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Babu BV, Hazarika CR, Raina SK, Masoodi SR, Basappa YC, Thomas N, Kerketta AS, Menon NK, Jebasingh FK. Prevalence of type 2 diabetes among tribal population of india: a multi-centric cross-sectional study. J Natl Med Assoc 2024; 116:153-164. [PMID: 38290904 DOI: 10.1016/j.jnma.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/12/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND The perception among healthcare workers is that the Indian tribal (indigenous) population are less affected by diabetes. This paper reports the prevalence of type 2 diabetes and its associated factors among tribal populations from six districts across India. METHODOLOGY Random blood glucose (RBG) and fasting blood glucose (FBG) were measured for 8486 and 3131 adults, respectively, with a glucose meter. FBG ≥ 126 mg/dL (7.0 mmol/L) and RBG ≥ 200 mg/dL (11.1 mmol/L) were used to diagnose diabetes. In addition, blood pressure, anthropometric (height, weight, waist and hip circumferences), socio-demographic (age, gender, education, type of tribe and type of village) and behavioural data (tobacco smoking, non-smoking tobacco use and alcohol consumption) were collected. RESULTS The overall prevalence of type 2 diabetes, based on RBG, was 4.77% (95% CI: 4.33-5.25). The prevalence of type 2 diabetes and prediabetes, based on FBG, was 6.80% (95% CI: 5.95-7.74) and 8.69% (7.72-9.73), respectively. The prevalence of type 2 diabetes was significantly associated with age (p<0.001), smokeless tobacco use (p < 0.05), hypertension (p < 0.001) and obesity (p < 0.01). CONCLUSION The prevalence of type 2 diabetes among the Indian tribal population reported in this study is less than the national average of 7.3% for the general population. Hypertension and obesity were the major risk factors. Due to changing behavioural patterns, including dietary behaviour, there is likely to be an increase in the prevalence of hypertension and obesity, which further leads to increased prevalence of type 2 diabetes. Hence, appropriate interventions are to be initiated by the primary healthcare system.
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Affiliation(s)
- Bontha V Babu
- Socio Behavioral, Health Systems and Implementation Research Division, Indian Council of Medical Research, New Delhi, India.
| | - Chaya R Hazarika
- Socio Behavioral, Health Systems and Implementation Research Division, Indian Council of Medical Research, New Delhi, India
| | - Sunil K Raina
- Department of Community Medicine, Dr Rajendra Prasad Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - Shariq R Masoodi
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Nihal Thomas
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
| | | | | | - Felix K Jebasingh
- Department of Endocrinology, Diabetes & Metabolism, Christian Medical College, Vellore, India
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Ahmed MA, Bailey HD, Pereira G, White SW, Hare MJ, Wong K, Marriott R, Shepherd CC. Overweight/obesity and other predictors of gestational diabetes among Aboriginal and non-Aboriginal women in Western Australia. Prev Med Rep 2023; 36:102444. [PMID: 37840590 PMCID: PMC10568432 DOI: 10.1016/j.pmedr.2023.102444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023] Open
Abstract
This population-based study investigated the association of BMI and other predictors with gestational diabetes mellitus (GDM) among Australian Aboriginal and non-Aboriginal mothers. We conducted a state-wide retrospective cohort study that included all singleton births in Western Australia (n = 134,552) between 2012 and 2015 using population health datasets linked by the Western Australian Data Linkage Branch. Associations between GDM and its predictors were estimated as adjusted relative risks (aRRs) from multivariable generalised linear models. Adjusted ratio of relative risks (aRRRs) compared RRs in Aboriginal and non-Aboriginal mothers. Adjusted population attributable fractions estimated the contribution of overweight/obesity to GDM burden, and adjusted predicted probabilities for GDM were plotted against BMI levels. The following predictors had stronger associations with GDM in Aboriginal, compared to non-Aboriginal, mothers: maternal obesity (aRR [95% CI] 3.16 [2.54-3.93]; aRRR 1.57 [1.26-1.94]), previous LGA (aRR 1.70 [1.37-2.12]; aRRR 1.41 [1.13-1.76]) and previous macrosomia (birthweight ≥ 4 kg) (aRR 1.55 [1.24-1.94]; aRRR 1.53 [1.22-1.91]). 46.1% (95% CI: 36.6-54.1) of GDM cases in Aboriginal women (23.3% in non-Aboriginal mothers, 95% CI: 21.6-25.1) were attributed to overweight/obesity. Compared to non-Aboriginal mothers, adjusted GDM probabilities were higher at all BMI levels and showed greater increase with BMI. Overweight/obesity is a key driver of GDM among Aboriginal women. Association between BMI and GDM is stronger in Aboriginal, compared to non-Aboriginal, women especially at higher BMI.
