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Hiyare-Hewage A, Sinka V, Grande ED, Kerr M, Kim S, Mallitt KA, Dickson M, Jaure A, Wilson R, Craig JC, Stephens JH. The cultural safety of research reports on primary healthcare use by Indigenous Peoples: a systematic review. BMC Health Serv Res 2024; 24:873. [PMID: 39085815 PMCID: PMC11293170 DOI: 10.1186/s12913-024-11314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/15/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION Community-driven research in primary healthcare (PHC) may reduce the chronic disease burden in Indigenous peoples. This systematic review assessed the cultural safety of reports of research on PHC use by Indigenous peoples from four countries with similar colonial histories. METHODS Medline, CINAHL and Embase were all systematically searched from 1st January 2002 to 4th April 2023. Papers were included if they were original studies, published in English and included data (quantitative, qualitative and/or mixed methods) on primary healthcare use for chronic disease (chronic kidney disease, cardiovascular disease and/or diabetes mellitus) by Indigenous Peoples from Western colonial countries. Study screening and data extraction were undertaken independently by two authors, at least one of whom was Indigenous. The baseline characteristics of the papers were analyzed using descriptive statistics. Aspects of cultural safety of the research papers were assessed using two quality appraisal tools: the CONSIDER tool and the CREATE tool (subset analysis). This systematic review was conducted in accordance with the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. RESULTS We identified 35 papers from Australia, New Zealand, Canada, and the United States. Most papers were quantitative (n = 21) and included data on 42,438 people. Cultural safety across the included papers varied significantly with gaps in adequate reporting of research partnerships, provision of clear collective consent from participants and Indigenous research governance throughout the research process, particularly in dissemination. The majority of the papers (94%, 33/35) stated that research aims emerged from communities or empirical evidence. We also found that 71.4% (25/35) of papers reported of using strengths-based approaches by considering the impacts of colonization on reduced primary healthcare access. CONCLUSION Research on Indigenous PHC use should adopt more culturally safe ways of providing care and producing research outputs which are relevant to community needs by privileging Indigenous voices throughout the research process including dissemination. Indigenous stakeholders should participate more formally and explicitly throughout the process to guide research practices, inclusive of Indigenous values and community needs.
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Affiliation(s)
- Amandi Hiyare-Hewage
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Victoria Sinka
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Eleonora Dal Grande
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Marianne Kerr
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Kylie-Ann Mallitt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Michelle Dickson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Poche Centre for Indigenous Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Allison Jaure
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Rhonda Wilson
- Department of Nursing, RMIT University, Melbourne, Australia
| | - Jonathan C Craig
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Jacqueline H Stephens
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Chen M, Pu L, Gan Y, Wang X, Kong L, Guo M, Yang H, Li Z, Xiong Z. The association between variability of risk factors and complications in type 2 diabetes mellitus: a retrospective study. Sci Rep 2024; 14:6357. [PMID: 38491155 PMCID: PMC10943073 DOI: 10.1038/s41598-024-56777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
The variability in diabetes risk factors, such as uric acid and lipids, may influence the development of complications. This study aimed to investigate the influence of such variability on the occurrence of diabetic complications. A retrospective analysis of electronic medical records was conducted with type 2 diabetic patients who received treatment at a tertiary care hospital in Chengdu, Sichuan Province, between 2013 and 2022. The risk factor variability is presented as the standard deviation (SD). The associations between the variability and complications were examined using a binary logistic regression model. The study included 369 patients with type 2 diabetes. The findings revealed that outpatient special disease management served as a protective factor against the development of complications [OR = 0.53, 95% confidence interval (CI) (0.29-0.10)], particularly for the prevention of diabetic peripheral neuropathy [OR = 0.51, 95% CI (0.30-0.86)]. Variability in total cholesterol (TC-SD) was found to be a risk factor for the development of complications [OR = 2.42, 95% CI (1.18-4.97)] and acted as a risk factor for diabetic peripheral vasculopathy [OR = 2.50, 95% CI (1.25-5.02)]. TC-SD is a risk factor for the occurrence of diabetic peripheral neuropathy and diabetic peripheral vasculopathy, whereas outpatient special disease management functions as a protective factor against complications and diabetic peripheral neuropathy. Thus, in addition to glycaemic control, the regulation of lipid levels should be emphasized, particularly among patients without outpatient special disease management, to delay the onset of complications.
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Affiliation(s)
- Mengjie Chen
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China
| | - Lihui Pu
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, 4111, Australia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Erasmus MC, University Medical Centre Rotterdam, Department Internal Medicine, Section Nursing Science, Rotterdam, The Netherlands
| | - Yuqin Gan
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China
| | - Xiaoxia Wang
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China
| | - Laixi Kong
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China
| | - Maoting Guo
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China
| | - Huiqi Yang
- Nanbu County People's Hospital, Nanchong, 637300, Sichuan, China
| | - Zhe Li
- Mental Health Center, West China Hospital, Sichuan University, No. 28 Dianxin South Road, Chengdu, 610041, Sichuan, China.
- Sichuan Clinical Medical Research Center for Mental Disorders, No. 28 Dianxin South Road, Chengdu, 610041, Sichuan, China.
| | - Zhenzhen Xiong
- School of Nursing, Chengdu Medical College, No. 601 Tian Hui Road, Rong Du Avenue, Chengdu, 610083, Sichuan, China.
