The authors declare that they have no competing interests.
KOD and LMB designed and conducted the remote Australian study, JC, JS, KOD and LMB designed and conducted the DRUID study. AJH, SBH, MM, PC and BZ designed and conducted the Canadian study. LMB designed and performed the statistical analyses guided by AH, JC and KOD. LMB drafted the manuscript and all authors contributed important intellectual content. All authors approved the final version for publication. All authors read and approved the final manuscript.
Indigenous populations of Australia and Canada experience disproportionately high rates of chronic disease. Our goal was to compare cardiovascular (CVD) risk profile and diabetes complications from three recent comprehensive studies of diabetes complications in different Indigenous populations in Australia and Canada.
We compared participants from three recent studies: remote Indigenous Australians (2002-2003, n = 37 known diabetes), urban Indigenous Australians (2003-2005, n = 99 known diabetes), and remote Aboriginal Canadians (2001-2002, n = 188 known diabetes).
The three groups were similar for HbA1c, systolic BP, diabetes duration. Although leaner by body-mass-index criteria, remote Indigenous Australians displayed a more adverse CVD risk profile with respect to: waist-hip-ratio (1.03, 0.99, 0.94, remote Indigenous Australians, urban Indigenous Australians, remote Canadians, p < 0.001); HDL-cholesterol (0.82, 0.96, 1.17 mmol/L, p < 0.001); urine albumin-creatinine-ratio (10.3, 2.4, 4.5 mg/mmol); and C-reactive protein. With respect to diabetes complications, microalbuminuria (50%, 25%, 41%, p = 0.001) was more common among both remote groups than urban Indigenous Australians, but there were no differences for peripheral neuropathy, retinopathy or peripheral vascular disease.
Although there are many similarities in diabetes phenotype in Indigenous populations, this comparison demonstrates that CVD risk profiles and diabetes complications may differ among groups. Irrespective, management and intervention strategies are required from a young age in Indigenous populations and need to be designed in consultation with communities and tailored to community and individual needs.
Australian Institute of Health and Welfare. The health and welfare of Australia's Aboriginal and Torres Strait Islander people, an overview 2011. Cat no: IHW 42. 2011, Canberra: AIHW
Potential years of life lost at ages 25 to 74 among Status Indians, 1991 to 2001. Statistics Canada, Catalogue no. 82-003-XPE. [ http://www.statcan.gc.ca/pub/82-003-x/2011001/article/11409-eng.pdf]
Potential years of life lost at ages 25 to 74 among Metis and non-Status Indians, 1991 to 2001. Statistics Canada, Catalogue no 82-003-XPE. [ http://www.statcan.gc.ca/pub/82-003-x/2011001/article/11408-eng.pdf]
Hoy WE, Mathews JD, McCredie DA, Pugsley DJ, Hayhurst BG, Rees M, Kile E, Walker KA, Wang Z: The multidimensional nature of renal disease: rates and associations of albuminuria in an Australian Aboriginal community. Kidney Int. 1998, 54 (4): 1296-1304. 10.1046/j.1523-1755.1998.00099.x. CrossRefPubMed
Yeates K, Tonelli M: Chronic kidney disease among Aboriginal people living in Canada. Clin Nephrol. 2010, 74 (Suppl 1): S57-S60. PubMed
Katzenellenbogen JM, Sanfilippo FM, Hobbs MS, Briffa TG, Ridout SC, Knuiman MW, Dimer L, Taylor KP, Thompson PL, Thompson SC: Incidence of and case fatality following acute myocardial infarction in Aboriginal and non-Aboriginal Western Australians (2000-2004): a linked data study. Heart Lung Circ. 2010, 19 (12): 717-725. 10.1016/j.hlc.2010.08.009. CrossRefPubMed
Hanley AJG, Harris SB, Mamakeesick M, Goodwin K, Fiddler E, Hegele RA, Spence JD, House AA, Brown E, Schoales B, et al: Complications of Type 2 Diabetes Among Aboriginal Canadians: Prevalence and associated risk factors. Diabetes Care. 2005, 28 (8): 2054-2057. 10.2337/diacare.28.8.2054. CrossRefPubMed
Cunningham J, O'Dea K, Dunbar T, Weeramanthri TS, Zimmet P, Shaw J: Study Protocol - Diabetes and related conditions in urban Indigenous people in the Darwin, Australia region: aims, methods and participation in the DRUID Study. BMC Public Health. 2006, 6: 8-10.1186/1471-2458-6-8. PubMedCentralCrossRefPubMed
Hanley A, Harris SB, Mamakeesick M, Goodwin K, Fiddler E, Hegele RA, McLaughlin JR, Zinman B: Complications of Type 2 Diabetes Among Aboriginal Canadians: Increasing the Understanding of Prevalence and Risk Factors. Canadian Journal of Diabetes. 2003, 27 (4): 455-463.