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Affiliation(s)
- Marwan Awad Ahmed
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Helen D. Bailey
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Gavin Pereira
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Scott W. White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Matthew J.L. Hare
- Wellbeing and Chronic Preventable Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Rhonda Marriott
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - Carrington C.J. Shepherd
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
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Khurana I, Howard NJ, Maxwell S, Du Preez A, Kaipananickal H, Breen J, Buckberry S, Okabe J, Al-Hasani K, Nakasatien S, Himathongkam T, Cooper ME, Maple-Brown L, Thewjitcharoen Y, Brown A, El-Osta A. Circulating epigenomic biomarkers correspond with kidney disease susceptibility in high-risk populations with type 2 diabetes mellitus. Diabetes Res Clin Pract 2023; 204:110918. [PMID: 37748713 DOI: 10.1016/j.diabres.2023.110918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/05/2023] [Accepted: 09/21/2023] [Indexed: 09/27/2023]
Abstract
AIMS To investigate epigenomic indices of diabetic kidney disease (DKD) susceptibility among high-risk populations with type 2 diabetes mellitus. METHODS KDIGO (Kidney Disease: Improving Global Outcomes) clinical guidelines were used to classify people living with or without DKD. Differential gene methylation of DKD was then assessed in a discovery Aboriginal Diabetes Study cohort (PROPHECY, 89 people) and an external independent study from Thailand (THEPTARIN, 128 people). Corresponding mRNA levels were also measured and linked to levels of albuminuria and eGFR. RESULTS Increased DKD risk was associated with reduced methylation and elevated gene expression in the PROPHECY discovery cohort of Aboriginal Australians and these findings were externally validated in the THEPTARIN diabetes registry of Thai people living with type 2 diabetes mellitus. CONCLUSIONS Novel epigenomic scores can improve diagnostic performance over clinical modelling using albuminuria and GFR alone and can distinguish DKD susceptibility.
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Affiliation(s)
- Ishant Khurana
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | - Natasha J Howard
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Scott Maxwell
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | - Anelle Du Preez
- Wardliparingga Aboriginal Health Equity Theme, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Harikrishnan Kaipananickal
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | - James Breen
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia; Telethon Kids Institute, Perth, WA, Australia
| | - Sam Buckberry
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia; Telethon Kids Institute, Perth, WA, Australia
| | - Jun Okabe
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | - Keith Al-Hasani
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | | | | | - Mark E Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia; Department of Endocrinology, Royal Darwin Hospital, Northern Territory, Australia
| | | | - Alex Brown
- National Centre for Indigenous Genomics, Australian National University, Canberra, ACT, Australia; Telethon Kids Institute, Perth, WA, Australia.
| | - Assam El-Osta
- Baker Heart and Diabetes Institute, Epigenetics in Human Health and Disease Program, Melbourne, Vic, Australia; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Vic, Australia; University College Copenhagen, Faculty of Health, Department of Technology, Biomedical Laboratory Science, Copenhagen, Denmark.