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Eer ASY, Hearn T, Atkinson-Briggs S, Drake S, Singh S, Neoh S, Pyrlis F, Hachem M, Zajac JD, Burchill LJ, Ekinci EI. Improved metabolic parameters of people with diabetes attending an aboriginal health service in regional victoria. Intern Med J 2022; 53:787-797. [PMID: 35717668 DOI: 10.1111/imj.15856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 06/14/2022] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate the baseline metabolic parameters and presence of diabetes complications in people with type 2 diabetes attending Rumbalara Aboriginal Co-operative in 2017 and compare it with other Aboriginal and Torres Strait Islander studies and Australian specialist diabetes services. METHODS Clinical and biochemical characteristics were determined, including diabetes type, age, weight, body mass index (BMI), blood pressure, micro- and macrovascular complications, glycosylated haemoglobin (HbA1c), haemoglobin, renal function, lipid profile, urine albumin:creatinine ratio, diabetes medications, renin angiotensin system inhibition therapies, HMG-CoA reductase inhibitors, and antiplatelet agents. RESULTS 126 individuals had diabetes, 121 had type 2 diabetes. 113 identified as Aboriginal and/or Torres Strait Islander. Median age was 57.5 (48 - 68) years, median HbA1c was 7.8% (6.8 - 9.6), and median BMI 33.4kg/m2 (29 - 42.3). Compared to other Australian Aboriginal and Torres Strait Islander populations, this population was older, had more obesity but with better glycaemia management. Compared to specialist diabetes services, this population was of similar age, with greater BMI but comparable HbA1c. CONCLUSIONS Aboriginal people living with type 2 diabetes attending this regional Aboriginal health service have comparable glycaemic management to specialist diabetes services in Australia, managed largely by primary care physicians with limited access to specialist care for the last five years. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Audrey Sing Yi Eer
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, The University of Melbourne (Austin Health)
| | - Tracey Hearn
- Rumbalara Aboriginal Co-operative, Mooroopna, VIC, Australia
| | | | - Shannon Drake
- Rumbalara Aboriginal Co-operative, Mooroopna, VIC, Australia
| | - Satpal Singh
- Rumbalara Aboriginal Co-operative, Mooroopna, VIC, Australia
| | - Sandra Neoh
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Felicity Pyrlis
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Mariam Hachem
- Department of Medicine, The University of Melbourne (Austin Health)
| | - Jeffrey David Zajac
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, The University of Melbourne (Austin Health)
| | - Luke James Burchill
- Department of Medicine, The University of Melbourne (Royal Melbourne Hospital)
| | - Elif Ilhan Ekinci
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, The University of Melbourne (Austin Health)
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Ho CLB, Chih HJ, Garimella PS, Matsushita K, Jansen S, Reid CM. Prevalence and risk factors of peripheral artery disease in a population with chronic kidney disease in Australia: A systematic review and meta-analysis. Nephrology (Carlton) 2021; 26:798-808. [PMID: 34156137 DOI: 10.1111/nep.13914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022]
Abstract
There is a lack of clarity and guidance for screening peripheral artery disease (PAD) in persons with chronic kidney disease (CKD) and end stage kidney disease (ESKD) despite this group being at excess risk of cardiovascular disease (CVD). In this current study, we performed a systematic review and meta-analysis to examine the prevalence and risk factors for PAD in persons with CKD in Australian cohorts. We used the inverse variance heterogeneity meta-analysis with double arcsine transformation to summarize the prevalence of PAD (with 95% CIs). Nine studies and 18 reports from the Australia and New Zealand dialysis and transplant registry with 36 cohorts were included in the review. We found a substantially higher PAD prevalence in cohorts based on an ankle-brachial index (ABI) or toe systolic pressure (TBI) than cohorts based on self-reported history. Higher PAD prevalence was observed in ESKD persons than CKD persons without dialysis (PAD diagnosis based on ABI or TBI: 31% in ESKD persons and 23% in CKD persons, PAD diagnosis based on self-reported history: 17% in ESKD persons and 10% in CKD persons). Older age, Caucasian race, cerebrovascular disease and haemodialysis were associated with the presence of PAD in ESKD persons. Our findings indicated a considerable proportion of PAD in CKD and ESKD persons particularly in those with ESKD. To develop and provide an adequate plan to clinically manage CKD patients with PAD, evidence of cost-effectiveness and clinical benefit of early detection of PAD in persons with CKD in Australia is recommended for future studies.
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Affiliation(s)
- Chau L B Ho
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Hui J Chih
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Pranav S Garimella
- Department of Medicine, University of California San Diego, California, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Division of Cardiology, Johns Hopkins School of Medicine, Maryland, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Maryland, USA
| | - Shirley Jansen
- Curtin Medical School, Curtin University, Perth, WA, Australia.,Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Heart and Vascular Research Institute, Harry Perkins Institute for Medical Research, Perth, WA, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, WA, Australia.,CCRE Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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5
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Sainsbury E, Shi Y, Flack J, Colagiuri S. The diagnosis and management of diabetes in Australia: Does the "Rule of Halves" apply? Diabetes Res Clin Pract 2020; 170:108524. [PMID: 33164851 DOI: 10.1016/j.diabres.2020.108524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/10/2020] [Accepted: 10/15/2020] [Indexed: 01/17/2023]
Abstract
The Rule of Halves (ROH) is a theoretical framework which states that roughly half of all people with a condition are diagnosed; half of those diagnosed receive care; half of those who receive care achieve their treatment targets; and half of those who reach their targets achieve the desired treatment outcomes. This review examined the applicability of the ROH to diabetes in Australia. Five databases were searched for articles and government reports published between January 2000 and August 2019. Data was extracted for each level of the framework, and pooled sample proportions calculated for the total population and sub-group analysis by ethnicity and type of diabetes. The results showed that 72% of people with diabetes are diagnosed. Approximately 50% are receiving standard care, and 40-60% are meeting treatment targets for HbA1c, blood pressure and lipid levels. Overall, Australia is doing better than the ROH when it comes to achieving treatment outcomes; prevalence of microvascular complications was 20-30% and cardiovascular disease 62%. Indigenous people were less likely to meet treatment targets and more likely to experience adverse complications of diabetes. This review indicates the ROH does generally apply for diabetes care and management in Australia, highlighting the need for further improvement.