Hanley AJG, Harris SB, Barnie A, Gittelsohn J, Wolever TMS, Logan A, Zinman B: The Sandy Lake Health and Diabetes Project: Design, Methods and Lessons Learned. Chronic Dis Can. 1995, 16 (4): 149-156.
Waldram J, Herring DA, Young TK: Aboriginal Health in Canada: historical, cultural, and epidemiological perspectives. 1995, Toronto: University of Toronto Press
World Health Organisation. Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. 1999, Geneva: Department of Noncommunicable Disease Surveillance, WHO
Parsons MP, Newman DJ, Newall RG, Price CP: Validation of a point-of-care assay for the urinary albumin:creatinine ratio. Clin Chem. 1999, 45 (3): 414-417. PubMed
Bryant W, Greenfield JR, Chisholm DJ, Campbell LV: Diabetes guidelines: easier to preach than to practise?. Med J Aust. 2006, 185 (6): 305-309. PubMed
Flack JR, Colagiuri S: Final report of the Australian National Diabetes Information Audit and Benchmarking (ANDIAB) 2004. (Accessed April 2007), [ http://www.health.gov.au/internet/wcms/publishing.nsf/Content/pq-diabetes-pubs-andiab04]
Bailie RS, Si D, Robinson GW, Togni SJ, D'Abbs PH: A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care. Med J Aust. 2004, 181 (4): 195-200. PubMed
McDermott RA, Tulip F, Schmidt B: Diabetes care in remote northern Australian Indigenous communities. Med J Aust. 2004, 180 (10): 512-516. PubMed
Davis TM, Davis WA, Bruce DG: Glycaemic levels triggering intensification of therapy in type 2 diabetes in the community: the Fremantle Diabetes Study. Med J Aust. 2006, 184 (7): 325-328. PubMed
Cass A, Cunningham J, Snelling P, Wang Z, Hoy W: End-stage renal disease in indigenous Australians: a disease of disadvantage. Ethn Dis. 2002, 12 (3): 373-378. PubMed
Cass A, Cunningham J, Wang Z, Hoy W: Regional variation in the incidence of end-stage renal disease in Indigenous Australians. Med J Aust. 2001, 175 (1): 24-27. PubMed
McDonald S, Maguire G, Duarte N, Wang XL, Hoy W: C-reactive protein, cardiovascular risk, and renal disease in a remote Australian Aboriginal community. Clin Sci (Lond). 2004, 106 (2): 121-128. 10.1042/CS20030186. CrossRef
Rowley K, Walker KZ, Cohen J, Jenkins AJ, O'Neal D, Su Q, Best JD, O'Dea K: Inflammation and vascular endothelial activation in an Aboriginal population: relationships to coronary disease risk factors and nutritional markers. Med J Aust. 2003, 178 (10): 495-500. PubMed
Yudkin J, Yajnik C, Mohamed-Ali V, Bulmer K: High levels of circulating proinflammatory cytokines and leptin in urban, but not rural, Indians. A potential explanation for increased risk of diabetes and coronary heart disease. Diabetes Care. 1999, 22 (2): 363-364. 10.2337/diacare.22.2.363. CrossRefPubMed
Ley SH, Hegele RA, Connelly PW, Harris SB, Mamakeesick M, Cao H, Gittelsohn J, Retnakaran R, Zinman B, Hanley AJ: Assessing the association of the HNF1A G319S variant with C-reactive protein in Aboriginal Canadians: a population-based epidemiological study. Cardiovasc Diabetol. 2010, 9: 39-10.1186/1475-2840-9-39. PubMedCentralCrossRefPubMed
Shemesh T, Rowley KG, Shephard M, Piers LS, O'Dea K: Agreement between laboratory results and on-site pathology testing using Bayer DCA2000+ and Cholestech LDX point-of-care methods in remote Australian Aboriginal communities. Clin Chim Acta. 2006, 367 (1-2): 69-76. 10.1016/j.cca.2005.11.014. CrossRefPubMed
ABS & AIHW (Australian Bureau of Statistics & Australian Institute of Health and Welfare). The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples. Canberra. 2005
Ricci-Cabello I, Ruiz-Pérez I, De Labry-Lima AO, Márquez-Calderón S: Do social inequalities exist in terms of the prevention, diagnosis, treatment, control and monitoring of diabetes? A systematic review. Health Soc Care Community. 2010, 18 (6): 572-587. 10.1111/j.1365-2524.2010.00960.x. CrossRefPubMed
Ong MA, Weeramanthri TS: Delay times and management of acute myocardial infarction in indigenous and non-indigenous people in the Northern Territory. Med J Aust. 2000, 173 (4): 201-204. PubMed
- Cardiovascular disease risk profile and microvascular complications of diabetes: comparison of Indigenous cohorts with diabetes in Australia and Canada
Louise J Maple-Brown
Stewart B Harris
Philip W Connelly
Anthony J Hanley
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II