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Pink N, Liddell A, Gonzalez-Chica D, Stocks N. Pharmaceutical management of type 2 diabetes among Indigenous Australians living in urban or rural locations: a comparative study using a national general practice database. Aust J Rural Health 2023; 31:979-990. [PMID: 37622661 DOI: 10.1111/ajr.13032] [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: 03/21/2023] [Revised: 07/17/2023] [Accepted: 08/06/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Type 2 diabetes is more prevalent among Aboriginal and Torres Strait Islander Peoples, especially those living in rural than urban areas. However, little is known about how diabetes is managed in different settings. OBJECTIVE To investigate differences in the prevalence of diabetes and the prescription of antidiabetic medications for Aboriginal and/or Torres Strait Islander Peoples living in urban or rural Australia. DESIGN Cross-sectional study using de-identified electronic medical records of 29,429 Aboriginal and/or Torres Strait Islander adults (60.4% females; mean age 45.2 ± 17.3 years) regularly attending 528 'mainstream' Australian general practices (MedicineInsight) in 2018. FINDINGS The prevalence of diabetes was 16.0%, and it was more frequent among those living in rural areas (22.0; 95% CI 19.3-24.4) than inner regional (17.6%; 95% CI 16.0-19.2) or major cities (15.8%; 95% CI 14.7-17.0; p < 0.001). The highest prevalence of diabetes was for males living in rural settings (25.0%). Of those with diabetes, 71.6% (95% CI 69.0-74.0) were prescribed antidiabetics, with a similar frequency in urban and rural areas (p = 0.291). After adjustment for sociodemographics, the only difference in diabetes management was a higher prescription of sulfonylureas in rural areas than in major cities (OR 1.39; 1.07-1.80). DISCUSSION The prevalence of diabetes was similar to other national data, although we found it was more frequent amongst Aboriginal and/or Torres Strait Islander males, especially those from rural areas. CONCLUSION Despite current recommendations, one-in-four Indigenous Australians with diabetes were not prescribed antidiabetics. The clinical significance of more frequent prescriptions of sulfonylureas in rural locations remains unclear.
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Affiliation(s)
- Natalie Pink
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- GPEx, General Practice Regional Training Organisation, Unley, Adelaide, South Australia, Australia
| | - Antoinette Liddell
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, South Australia, Australia
| | - David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
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Feig DS. Epidemiology and Therapeutic Strategies for Women With Preexisting Diabetes in Pregnancy: How Far Have We Come? The 2021 Norbert Freinkel Award Lecture. Diabetes Care 2022; 45:2484-2491. [PMID: 37579297 DOI: 10.2337/dci21-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
The field of diabetes in pregnancy has witnessed tremendous changes over the past 30 years, with an explosive growth in case numbers along with new and exciting opportunities to affect outcomes. Type 1 diabetes in pregnancy has increased by 40%, but type 2 diabetes in pregnancy, rarely seen 30 years ago, has more than doubled and, in some cases, tripled in prevalence. Compared with women with type 2 diabetes, women with type 1 diabetes have higher HbA1c, more large-for-gestational-age infants, and more preterm births. Women with type 2 diabetes have more chronic hypertension, more socioeconomic deprivation, and higher rates of perinatal mortality. Large randomized trials in women with diabetes in pregnancy have helped us understand the effectiveness of new technologies (i.e., continuous glucose monitoring) in women with type 1 diabetes, and the addition of metformin to insulin in women with type 2 diabetes, in improving pregnancy outcomes. Future endeavors, including artificial pancreas systems in women with type 1 diabetes and the use of continuous glucose monitoring, a better understanding of nutrition during pregnancy, and approaches to improve preconception and pregnancy self-care in women with type 2 diabetes, may lead to further improved outcomes.
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Affiliation(s)
- Denice S Feig
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
- Sinai Health System, Mount Sinai Hospital, Toronto, Canada
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Prevalence and Early Prediction of Diabetes Using Machine Learning in North Kashmir: A Case Study of District Bandipora. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:2789760. [PMID: 36238678 PMCID: PMC9553420 DOI: 10.1155/2022/2789760] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022]
Abstract
Diabetes is one of the biggest health problems that affect millions of people across the world. Uncontrolled diabetes can increase the risk of heart attack, cancer, kidney damage, blindness, and other illnesses. Researchers are motivated to create a Machine Learning methodology that can predict diabetes in the future. Exploiting Machine Learning Algorithms (MLA) is essential if healthcare professionals are able to identify diseases more effectively. In order to improve the medical diagnosis of diabetes this research explored and contrasts various MLA that can identify diabetes risk early. The research includes the analysis on real datasets such as a clinical dataset gathered from a doctor in the Indian district of Bandipora in the years April 2021–Feb2022. MLA are currently important in the healthcare sector due to their prediction abilities. Researchers are using MLA to improve disease prediction and reduce cost. In this Paper author developed a methodology using Machine Learning Algorithms for Diabetes Disease Risk Prediction in North Kashmir. Six MLA have been successfully used in the experimental study such as Random Forest (RF), Multi-Layer Perceptron (MLP), Support Vector Machine (SVM), Gradient Boost (GB), Decision Tree (DT), and Logistic Regression (LR). RF is the most accurate classifier with the uppermost accuracy rate of 98 percent followed by MLP (90.99%), SVM (92%), GBC (97%), DT (96%), and LR (69%), respectively, with the balanced data set. Lastly, this study enables us to effectively identify the prevalence and prediction of diabetes.