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Affiliation(s)
- Emma Sainsbury
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
| | - Yumeng Shi
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
| | - Jeff Flack
- Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney NSW, Australia.
| | - Stephen Colagiuri
- University of Sydney, Charles Perkins Centre, Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, Australia.
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6
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West M, Chuter V, Munteanu S, Hawke F. Defining the gap: a systematic review of the difference in rates of diabetes-related foot complications in Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians. J Foot Ankle Res 2017; 10:48. [PMID: 29151893 PMCID: PMC5678749 DOI: 10.1186/s13047-017-0230-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/25/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Aboriginal and Torres Strait Islander community has an increased risk of developing chronic illnesses including diabetes. Among people with diabetes, foot complications are common and make a significant contribution to the morbidity and mortality associated with this disease. The aim of this review was to systematically evaluate the literature comparing the rates of diabetes related foot complications in Aboriginal and Torres Strait Islander Australians to non-Indigenous Australians. METHODS MEDLINE, EMBASE, The Cochrane Library; PUBMED and CINAHL were searched from inception until August 2016. Inclusion criteria were: published cross-sectional or longitudinal studies reporting the prevalence of diabetes related foot complications in both a cohort of Aboriginal and Torres Strait Islander Australians and a cohort of one other Australian population of any age with diabetes. Risk of bias was assessed using the STROBE tool. RESULTS Eleven studies including a total of 157,892 participants were included. Studies were set in Queensland, the Northern Territory and Western Australia, primarily in rural and remote areas. Aboriginal and Torres Strait Islander Australians experienced substantially more diabetes related foot complications with the mean age up to 14 years younger than non-Indigenous Australians. Aboriginality was associated with increased risk of peripheral neuropathy, foot ulceration and amputation. In several studies, Aboriginal and Torres Strait Islander Australians accounted for the vast majority of diabetes related foot complications (up to 91%) while comprising only a small proportion of the regional population. Reporting quality as assessed with the STROBE tool showed underreporting of: methods, sample description and potential sources of bias. There are no data available for some Australian states and for specific types of diabetes related foot complications. CONCLUSIONS Aboriginal and Torres Strait Islander Australians have a 3-6 fold increased likelihood of experiencing a diabetes related foot complication compared to non-Indigenous Australians. Evidence-based, culturally appropriate screening and intervention programs and improved access to effective health care services are required to prevent a widening of the gap in diabetes related foot complications between Aboriginal and Torres Strait Islander and non-Indigenous Australians.
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Affiliation(s)
- Matthew West
- Discipline of Podiatry, Faculty of Health and Medicine, University of Newcastle, Box 127, Ourimbah, PO 2258 Australia
| | - Vivienne Chuter
- Discipline of Podiatry, Faculty of Health and Medicine, University of Newcastle, Box 127, Ourimbah, PO 2258 Australia
| | - Shannon Munteanu
- Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Fiona Hawke
- Discipline of Podiatry, Faculty of Health and Medicine, University of Newcastle, Box 127, Ourimbah, PO 2258 Australia
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Jaiswal M, Fufaa GD, Martin CL, Pop-Busui R, Nelson RG, Feldman EL. Burden of Diabetic Peripheral Neuropathy in Pima Indians With Type 2 Diabetes. Diabetes Care 2016; 39:e63-4. [PMID: 26908916 PMCID: PMC4806773 DOI: 10.2337/dc16-0082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/17/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Mamta Jaiswal
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Gudeta D Fufaa
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | | | - Rodica Pop-Busui
- Department of Endocrinology, University of Michigan, Ann Arbor, MI
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI
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Glycaemic control and associated factors among patients with diabetes at public health clinics in Johor, Malaysia. Public Health 2016; 135:56-65. [PMID: 26976488 DOI: 10.1016/j.puhe.2015.07.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 02/06/2015] [Accepted: 07/21/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine the prevalence of glycaemic control and factors associated with poor glycaemic control [glycosylated haemoglobin (HbA1c) ≥6.5%] among patients with type 2 diabetes treated in public health clinics in Johor, Malaysia. STUDY DESIGN Cross-sectional study. METHODS A review of all patients aged over 18 years and with a diagnosis of type 2 diabetes for >1 year. The National Diabetic Registry was used as the database for attendees at public health clinics in Johor Bahru between January and December 2013. A required sample of 660 was calculated, and a random sampling method was applied to acquire patient information across the 13 public health clinics in Johor Bahru. All relevant information (e.g. HbA1c, type of treatment and other parameters for glycaemic control) were abstracted from the registry. RESULTS Sixty-eight percent of 706 patients had HbA1c >6.5%, and mean HbA1c was 7.8%. Younger patients (72.3%) had poorer glycaemic control than older patients (63.0%), and most patients with poor glycaemic control were obese (79.2%). Approximately 31.7% of patients did not achieve the target blood pressure <130/80 mmHg, and 58.5% did not achieve the target lipid profile. Multiple logistic regression analysis revealed that age (<60 years), sex (male), duration of diabetes (>5 years), body mass index (obese), type of treatment (diet therapy vs combination therapy) and abnormal lipid profile were significantly associated with increased odds of HbA1C >6.5%. CONCLUSIONS More than half (68%) of the patients with diabetes had HbA1c >6.5%. This highlights the importance of providing organized care to manage patients with diabetes in the primary care setting, such as weight reduction programmes, proper prescribing treatment, and age- and gender-specific groups to ensure good glycaemic control.
