1186/1472-6963-11-24 . ISSN   1472-6963. PMC   3045287 . PMID   21281520.
  21. ↑ "Diabetic Retinopathy". www.visionaustralia.org. Archived from the original on 10 February 2016. Retrieved 3 September 2015.
  22. 1 2 3 4 "Review of diabetes among Indigenous peoples « Reviews « Diabetes « Chronic conditions « Australian Indigenous HealthInfoNet". www.healthinfonet.ecu.edu.au. Retrieved 3 September 2015.
  23. 1 2 (2011). Diabetes in rural Australia. [Pamphlet]. Deakin West, Australia: National Rural Health Alliance
  24. 1 2 "4727.0.55.001 - Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-13". www.abs.gov.au. 27 November 2013. Retrieved 3 September 2015.
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