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Potential Determinants of Cardio-Metabolic Risk among Aboriginal and Torres Strait Islander Children and Adolescents: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159180. [PMID: 35954531 PMCID: PMC9368168 DOI: 10.3390/ijerph19159180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
Prevention initiatives during childhood and adolescence have great potential to address the health inequities experienced by Aboriginal and Torres Strait Islander (Indigenous) populations in Australia by targeting modifiable risk factors for cardio-metabolic diseases. We aimed to synthesize existing evidence about potential determinants of cardio-metabolic risk markers—obesity, elevated blood pressure, elevated blood glucose, abnormal lipids, or a clustering of these factors known as the metabolic syndrome (MetS)—for Indigenous children and adolescents. We systematically searched six databases for journal articles and three websites for relevant grey literature. Included articles (n = 47) reported associations between exposures (or interventions) and one or more of the risk markers among Indigenous participants aged 0–24 years. Data from 18 distinct studies about 41 exposure–outcome associations were synthesized (by outcome: obesity [n = 18]; blood pressure [n = 9]; glucose, insulin or diabetes [n = 4]; lipids [n = 5]; and MetS [n = 5]). Obesity was associated with each of the other cardio-metabolic risk markers. Larger birth size and higher area-level socioeconomic status were associated with obesity; the latter is opposite to what is observed in the non-Indigenous population. There were major gaps in the evidence for other risk markers, as well as by age group, geography, and exposure type. Screening for risk markers among those with obesity and culturally appropriate obesity prevention initiatives could reduce the burden of cardio-metabolic disease.
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Speight J, Baptista S, Lee C, Sher L, Skinner TC, Brown A. The Social and Emotional Well-being of Indigenous Peoples Living With Diabetes: A Systematic Review Protocol. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:902395. [PMID: 36992776 PMCID: PMC10012064 DOI: 10.3389/fcdhc.2022.902395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022]
Abstract
IntroductionGlobally, Indigenous people have a greater incidence and earlier onset of diabetes than the general population and have higher documented rates of emotional distress and mental illness. This systematic review will provide a synthesis and critical appraisal of the evidence focused on the social and emotional well-being of Indigenous peoples living with diabetes, including prevalence, impact, moderators, and the efficacy of interventions.MethodsWe will search MEDLINE Complete, EMBASE, APA PsycINFO, and CINAHL Complete from inception until late April 2021. Search strategies will include keywords related to Indigenous peoples, diabetes, and social and emotional well-being. All abstracts will be rated independently by two researchers against specified inclusion criteria. Eligible studies will report social and emotional well-being data for Indigenous people with diabetes, and/or report on the efficacy of interventions designed to address social and emotional well-being in this population. For each eligible study, quality will be rated using standard checklists to appraise each study’s internal validity, to be determined based on study type. Any discrepancies will be resolved through discussions and consultation with other investigators as needed. We expect to present a narrative synthesis of the evidence.DiscussionThe findings of the systematic review will enable greater understanding of the impact of relationships between diabetes and emotional well-being among Indigenous peoples to inform research, policy and practice. The findings will be accessible to Indigenous people affected by diabetes through a summary published in plain language on our research centre’s website.Systematic Review RegistrationPROSPERO registration number: CRD42021246560.