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9
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Vasant BR, Matthews V, Burgess CP, Connors CM, Bailie RS. Wide Variation in Absolute Cardiovascular Risk Assessment in Aboriginal and Torres Strait Islander People with Type 2 Diabetes. Front Public Health 2016; 4:37. [PMID: 27014674 PMCID: PMC4781864 DOI: 10.3389/fpubh.2016.00037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/22/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Absolute cardiovascular risk assessment (CVRA) is based on the combined effects of multiple risk factors and can identify asymptomatic individuals at high risk of cardiovascular disease (CVD). Aboriginal and Torres Strait Islander people, the Indigenous people of Australia, are disproportionately affected by CVD and diabetes. Our study aimed to investigate variations in the use of absolute CVRA in patients with diabetes at Indigenous community healthcare centers and to identify patient and health center characteristics that may contribute to this variation. METHODS Audits of clinical records of 1,728 patients with a known diagnosis of diabetes across 121 health centers in four Australian States/Territories [Northern Territory (NT), South Australia, Western Australia, and Queensland] over the period 2012-2014 were conducted as part of a large-scale continuous quality improvement program. Multilevel regression modeling was used to quantify variation in recording of CVRA attributable to health center and patient characteristics. RESULTS The proportion of eligible patients with documented CVRA was 33% (n = 574/1,728). The majority (95%) of assessments were conducted in the NT. Multilevel regression analysis showed health center characteristics accounted for 70% of the variation in assessments in the NT. Government-operated health centers had 18.8 times the odds (95% CI 7.7-46.2) of recording CVRA delivery compared with other health centers. CONCLUSION Health centers in the NT delivered the majority of absolute CVRA to Indigenous patients with diabetes in our study. Health systems factors that may have facilitated provision of CVRA in the NT include decision support tools and a reporting process for CVRA delivery. Implementation of similar systems in other jurisdictions may help improve CVRA delivery. Early identification and treatment of high risk individuals through wider use of CVRA may help reduce the burden of CVD in Indigenous Australians with diabetes.
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Affiliation(s)
- Bhakti R. Vasant
- Menzies School of Health Research (Brisbane Office), Brisbane, QLD, Australia
| | - Veronica Matthews
- Menzies School of Health Research (Brisbane Office), Brisbane, QLD, Australia
| | - Christopher P. Burgess
- Top End Health Services, Primary Health Care Branch, Northern Territory Government, Casuarina, NT, Australia
| | - Christine M. Connors
- Top End Health Services, Primary Health Care Branch, Northern Territory Government, Casuarina, NT, Australia
| | - Ross S. Bailie
- Menzies School of Health Research (Brisbane Office), Brisbane, QLD, Australia
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10
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Arnold LW, Hoy WE, Sharma SK, Wang Z. The Association between HbA1c and Cardiovascular Disease Markers in a Remote Indigenous Australian Community with and without Diagnosed Diabetes. J Diabetes Res 2016; 2016:5342304. [PMID: 26989697 PMCID: PMC4773550 DOI: 10.1155/2016/5342304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/19/2016] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES This study investigates the burden of cardiovascular risk markers in people with and without diabetes in a remote Indigenous Australian community, based on their HbA1c concentration. METHODS This study included health screening exams of 1187 remote Indigenous residents over 15 years old who represented 70% of the age-eligible community. The participants were stratified by HbA1c into 5 groups using cut-off points recommended by international organisations. The associations of traditional cardiovascular risk markers with HbA1c groups were assessed using logistic and linear regressions and ANOVA models. RESULTS Of the 1187 participants, 158 (13%) had a previous diabetes diagnosis, up to 568 (48%) were at high risk (5.7-6.4% (39-46 mmol/mol) HbA1c), and 67 (6%) potential new cases of diabetes (≥6.5% (48 mmol/mol)) were identified. Individuals with higher HbA1c levels were more likely to have albuminuria (OR 3.14, 95% CI 1.26-7.82) and dyslipidaemia (OR 2.37, 95% CI 1.29-4.34) and visited the clinic more often (OR 2.52, 95% CI 1.26-4.99). Almost all traditional CVD risk factors showed a positive association with HbA1c. CONCLUSIONS Screening in this remote Indigenous Australian community highlights the high proportion of individuals who are at high risk of diabetes as indicated by HbA1c and who also had an accentuated cardiovascular risk profile.
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Affiliation(s)
- Luke W. Arnold
- Centre for Chronic Disease, The University of Queensland School of Medicine, Royal Brisbane & Women's Hospital, Health Sciences Building Level 8, Herston, QLD 4029, Australia
- *Luke W. Arnold:
| | - Wendy E. Hoy
- Centre for Chronic Disease, The University of Queensland School of Medicine, Royal Brisbane & Women's Hospital, Health Sciences Building Level 8, Herston, QLD 4029, Australia
| | - Suresh K. Sharma
- Division of Medicine, Royal Darwin Hospital, Top End Health Network, Northern Territory Government, Tiwi, NT 0810, Australia
| | - Zhiqiang Wang
- Centre for Chronic Disease, The University of Queensland School of Medicine, Royal Brisbane & Women's Hospital, Health Sciences Building Level 8, Herston, QLD 4029, Australia
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Blatchford L, Morey P, McConigley R. Identifying type 2 diabetes risk classification systems and recommendations for review of podiatric care in an Australian Aboriginal health clinic. J Foot Ankle Res 2015; 8:34. [PMID: 26229555 PMCID: PMC4520286 DOI: 10.1186/s13047-015-0089-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 07/15/2015] [Indexed: 11/26/2022] Open
Abstract
Background There are several risk classification systems developed to facilitate diabetic foot assessments and prioritise diabetes patients for foot prevention services according to risk factors. Utilisation of both The University of Texas Diabetic Foot Risk Classification System (UTDFRCS) and The National Evidence-Based Guideline on Prevention, Identification and Management of Foot Complications in Diabetes (Part of the Guidelines on Management of Type 2 Diabetes), allows guidance for the podiatrist in terms of review timeframes for future assessments and treatment. The aim of this clinical audit was to classify Aboriginal type 2 diabetes subjects’ risk status according to UTDFRCS and identify if evidence based standards are being met for podiatry services at the Albury-Wodonga Aboriginal Health Service in New South Wales, Australia. Methods A retrospective clinical audit over a twenty six month period was undertaken at the Albury-Wodonga Aboriginal Health Service, New South Wales. This is a primary health care facility that started podiatry services in August 2011. The primary variables of interest were the UTDFRCS for each subject and whether those participants met or did not meet the National Evidence-Based Guideline for review appointment timeframes. Other variables of interest include age, gender, duration of diabetes, occasions of visits and cancelled and failure to attend appointments to the podiatry service over the data collection period. Results There was excellent overall adherence (94 %) of this sample population (n = 729) to the National Evidence-Based Guideline for podiatric review timeframes according to their risk status. Males were reported to be less likely to comply with the review timeframes compared to women. There was no association between risk status and age (OR = 1.04, p = 0.11), duration of diabetes (OR = 1.03, p = 0.71) or gender (OR = 0.77, p = 0.67). Conclusions Regular foot examinations aid in stratifying patients according to risk status, guiding podiatry interventions to reduce the likelihood of ulceration and amputation. This primary health care setting has achieved podiatric evidence based standards for Aboriginal people with type 2 diabetes, demonstrated by acceptable timeframes for review appointments.
