Characteristics of Indigenous adults with poorly controlled diabetes in north Queensland: implications for services.

David Ross Johnson,Robyn Anne Mcdermott,Sean Matthew Taylor,Katina D’Onise,Cilla Louise Preece,Peter Marshall Clifton,Barbara Anne Schmidt

doi:10.1186/s12889-015-1660-2

Abstract

BackgroundIndigenous Australian adults with diabetes continue to have suboptimal clinical control and poorer outcomes compared with non-Indigenous people although there is a paucity of data documenting the detailed health status of Indigenous people in Australia. To further investigate the characteristics of Indigenous Australian adults with poorly controlled diabetes we analysed baseline data from a cluster randomized trial aiming to deliver a program of integrated community-based intensive chronic disease management for Indigenous people in remote communities in far north Queensland, Australia.MethodsIndigenous adults aged 18 to 65 years from 12 clinics in rural north Queensland with established type 2 diabetes and with HbA1c ≥8.5% were invited to participate. The primary outcome variable measured at baseline was HbA1c. Other variables measured included socio-demographic indicators, health literacy, BMI, blood pressure, lipids, renal function, smoking status and quality of life measures. Data were collected between December 2010 and July 2011. Analysis was performed by ethnicity – Aboriginal or Torres Strait Islander.ResultsOne hundred and ninety three participants were included in the analysis. Very high rates of albuminuria, high rates of smoking, dyslipidaemia, hypertension and elevated BMI were recorded. Aboriginal participants reported higher levels of socio-economic disadvantage, higher smoking rates, lower BMI and worse self-reported health status than Torres Strait Islander participants.ConclusionThese results demonstrate a high potential for improved culturally sound community-based management of diabetes and other comorbid conditions in this very high risk population. They also provide further evidence for including albuminuria in cardiovascular risk calculation.

Highlights

Indigenous Australian adults with diabetes continue to have suboptimal clinical control and poorer outcomes compared with non-Indigenous people there is a paucity of data documenting the detailed health status of Indigenous people in Australia
While improvements have been made in the provision of routine clinical care processes, there has been less success translating this into improved intermediate clinical outcomes, such as glycaemic control for people with diabetes or reduction in risk factors such as overweight and obesity [12,13]
Study design, setting and participant selection This is a baseline analysis of the GBACC study whose methodology has been described elsewhere [19]. This is an open parallel randomised cluster trial delivering integrated community-based, intensive chronic disease management, compared to usual care, via rural and remote Indigenous primary health care services to Indigenous Australians living in far North Queensland, Australia

Summary

Introduction

While improvements have been made in the provision of routine clinical care processes, there has been less success translating this into improved intermediate clinical outcomes, such as glycaemic control for people with diabetes or reduction in risk factors such as overweight and obesity [12,13]. This has been in part attributed to what has been termed the ‘clinical inertia’ of treating doctors [14], relating to delays in initiating insulin [15]. In Australia, there is good evidence that Indigenous Health Workers (IHWs) are well placed to provide routine chronic disease care via the use of disease management protocols which is cost effective as long as there is: (1) adequate training in chronic disease management and health promotion/disease prevention; (2) good clinical support mechanisms and; (3) system-level support to ensure adequate staffing to enable chronic disease selfmanagement support for individuals, families and groups in community settings [16,17,18]

Methods

Results

Discussion

Conclusion