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Affiliation(s)
- Jane Speight
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Shaira Baptista
- School of Psychology, Deakin University, Geelong, VIC, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- *Correspondence: Shaira Baptista,
| | - Christopher Lee
- First Nations Diabetes consumer and advocate, Melbourne, VIC, Australia
| | - Louisa Sher
- Library, Deakin University, Geelong, VIC, Australia
| | - Timothy C. Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- LaTrobe University, Melbourne, VIC, Australia
| | - Alex Brown
- College of Health & Medicine, Australian National University, Canberra, ACT, Australia
- Telethon Kids Institute, Perth, WA, Australia
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Hare MJL, Zhao Y, Guthridge S, Burgess P, Barr ELM, Ellis E, Butler D, Rosser A, Falhammar H, Maple-Brown LJ. Prevalence and incidence of diabetes among Aboriginal people in remote communities of the Northern Territory, Australia: a retrospective, longitudinal data-linkage study. BMJ Open 2022; 12:e059716. [PMID: 35569825 PMCID: PMC9125760 DOI: 10.1136/bmjopen-2021-059716] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the prevalence and incidence of diabetes among Aboriginal peoples in remote communities of the Northern Territory (NT), Australia. DESIGN Retrospective cohort analysis of linked clinical and administrative data sets from 1 July 2012 to 30 June 2019. SETTING Remote health centres using the NT Government Primary Care Information System (51 out of a total of 84 remote health centres in the NT). PARTICIPANTS All Aboriginal clients residing in remote communities serviced by these health centres (N=21 267). PRIMARY OUTCOME MEASURES Diabetes diagnoses were established using hospital and primary care coding, biochemistry and prescription data. RESULTS Diabetes prevalence across all ages increased from 14.4% (95% CI: 13.9% to 14.9%) to 17.0% (95% CI: 16.5% to 17.5%) over 7 years. Among adults (≥20 years), the 2018/2019 diabetes prevalence was 28.6% (95% CI: 27.8% to 29.4%), being higher in Central Australia (39.5%, 95% CI: 37.8% to 41.1%) compared with the Top End region (24.2%, 95% CI: 23.3% to 25.1%, p<0.001). Between 2016/2017 and 2018/2019, diabetes incidence across all ages was 7.9 per 1000 person-years (95% CI: 7.3 to 8.7 per 1000 person-years). The adult incidence of diabetes was 12.6 per 1000 person-years (95% CI: 11.5 to 13.8 per 1000 person-years). CONCLUSIONS The burden of diabetes in the remote Aboriginal population of the NT is among the highest in the world. Strengthened systems of care and public health prevention strategies, developed in partnership with Aboriginal communities, are needed.
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Affiliation(s)
- Matthew J L Hare
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Yuejen Zhao
- Population and Digital Health, NT Health, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Paul Burgess
- Population and Digital Health, NT Health, Darwin, Northern Territory, Australia
- Primary Health Care Division, Top End Region, NT Health, Darwin, Northern Territory, Australia
| | - Elizabeth L M Barr
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Elna Ellis
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Deborah Butler
- Sector and System Leadership Division, NT Health, Darwin, Northern Territory, Australia
| | - Amy Rosser
- Primary Health Care Division, Central Australia Region, NT Health, Alice Springs, Northern Territory, Australia
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Louise J Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Endocrinology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Zengin A, Shore-Lorenti C, Sim M, Maple-Brown L, Brennan-Olsen SL, Lewis JR, Ockwell J, Walker T, Scott D, Ebeling P. Why Aboriginal and Torres Strait Islander Australians fall and fracture: the codesigned Study of Indigenous Muscle and Bone Ageing (SIMBA) protocol. BMJ Open 2022; 12:e056589. [PMID: 35379631 PMCID: PMC8981296 DOI: 10.1136/bmjopen-2021-056589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Aboriginal and Torres Strait Islander Australians have a substantially greater fracture risk, where men are 50% and women are 26% more likely to experience a hip fracture compared with non-Indigenous Australians. Fall-related injuries in this population have also increased by 10%/year compared with 4.3%/year in non-Indigenous Australians. This study aims to determine why falls and fracture risk are higher in Aboriginal and Torres Strait Islander Australians. SETTING All clinical assessments will be performed at one centre in Melbourne, Australia. At baseline, participants will have clinical assessments, including questionnaires, anthropometry, bone structure, body composition and physical performance tests. These assessments will be repeated at follow-up 1 and follow-up 2, with an interval of 12 months between each clinical visit. PARTICIPANTS This codesigned prospective observational study aims to recruit a total of 298 adults who identify as Aboriginal and Torres Strait Islander and reside within Victoria, Australia. Stratified sampling by age and sex will be used to ensure equitable distribution of men and women across four age-bands (35-44, 45-54, 55-64 and 65+ years). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome is within-individual yearly change in areal bone mineral density at the total hip, femoral neck and lumbar spine assessed by dual energy X-ray absorptiometry. Within-individual change in cortical and trabecular volumetric bone mineral density at the radius and tibia using high-resolution peripheral quantitative computed tomography will be determined. Secondary outcomes include yearly differences in physical performance and body composition. ETHICAL APPROVAL Ethics approval for this study has been granted by the Monash Health Human Research Ethics Committee (project number: RES-19-0000374A). TRIAL REGISTRATION NUMBER ACTRN12620000161921.