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Affiliation(s)
- Lauren Blatchford
- Albury-Wodonga Aboriginal Health Service, 644 Daniel St, Glenroy, NSW 2640 Australia
| | - Pam Morey
- WoundsWest, Curtin University, GPO U 1987, Perth, WA 6845 Australia
| | - Ruth McConigley
- School of Nursing and Midwifery, Curtin University, GPO U 1987, Perth, WA 6845 Australia
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Stoneman A, Atkinson D, Davey M, Marley JV. Quality improvement in practice: improving diabetes care and patient outcomes in Aboriginal Community Controlled Health Services. BMC Health Serv Res 2014; 14:481. [PMID: 25288282 PMCID: PMC4282197 DOI: 10.1186/1472-6963-14-481] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Management of chronic disease, including diabetes, is a central focus of most Aboriginal Community Controlled Health Services (ACCHSs) in Australia. We have previously demonstrated that diabetes monitoring and outcomes can be improved and maintained over a 10-year period at Derby Aboriginal Health Service (DAHS). While continuous quality improvement (CQI) has been shown to improve service delivery rates and clinical outcome measures, the process of interpreting audit results and developing strategies for improvement is less well described. This paper describes the evaluation of care of patients with type 2 diabetes mellitus (T2DM) and features of effective CQI in ACCHSs in the remote Kimberley region of north Western Australia. Methods Retrospective audit of records for Aboriginal and Torres Strait Islander primary care patients aged ≥15 years with a confirmed diagnosis of T2DM at four Kimberley ACCHSs from 1 July 2011 to 30 June 2012. Interviews with health service staff and focus group discussions with patients post audit. Main outcome measures: diabetes care related activities, clinical outcome measures and factors influencing good diabetes related care and effective CQI. Results A total of 348 patients from the four ACCHSs were included in the study. Clinical care activities were generally high across three of the four health services (at least 71% of patients had cholesterol recorded, 89% blood pressure, 84% HbA1c). Patients from DAHS had lower median cholesterol levels (4.4 mmol/L) and the highest proportion of patients meeting clinical targets for HbA1c (31% v 16% ACCHS-3; P = 0.02). Features that facilitated good care included clearly defined staff roles for diabetes management, support and involvement of Aboriginal Health Workers, efficient recall systems, and well-coordinated allied health services. Effective CQI features included seamless and timely data collection, local ownership of the process, openness to admitting deficiencies and willingness to embrace change. Conclusions Well-designed health care delivery and CQI systems, with a strong sense of ownership over diabetes management led to increased service delivery rates and improved clinical outcome measures in ACCHSs. Locally run CQI processes may be more responsive to individual health services and more sustainable than externally driven systems.
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Affiliation(s)
- Alice Stoneman
- Launceston Clinical School, University of Tasmania, Locked Bag 1377, Launceston, TAS 7250, Australia.
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13
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Majoni SW, Abeyaratne A. Renal transplantation in Indigenous Australians of the Northern Territory: closing the gap. Intern Med J 2013; 43:1059-66. [DOI: 10.1111/imj.12274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 08/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- S. W. Majoni
- Department of Nephrology, Division of Medicine; Royal Darwin Hospital; Darwin Northern Territory Australia
- Royal Darwin Hospital Campus; Flinders University and Northern Territory Clinical School; Darwin Northern Territory Australia
| | - A. Abeyaratne
- Department of Nephrology, Division of Medicine; Royal Darwin Hospital; Darwin Northern Territory Australia
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15
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Abu-Qamar M, Wilson A. Evidence-based decision-making: the case for diabetes care. INT J EVID-BASED HEA 2012; 5:254-60. [PMID: 21631789 DOI: 10.1111/j.1479-6988.2007.00066.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Clinical decisions in diabetes care are complex, because they cover a wide range of unrelated issues which are affected by varied contexts of healthcare providers from multiple disciplines. The purpose of this paper is to reflect on the extent to which evidence is used to underpin clinical decisions within the area of diabetes care. In order to do this, it is necessary to capture information on the application of principles of evidence-based practice in diabetes care. Publications debating the nature of evidence-based practice and diabetes care were identified through searching the MEDLINE and CINAHL databases and located through the search engine Google. Additional publications were identified from references cited in relevant papers. These publications viewed evidence-based decisions as a balanced integration of different aspects of the clinical situation such as patient preference and clinician experience, in addition to the best available evidence. Simultaneously, each aspect of clinical care needs different forms of evidence. This is the argument for evidence-based diabetes care, where heterogeneous variables interact in different milieus. In conclusion, evidence-based diabetes care is a loose structure and set of ideas which needs to be adjusted according to each specific clinical situation.
