Incidence of type 2 diabetes in Aboriginal Australians: An 11-year prospective cohort study

Centre for Chronic Disease, School of Medicine, University of Queensland, Herston, 4029 QLD, Australia.
BMC Public Health (Impact Factor: 2.26). 08/2010; 10(1):487. DOI: 10.1186/1471-2458-10-487
Source: PubMed


Diabetes is an important contributor to the health inequity between Aboriginal and non-Aboriginal Australians. This study aims to estimate incidence rates of diabetes and to assess its associations with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) among Aboriginal participants in a remote community.
Six hundred and eighty six (686) Aboriginal Australians aged 20 to 74 years free from diabetes at baseline were followed for a median of 11 years. During the follow-up period, new diabetes cases were identified through hospital records. Cox proportional hazards models were used to assess relationships of the incidence rates of diabetes with IFG, IGT and body mass index (BMI).
One hundred and twenty four (124) new diabetes cases were diagnosed during the follow up period. Incidence rates increased with increasing age, from 2.2 per 1000 person-years for those younger than 25 years to 39.9 per 1000 person-years for those 45-54 years. By age of 60 years, cumulative incidence rates were 49% for Aboriginal men and 70% for Aboriginal women. The rate ratio for developing diabetes in the presence of either IFG or IGT at baseline was 2.2 (95% CI: 1.5, 3.3), adjusting for age, sex and BMI. Rate ratios for developing diabetes were 2.2 (95% CI: 1.4, 3.5) for people who were overweight and 4.7 (95% CI: 3.0, 7.4) for people who were obese at baseline, with adjustment of age, sex and the presence of IFG/IGT.
Diabetes incidence rates are high in Aboriginal people. The lifetime risk of developing diabetes among Aboriginal men is one in two, and among Aboriginal women is two in three. Baseline IFG, IGT and obesity are important predictors of diabetes.

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    • "Existen diversas poblaciones en el mundo, tales como asiáticos, incluyendo India, los polinésicos (o polinesios), aborígenes australianos y los Indios Pima de Arizona, que han experimentado un aumento considerable en la incidencia de DT2 (Asghar et al., 2011; Wang et al., 2010; Pavkov et al., 2007 "

    Full-text · Article · Mar 2015
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    • "Compared with the general Australian population, Australian Indigenous people are far more likely to die (two to six times more) from: respiratory, cardiovascular, kidney and endocrine diseases (Thomson et al., 2011). Australia has a growing inequity in smoking prevalence rates, between its various population subgroups, with prevalence being particularly high in Indigenous populations (Marmot, 2005; Wang and Hoy, 2010). The smoking prevalence rate for Indigenous populations in Australia is 45% (ABS, 2009) and is far greater than non-Indigenous Australians (19%), and more pronounced than in many other Indigenous "
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    ABSTRACT: The prevalence rate of tobacco smoking remains high for Australian Indigenous people despite declining rates in other Australian populations. Given many Indigenous Australians continue to experience a range of social and economic structural problems, stress could be a significant contributing factor to preventing smoking abstinence. The reasons why some Indigenous people have remained resilient to stressful adverse conditions, and not rely on smoking to cope as a consequence, may provide important insights and lessons for health promotion policy and practice. In-depth interviews were employed to collect oral histories from 31 Indigenous adults who live in metropolitan Adelaide. Participants were recruited according to smoking status (non-smokers were compared with current smokers to gain a greater depth of understanding of how some participants have abstained from smoking). Perceived levels of stress were associated with encouraging smoking behaviour. Many participants reported having different stresses compared with non-Indigenous Australians, with some participants reporting having additional stressors such as constantly experiencing racism. Resilience often occurred when participants reported drawing upon internal psychological assets such as being motivated to quit and where external social support was available. These findings are discussed in relation to a recently developed psycho-social interactive model of resilience, and how this resilience model can be improved regarding the historical and cultural context of Indigenous Australians' experience of smoking.
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    • "While indigenous status and socio-economic status (SES) were not independent predictors of enrolment in this study, this may reflect a lack of power to detect an effect due to the small number of eligible participants of Aboriginal and Torres Strait Islander descent in the study (n = 81, 4.4%) and the limited variation in the SES of participants, with few participants (n = 61, 3.4%) from areas of high deprivation. Given the high prevalence of diabetes amongst Aboriginal and Torres Strait Islanders [28] and the poorer health status of low SES groups [29], further research is required to explore uptake of diabetes prevention programs in these populations. Finally, the lack of association between age and enrolment likely reflects the narrow age range for this study (50–65 years) and the limited age categories used in the AUSDRISK tool. "
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    ABSTRACT: Background The effectiveness of lifestyle interventions in reducing diabetes incidence has been well established. Little is known, however, about factors influencing the reach of diabetes prevention programs. This study examines the predictors of enrolment in the Sydney Diabetes Prevention Program (SDPP), a community-based diabetes prevention program conducted in general practice, New South Wales, Australia from 2008–2011. Methods SDPP was an effectiveness trial. Participating general practitioners (GPs) from three Divisions of General Practice invited individuals aged 50–65 years without known diabetes to complete the Australian Type 2 Diabetes Risk Assessment tool. Individuals at high risk of diabetes were invited to participate in a lifestyle modification program. A multivariate model using generalized estimating equations to control for clustering of enrolment outcomes by GPs was used to examine independent predictors of enrolment in the program. Predictors included age, gender, indigenous status, region of birth, socio-economic status, family history of diabetes, history of high glucose, use of anti-hypertensive medication, smoking status, fruit and vegetable intake, physical activity level and waist measurement. Results Of the 1821 eligible people identified as high risk, one third chose not to enrol in the lifestyle program. In multivariant analysis, physically inactive individuals (OR: 1.48, P = 0.004) and those with a family history of diabetes (OR: 1.67, P = 0.000) and history of high blood glucose levels (OR: 1.48, P = 0.001) were significantly more likely to enrol in the program. However, high risk individuals who smoked (OR: 0.52, P = 0.000), were born in a country with high diabetes risk (OR: 0.52, P = 0.000), were taking blood pressure lowering medications (OR: 0.80, P = 0.040) and consumed little fruit and vegetables (OR: 0.76, P = 0.047) were significantly less likely to take up the program. Conclusions Targeted strategies are likely to be needed to engage groups such as smokers and high risk ethnic groups. Further research is required to better understand factors influencing enrolment in diabetes prevention programs in the primary health care setting, both at the GP and individual level.
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