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Affiliation(s)
- Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Cat Shore-Lorenti
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Marc Sim
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia
| | - Louise Maple-Brown
- Charles Darwin University, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Endocrinology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sharon Lee Brennan-Olsen
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Victoria, Australia
- Department of Medicine-Western Health, University of Melbourne, St Albans, Victoria, Australia
| | - Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, Royal Perth Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer Ockwell
- Bunurong Health Service, Dandenong & District Aborigines Co-operative Ltd (DDACL), Dandenong, Victoria, Australia
| | - Troy Walker
- Health & Wellbeing, A2B Personnel, Echuca, Victoria, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Peter Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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11
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Rao BN, Quinn N, Januszewski AS, Peto T, Brazionis L, Aryal N, O'Connell RL, Li L, Summanen P, Scott R, O'Day J, Keech AC, Jenkins AJ. Retinopathy risk calculators in the prediction of sight-threatening diabetic retinopathy in type 2 diabetes: A FIELD substudy. Diabetes Res Clin Pract 2022; 186:109835. [PMID: 35314259 DOI: 10.1016/j.diabres.2022.109835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/08/2022] [Accepted: 03/16/2022] [Indexed: 01/09/2023]
Abstract
AIMS To evaluate the risk algorithm by Aspelund et al. for predicting sight-threatening diabetic retinopathy (STDR) in Type 2 diabetes (T2D), and to develop a new STDR prediction model. METHODS The Aspelund et al. algorithm was used to calculate STDR risk from baseline variables in 1012 participants in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) ophthalmological substudy, compared to on-trial STDR status, and receiver operating characteristic analysis performed. Using multivariable logistic regression, traditional risk factors and fenofibrate allocation as STDR predictors were evaluated, with bootstrap-based optimism-adjusted estimates of predictive performance calculated. RESULTS STDR developed in 28 participants. The Aspelund et al. algorithm predicted STDR at 2- and 5-years with area under the curve (AUC) 0.86 (95% CI 0.77-0.94) and 0.86 (0.81-0.92), respectively. In the second model STDR risk factors were any DR at baseline (OR 24.0 [95% CI 5.53-104]), HbA1c (OR 1.95 [1.43-2.64]) and male sex (OR 4.34 [1.32-14.3]), while fenofibrate (OR 0.13 [0.05-0.38]) was protective. This model had excellent discriminatory ability (AUC = 0.89). CONCLUSIONS The algorithm by Aspelund et al. predicts STDR well in the FIELD ophthalmology substudy. Logistic regression analysis found DR at baseline, male sex, and HbA1c were predictive of STDR and, fenofibrate was protective.
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Affiliation(s)
- Benjamin N Rao
- NHMRC Clinical Trials Centre, The University of Sydney, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Nicola Quinn
- NHMRC Clinical Trials Centre, The University of Sydney, Australia; Centre for Public Health, Queens University, Belfast, Northern Ireland, United Kingdom
| | | | - Tunde Peto
- Centre for Public Health, Queens University, Belfast, Northern Ireland, United Kingdom
| | - Laima Brazionis
- Department of Medicine, St. Vincent's Hospital Campus, The University of Melbourne, Australia
| | - Nanda Aryal
- NHMRC Clinical Trials Centre, The University of Sydney, Australia
| | | | - Liping Li
- NHMRC Clinical Trials Centre, The University of Sydney, Australia
| | - Paula Summanen
- Department of Ophthalmology, Helsinki University Hospital, University of Helsinki, Finland
| | - Russell Scott
- Lipid and Diabetes Research Group, Christchurch Hospital, Christchurch, New Zealand
| | - Justin O'Day
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, The University of Melbourne, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, The University of Sydney, Australia
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, The University of Sydney, Australia; Centre for Public Health, Queens University, Belfast, Northern Ireland, United Kingdom; Department of Medicine, St. Vincent's Hospital Campus, The University of Melbourne, Australia.