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Affiliation(s)
- Ma'en Abu-Qamar
- Discipline of Nursing, School of Population Health & Clinical Practice, Department of General Practice, The University of Adelaide, South Australia, Australia
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Maple-Brown LJ, Cunningham J, Zinman B, Mamakeesick M, Harris SB, Connelly PW, Shaw J, O'Dea K, Hanley AJ. Cardiovascular disease risk profile and microvascular complications of diabetes: comparison of Indigenous cohorts with diabetes in Australia and Canada. Cardiovasc Diabetol 2012; 11:30. [PMID: 22455801 PMCID: PMC3340324 DOI: 10.1186/1475-2840-11-30] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/28/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND 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. METHODS 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). RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Louise J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
- Leadership Sinai Centre for Diabetes, Mt Sinai Hospital, Toronto, Canada
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Bernard Zinman
- Leadership Sinai Centre for Diabetes, Mt Sinai Hospital, Toronto, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
| | - Mary Mamakeesick
- Sandy Lake Health and Diabetes Project, Sandy Lake First Nation, London, ON, Canada
| | - Stewart B Harris
- Centre for Studies in Family Medicine at The Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Philip W Connelly
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Jonathan Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Kerin O'Dea
- Sansom Institute for Health Research, University of South Australia, Adelaide, South, Australia
| | - Anthony J Hanley
- Leadership Sinai Centre for Diabetes, Mt Sinai Hospital, Toronto, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Department of Nutritional Sciences and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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The Combined Burden of Diabetes and Cardiovascular Disease in Indigenous Australians. CURRENT CARDIOVASCULAR RISK REPORTS 2011. [DOI: 10.1007/s12170-011-0165-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maple-Brown L, Hodge A, Cunningham J, Celermajer DS, O'Dea K. Risk factors for cardiovascular disease do not fully explain differences in carotid intima-media thickness between Indigenous and European Australians without diabetes. Clin Endocrinol (Oxf) 2009; 71:189-94. [PMID: 19178512 DOI: 10.1111/j.1365-2265.2008.03445.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether cardiovascular risk factors can explain the higher carotid intima-media thickness (CIMT) in Indigenous compared with European Australians. DESIGN Cross-sectional study in three subgroups. PATIENTS Non-diabetic urban European (n = 86), urban Indigenous (n = 69), and remote Indigenous (n = 60) Australians aged 25-64 years. MEASUREMENTS CIMT, age, sex, anthropometry, blood pressure, smoking status, fasting glucose and insulin, haemoglobin (Hb)A1c, homocysteine, C-reactive protein (CRP), lipids, urinary albumin and creatinine. RESULTS CIMT and levels of risk factors, except fasting glucose and total cholesterol, worsened across the three groups. Log(n) fasting insulin [beta = 0.022, 95% confidence interval (CI) 0-0.0439], age (beta = 0.006, 95% CI 0.004-0.007), gender (female beta = -0.005 vs. male, 95% CI -0.084 to -0.026), mean arterial pressure (MAP) (beta = 0.001, 95% CI 0.001-0.002) and ethnicity/location [urban Indigenous (beta = 0.027, 95% CI -0.010 to 0.064 vs. European); remote Indigenous (beta = 0.083, 95% CI 0.042-0.123 vs. European)] explained 41% of variance in CIMT. Significant interactions were seen for ethnicity/location with age (P = 0.014) and MAP (P = 0.018). Age was consistently associated with CIMT across the three populations, and was associated with larger increments in CIMT for the Indigenous subgroups (beta = 0.007, 95% CI 0.005-0.009 urban; beta = 0.007, 95% CI 0.004-0.010 remote) compared with Europeans (beta = 0.003, 95% CI 0.002-0.006) in models including age, sex and MAP. MAP was only associated with CIMT in the remote Indigenous subgroup. CONCLUSION After adjusting for selected risk factors, CIMT in remote Indigenous participants was still higher than in Europeans. The slope of the association between age and CIMT steepened from urban Europeans to remote Indigenous.
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Affiliation(s)
- L Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Maple-Brown L, Cunningham J, Dunne K, Whitbread C, Howard D, Weeramanthri T, Tatipata S, Dunbar T, Harper CA, Taylor HR, Zimmet P, O'Dea K, Shaw JE. Complications of diabetes in urban Indigenous Australians: the DRUID study. Diabetes Res Clin Pract 2008; 80:455-62. [PMID: 18294723 DOI: 10.1016/j.diabres.2008.01.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 01/10/2008] [Indexed: 10/22/2022]
Abstract
AIMS To accurately assess the management and complications of type 2 diabetes in urban Indigenous Australians and compare the risk of complications with a general Australian population (AusDiab Study). METHODS The Darwin Region Urban Indigenous Diabetes (DRUID) Study included 1004 volunteers aged >/=15 years; diabetes status was classifiable for 866. The assessment of diabetic complications and metabolic control was performed in participants with known diabetes (KDM) and diabetes newly diagnosed by the study (NDM) using an interviewer-administered questionnaire and clinical examination. RESULTS Among 172 DRUID participants eligible for complications assessment, 135 were assessed, including 99 KDM (mean age 53 years) and 36 NDM (mean age 47 years). Percentages of KDM participants meeting therapeutic targets were: HbA1c<7%, 29%; blood pressure<130/80mmHg, 45%; total cholesterol<5.5mmol/L, 65%. Among KDM, 39% had albuminuria, 21% retinopathy, 12% peripheral vascular disease (PVD), 9% neuropathy. Factors independently associated with diabetic complications were: albuminuria-HbA1c, systolic blood pressure; retinopathy-diabetes duration; PVD-age. Compared to AusDiab participants after adjusting for other risk factors, DRUID participants had 2-3-fold increased risk of albuminuria and PVD and a non-significant increased risk of neuropathy, but no increased risk of retinopathy. CONCLUSIONS Urban Indigenous Australians with diabetes are relatively young and have poor glycaemic control. Compared to the general Australian population with type 2 diabetes, they have greater adjusted risk of albuminuria and PVD but not retinopathy. Urgent action is required to prevent diabetes at a population level and improve diabetes management in this high-risk population.
