Complications of diabetes in urban Indigenous Australians: The DRUID study
Introduction
Relative to the overall Australian population, Indigenous Australians have a 15–20 year shorter life-expectancy and a 10-fold higher prevalence of diabetes (in those aged 20–50 years) [1], [2]. Complications of diabetes are significant contributors to premature mortality of Indigenous Australians [3], however this population is inadequately represented in relevant recent Australian studies (AusDiab [4], [5], [6], [7] and ANDIAB, National Association of Diabetes Centres [8]). It is also problematic to compare Indigenous and non-Indigenous groups with diabetes due to differences in age profiles (the age of onset of diabetes and its complications is much younger in Indigenous Australians).
There have been few studies involving complete assessment of complications of diabetes in Indigenous Australians [9], however high rates of nephropathy [10], [11], retinopathy [12], [13] and diabetic foot complications [14], [15] have been described in this population. Audits of Aboriginal people with diabetes have consistently reported poor glycaemic control despite adequate monitoring [16], [17], [18], [19], [20], [21] with better monitoring and control of blood pressure than glycaemia [20].
Of note, most Indigenous Australian studies concerned those living in rural and remote regions, while little is known about diabetes care and complications in the urban setting, where the majority of Indigenous Australians live [1]. The Darwin Region Urban Indigenous Diabetes (DRUID) Study was designed to address this knowledge gap. Compared to the rural/remote setting, health services are more likely to exist in urban Australia. However, there may still be important barriers for Indigenous Australians accessing these services, as evident by reported delays for Indigenous Australians accessing thrombolysis to a similar extent in both urban and remote settings (compared to non-Indigenous Australians) [22].
The aim of this study was to accurately assess metabolic control of type 2 diabetes and diabetes-related complications (micro- and macro-vascular) in an urban Indigenous cohort and to compare the risk of complications for DRUID participants with that of participants in the AusDiab Study of the general Australian population.
Section snippets
Participants
Participants were a subset of the DRUID Study, a cross-sectional study of approximately 1000 urban Indigenous people from Darwin, Australia, undertaken from September 2003 to March 2005. The population, methods and response rates of the DRUID Study have been previously described [23]. In summary, DRUID participants met the following eligibility criteria: identified as Aboriginal or Torres Strait Islander; aged ≥ 15 years; had resided within a specified geographical region around Darwin for at
Results
Diabetes status could be classified for 866 DRUID participants (Fig. 1). Of these, 172 (19.9%) had diabetes and were eligible for complications assessment, including 48 newly diagnosed by the study (28% of those with diabetes). The majority of participants with diabetes were women (74%). The proportions of females with diabetes were similar to proportions in the whole study sample for the age groups 45–54 years (70.8% female) and 55–64 years (71.2% female) but are not representative of the
Discussion
We report a minimum 2-fold independent increased risk of PVD and albuminuria in urban Indigenous Australians with diabetes compared to the general Australian population with diabetes. By contrast, we found no increase in relative odds of retinopathy in DRUID participants. Health care of DRUID participants was predominantly by primary health care providers, with moderate rates of meeting therapeutic targets.
Diabetes was common in this urban Indigenous cohort (19% of those with fasting bloods).
Conflict of interest
PZ has received fees for speaking and consulting from GlaxoSmithKline, Lilly Pharmaceuticals, Novartis, Bayer Schering Pharma AG, Merk, Sharp and Dohme, MerckAG, BMS, Solvay/Fournier and Sanofi Aventis. JES has received fees for speaking and for consulting from GlaxoSmithKline, Lilly Pharmaceuticals, Novo Nordisk, Bayer Schering Pharma AG, Merk, Sharp and Dohme, and Sanofi Aventis.
Acknowledgements
The authors gratefully acknowledge the support of DRUID study participants, study staff, members of the Indigenous Steering Group, and partner organisations. The DRUID Study was funded by the National Health and Medical Research Council (NHMRC Project Grant #236207), with additional support from the Australian Government Department of Employment and Workplace Relations, the Clive and Vera Ramaciotti Foundation, the Vincent Fairfax Family Foundation, the International Diabetes Institute (AusDiab
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