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12
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Ahmed MA, Bailey HD, Pereira G, White SW, Wong K, Shepherd CCJ. Trends and burden of diabetes in pregnancy among Aboriginal and non-Aboriginal mothers in Western Australia, 1998-2015. BMC Public Health 2022; 22:263. [PMID: 35139837 PMCID: PMC8827280 DOI: 10.1186/s12889-022-12663-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 01/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Diabetes in pregnancy (DIP), which includes pre-gestational and gestational diabetes, is more prevalent among Aboriginal women. DIP and its adverse neonatal outcomes are associated with diabetes and cardiovascular disease in the offspring. This study investigated the impact of DIP on trends of large for gestational age (LGA) in Aboriginal and non-Aboriginal populations, and added to the limited evidence on temporal trends of DIP burden in these populations. Methods We conducted a retrospective cohort study that included all births in Western Australia between 1998 and 2015 using linked population health datasets. Time trends of age-standardised and crude rates of pre-gestational and gestational diabetes were estimated in Aboriginal and non-Aboriginal mothers. Mixed-effects multivariable logistic regression was used to estimate the association between DIP and population LGA trends over time. Results Over the study period, there were 526,319 births in Western Australia, of which 6.4% were to Aboriginal mothers. The age-standardised annual rates of pre-gestational diabetes among Aboriginal mothers rose from 4.3% in 1998 to 5.4% in 2015 and remained below 1% in non-Aboriginal women. The comparable rates for gestational diabetes increased from 6.7 to 11.5% over the study period in Aboriginal women, and from 3.5 to 10.2% among non-Aboriginal mothers. LGA rates in Aboriginal babies remained high with inconsistent and no improvement in pregnancies complicated by gestational diabetes and pre-gestational diabetes, respectively. Regression analyses showed that DIP explained a large part of the increasing LGA rates over time in Aboriginal babies. Conclusions There has been a substantial increase in the burden of pre-gestational diabetes (Aboriginal women) and gestational diabetes (Aboriginal and non-Aboriginal) in recent decades. DIP appears to substantially contribute to increasing trends in LGA among Aboriginal babies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12663-6.
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Affiliation(s)
- Marwan Awad Ahmed
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia. .,School of Population and Global Health, The University of Western Australia, Perth, Australia.
| | - Helen D Bailey
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia
| | - Gavin Pereira
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.,Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia.,Maternal Fetal Medicine Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia.,Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Carrington C J Shepherd
- Telethon Kids Institute, University of Western Australia, P.O. Box 855, West Perth, Western Australia, 6872, Australia.,Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Australia.,Ngangk Yira Research Centre, Murdoch University, Perth, WA, Australia
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13
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Anstey KJ, Zheng L, Peters R, Kootar S, Barbera M, Stephen R, Dua T, Chowdhary N, Solomon A, Kivipelto M. Dementia Risk Scores and Their Role in the Implementation of Risk Reduction Guidelines. Front Neurol 2022; 12:765454. [PMID: 35058873 PMCID: PMC8764151 DOI: 10.3389/fneur.2021.765454] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/07/2021] [Indexed: 12/24/2022] Open
Abstract
Dementia prevention is a global health priority. In 2019, the World Health Organisation published its first evidence-based guidelines on dementia risk reduction. We are now at the stage where we need effective tools and resources to assess dementia risk and implement these guidelines into policy and practice. In this paper we review dementia risk scores as a means to facilitate this process. Specifically, we (a) discuss the rationale for dementia risk assessment, (b) outline some conceptual and methodological issues to consider when reviewing risk scores, (c) evaluate some dementia risk scores that are currently in use, and (d) provide some comments about future directions. A dementia risk score is a weighted composite of risk factors that reflects the likelihood of an individual developing dementia. In general, dementia risks scores have a wide range of implementations and benefits including providing early identification of individuals at high risk, improving risk perception for patients and physicians, and helping health professionals recommend targeted interventions to improve lifestyle habits to decrease dementia risk. A number of risk scores for dementia have been published, and some are widely used in research and clinical trials e.g., CAIDE, ANU-ADRI, and LIBRA. However, there are some methodological concerns and limitations associated with the use of these risk scores and more research is needed to increase their effectiveness and applicability. Overall, we conclude that, while further refinement of risk scores is underway, there is adequate evidence to use these assessments to implement guidelines on dementia risk reduction.