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Affiliation(s)
- Louise Maple-Brown
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, NT, Australia.
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20
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Evidence-based decision-making. INT J EVID-BASED HEA 2007. [DOI: 10.1097/01258363-200706000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maple-Brown LJ, Piers LS, O'Rourke MF, Celermajer DS, O'Dea K. Increased arterial stiffness in remote Indigenous Australians with high risk of cardiovascular disease. J Hypertens 2007; 25:585-91. [PMID: 17278975 DOI: 10.1097/hjh.0b013e328011f766] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess central and peripheral arterial stiffness in Indigenous and European Australians with and without type 2 diabetes using applanation tonometry to obtain the augmentation index (AI) and pulse wave velocity (PWV). METHODS AI was assessed in 162 Indigenous Australians (60 with type 2 diabetes) participating in a population-based study and 121 Australians of European ancestry (38 with diabetes) of similar age and sex. PWV was assessed in a subgroup: n = 62 indigenous, n = 118 European participants. RESULTS The indigenous group had higher AI than the European group [mean (SD) 32 (12) versus 24 (12)%, P < 0.0001] and carotid-femoral PWV [8.4 (1.8) versus 7.1 (2.2) ms(-1), P < 0.0001]. There were no significant differences between groups regarding blood pressure and total cholesterol; however, indigenous individuals had higher fasting glucose, insulin, haemoglobin A1c, triglycerides, waist circumference (despite lower body mass index), and a higher prevalence of cigarette smoking. Fifty-five per cent of the variance in AI was explained on multiple regression analysis by age, sex, indigenous participant, heart rate, mean arterial pressure, height, triglycerides and waist circumference. Age, indigenous participant, heart rate, mean arterial pressure and antihypertensive medication explained 56% of the variance in PWV. Variables of the metabolic syndrome and smoking, C-reactive protein (CRP), homocysteine and heart rate clustered with indigenous status on factor analysis. CONCLUSIONS Indigenous Australians have higher indices of peripheral and central arterial stiffness than European Australians of similar age and sex. Factor analysis revealed that metabolic syndrome variables, smoking, CRP, homocysteine and heart rate clustered with 'indigenous participant' and may explain increased arterial stiffness in this group.
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Maple-Brown L, Cunningham J, Celermajer DS, O'Dea K. Increased carotid intima-media thickness in remote and urban Indigenous Australians: impact of diabetes and components of the metabolic syndrome. Clin Endocrinol (Oxf) 2007; 66:419-25. [PMID: 17302878 DOI: 10.1111/j.1365-2265.2007.02749.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Indigenous Australians have rates of cardiovascular (CVD) mortality some seven to 10-fold higher than non-Indigenous Australians aged 25-64 years. We aimed to evaluate the impact of type 2 diabetes and components of the metabolic syndrome on carotid intima-media thickness (CIMT) as a marker of cardiovascular risk in Indigenous Australians living in remote and urban environments and in Australians of European ancestry. DESIGN, PATIENTS AND MEASUREMENTS CIMT was measured by high-resolution B-mode ultrasound imaging of the common carotid artery in 119 remote Indigenous, 144 urban Indigenous and 122 urban European Australians with and without diabetes. RESULTS In nondiabetic participants, CIMT was lowest in Europeans (mean (SD) 0.64 mm (0.10)), higher in urban Indigenous Australians (0.67 mm (0.12)) and highest in remote Indigenous Australians (0.73 mm (0.15), P < 0.001). CIMT was higher with diabetes with the same pattern observed between populations: 0.73 mm, 0.79 mm and 0.82 mm, respectively (P < 0.001). Traditional risk factors (age, male gender, blood pressure and HbA1c) explained 35-45% of the variance of CIMT within each population group. However, differences in CIMT between population groups were maintained after adjustment for these cardiovascular risks plus cholesterol and smoking (P < 0.001). Factor analysis revealed that variables of the metabolic syndrome, together with smoking and elevated C-reactive protein (CRP) and urinary albumin-creatinine ratio (ACR), are likely to explain the higher CIMT in Indigenous Australians (and the urban-remote gradient). Unmeasured variables (genetic, psychosocial and socioeconomic) may also contribute to higher CIMT in these populations. CONCLUSION Glycaemic control and metabolic syndrome components contribute significantly to premature atherogenesis in Indigenous Australians and we recommend that therapy should be targeted accordingly.
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Affiliation(s)
- L Maple-Brown
- Menzies School of Health Research, Darwin, Australia.
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Peiris D, Wirtanen C, Hall J. Aeromedical evacuations from an east Arnhem Land community 2003?2005: The impact on a primary health care centre. Aust J Rural Health 2006; 14:270-4. [PMID: 17121507 DOI: 10.1111/j.1440-1584.2006.00828.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To understand the profile and impact of aeromedical evacuations in remote Indigenous communities. DESIGN Descriptive study. SETTING A primary health care centre in east Arnhem Land, Northern Territory, Australia. PARTICIPANTS Four hundred and ten evacuations from a total population of more than 2200 were analysed from February 2003 to August 2005. MAIN OUTCOME MEASURES Patient demographics, seasonal variations, diagnostic categories, utilisation of staff resources. RESULTS On average 6.5% of the community were evacuated to hospital every year with an evacuation occurring every 2.2 days. Children aged under five years were 3.3-fold overrepresented in evacuations (comprising 37.7% of those evacuated versus 11.3% of the community, P < 0.001). Four diagnostic categories accounted for 61% of evacuations: respiratory disease (21%), obstetric conditions (15%), gastroenteritis (14%) and injury/poisoning (11%). Over the study period four patients required intubation at the clinic. Evacuation rates were higher in the monsoon season. Forty-seven per cent of evacuations occurred after hours. The waiting time for plane arrival ranged from one hour to 21 hours with a median wait-time of three hours. CONCLUSION Aeromedical evacuations place a heavy burden on primary health centres. Clinic staff are regularly required to provide hospital-level acute care, often for several hours at a time. Meeting this burden competes with primary prevention programs and regular clinic duties. The age and diagnostic profiles encountered in this study have significant implications for the range of skills required to provide an adequate acute care service. This study highlights the need for remote area health centres to be well resourced to meet these needs.
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Affiliation(s)
- David Peiris
- Ngalkanbuy Health Centre, Galiwin'ku, Elcho Island, Northern Territory, Australia.
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Daniel M, Brown A, Dhurrkay JG, Cargo MD, O'Dea K. Mastery, perceived stress and health-related behaviour in northeast Arnhem Land: a cross-sectional study. Int J Equity Health 2006; 5:10. [PMID: 17002809 PMCID: PMC1601956 DOI: 10.1186/1475-9276-5-10] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 09/27/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous peoples in Australia are disadvantaged on all markers of health and social status across the life course. Psychosocial factors are implicated in the aetiology of chronic diseases and in pathways underpinning social health disparities. Minimal research has investigated psychosocial factors and health in Indigenous peoples. This study evaluated associations between mastery, perceived stress, and health-related behaviour for a remote Indigenous population in Australia. METHODS Complete data on mastery (the degree to which individuals feel in control of their lives), perceived stress, physical activity, and fruit and vegetable consumption were obtained for 177 participants in a community-based chronic disease risk factor survey. Psychosocial questionnaires were completed as an option during community screening (response rate = 61.9%). Extensive consultation facilitated the cross-cultural adaptation of measures. RESULTS Mastery was inversely correlated with perceived stress measures (p < 0.009): recent stress, r = -0.47; chronic stress, r = -0.41; and youth stress, r = -0.30. Relationships between mastery and behaviour varied according to age group (<25 or > or =25 years) for physical activity (p = 0.001) and vegetable consumption (p = 0.005). Individuals aged > or =25 years engaging in < or =2 bouts of physical activity/week had lower mastery than individuals engaging in > or =3 bouts/week, with means (95% CI) of 14.8 (13.7-15.8) and 17.1 (15.3-19.0), respectively (p = 0.026). Individuals aged > or =25 years eating vegetables < or =3 times/week had lower mastery than those eating vegetables > or =4 times/week (p = 0.009) [means 14.7 (13.8-15.5) and 17.3 (15.5-19.1), respectively]. Individuals <25 years engaging in < or =2 bouts of physical activity/week had greater mastery than individuals engaging in > or =3 bouts/week (p = 0.022) [means 17.2 (15.2-19.2) and 13.8 (11.9-15.7), respectively]. For men > or =25 years and women > or =15 years, mastery was inversely related to age (p < 0.002). Men <25 years had less mastery than women of equivalent age (p = 0.001) [means 13.4 (12.1-14.7) and 17.5 (15.3-19.8), respectively]. CONCLUSION Consistent with previous research, this study provides additional support for a link between mastery and health-related behaviour, and extends evidence of this association to a remote Indigenous population. Mastery's association with perceived stress, its age-specific association with health behaviour, and findings of low mastery amongst young men, highlights a need for life course research accounting for contextual factors affecting Indigenous peoples.
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Affiliation(s)
- Mark Daniel
- Département de médecine sociale et préventive, Université de Montréal, Québec, Canada
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Canada Research Chair for Biopsychosocial Pathways in Population Health, Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CHUM) – Hôtel-Dieu, Édifice Saint-Urbain, Axe santé des populations, 3875 rue Saint Urbain, Montréal, Québec H2W 1V1, Canada
| | - Alex Brown
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | | | - Margaret D Cargo
- Psychosocial Research Division, Douglas Hospital Research Centre, McGill University, Canada
| | - Kerin O'Dea
- Department of Medicine, St. Vincent's Hospital, The University of Melbourne, Australia
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Maple-Brown LJ, Piers LS, O'Rourke MF, Celermajer DS, O'Dea K. Central obesity is associated with reduced peripheral wave reflection in Indigenous Australians irrespective of diabetes status. J Hypertens 2005; 23:1403-7. [PMID: 15942464 DOI: 10.1097/01.hjh.0000173524.80802.5a] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the influence of central obesity and type 2 diabetes on peripheral wave reflection in Indigenous Australians. DESIGN AND METHODS A cross-sectional study of remote Indigenous Australians with (n = 43) and without (n = 54) type 2 diabetes of similar age (47 years) and sex; using anthropometric and bioelectrical impedance measures of obesity and applanation tonometry to determine the aortic augmentation index (AI) as an index of peripheral wave reflection. RESULTS Indices of obesity were significantly higher in the diabetic than non-diabetic participants [body mass index (BMI): 27.3 versus 24.6 kg/m, P = 0.018; waist circumference: women 101 versus 94 cm, P = 0.008, men 102 versus 91 cm, P = 0.039]. AI was negatively related to obesity: BMI (r = -0.35, P = 0.0003), weight (r = -0.44, P < 0.0005), waist circumference (r = -0.34, P = 0.0003) and fat mass (r = -0.35, P < 0.0005). There was no significant difference in AI between the groups with and without diabetes. On multiple regression analysis, 66% of the variance in AI was explained with the following significant predictors: age, heart rate, male gender, fat mass and mean arterial pressure. Similar results were obtained when weight, waist circumference or BMI were substituted for fat mass. CONCLUSION When compared with Indigenous Australians without diabetes, those with type 2 diabetes do not have greater aortic pressure augmentation from peripheral wave reflection. However, obesity, irrespective of the index used, was related to lower peripheral wave reflection in both those with and without type 2 diabetes.
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