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Affiliation(s)
- Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Lidan Zheng
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Ruth Peters
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Scherazad Kootar
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Mariagnese Barbera
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Ruth Stephen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tarun Dua
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Neerja Chowdhary
- Brain Health Unit, Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alina Solomon
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom.,Division of Clinical Geriatrics, Department of Neurobiology, Center for Alzheimer's Research, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Miia Kivipelto
- The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom.,Division of Clinical Geriatrics, Department of Neurobiology, Center for Alzheimer's Research, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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14
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Núñez-Rocha GM, Esqueda-Eguía BM, Salinas-Martínez AM, Ávila-Ortiz MN, Castro-Sánchez AE, Zambrano-Moreno A, Hernández-Ruiz KJ. Differences in Social Determinants of Health between Urban Indigenous Migrants and Non-Indigenous People in North-Eastern Mexico: An Analysis to Prioritize. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168464. [PMID: 34444213 PMCID: PMC8392500 DOI: 10.3390/ijerph18168464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/25/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022]
Abstract
The degree to which social determinants of health differ between indigenous migrants and non-indigenous people born and raised locally is currently unknown. We compared social determinants of health between indigenous migrants and non-indigenous people from urban north-eastern Mexico. Additionally, we ranked priorities for addressing the negative social determinants of health. This was a population-based comparative cross-sectional study (n = 235 indigenous migrants and 168 non-indigenous people). A two-stage non-random sampling was carried out from June to August of 2019. Heads of households ≥18 years and those with the ability to communicate in Spanish were recruited house by house. Structural and intermediary determinants of health were identified according to the World Health Organization Conceptual Framework and priorities were ranked using Z-scores. Being a migrant indigenous increased 1.6 times the odds of low education (95% CI = 1.1, 2.4). In addition, the migrant indigenous status increased the odds of poor housing, unhealthy behaviour and low social cohesion (p < 0.05). Housing, behaviours and health service accessibility were top priorities for indigenous migrants and structural determinants for non-indigenous people. The findings show that the right to access the social determinants of health has not yet been guaranteed for indigenous communities.
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Affiliation(s)
- Georgina Mayela Núñez-Rocha
- Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Nuevo León 66455, Mexico; (B.M.E.-E.); (A.M.S.-M.); (M.N.Á.-O.); (A.E.C.-S.); (A.Z.-M.); (K.J.H.-R.)
- Correspondence:
| | - Brenda Mayela Esqueda-Eguía
- Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Nuevo León 66455, Mexico; (B.M.E.-E.); (A.M.S.-M.); (M.N.Á.-O.); (A.E.C.-S.); (A.Z.-M.); (K.J.H.-R.)
| | - Ana María Salinas-Martínez
- Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Nuevo León 66455, Mexico; (B.M.E.-E.); (A.M.S.-M.); (M.N.Á.-O.); (A.E.C.-S.); (A.Z.-M.); (K.J.H.-R.)
- Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro Social, Nuevo León 64360, Mexico
| | - María Natividad Ávila-Ortiz
- Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Nuevo León 66455, Mexico; (B.M.E.-E.); (A.M.S.-M.); (M.N.Á.-O.); (A.E.C.-S.); (A.Z.-M.); (K.J.H.-R.)
| | - Ana Elisa Castro-Sánchez
- Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Nuevo León 66455, Mexico; (B.M.E.-E.); (A.M.S.-M.); (M.N.Á.-O.); (A.E.C.-S.); (A.Z.-M.); (K.J.H.-R.)
| | - Adriana Zambrano-Moreno
- Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Nuevo León 66455, Mexico; (B.M.E.-E.); (A.M.S.-M.); (M.N.Á.-O.); (A.E.C.-S.); (A.Z.-M.); (K.J.H.-R.)
| | - Karina Janett Hernández-Ruiz
- Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Nuevo León 66455, Mexico; (B.M.E.-E.); (A.M.S.-M.); (M.N.Á.-O.); (A.E.C.-S.); (A.Z.-M.); (K.J.H.-R.)
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15
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Cuadros DF, Li J, Musuka G, Awad SF. Spatial epidemiology of diabetes: Methods and insights. World J Diabetes 2021; 12:1042-1056. [PMID: 34326953 PMCID: PMC8311478 DOI: 10.4239/wjd.v12.i7.1042] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/07/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) is a growing epidemic with global proportions. It is estimated that in 2019, 463 million adults aged 20-79 years were living with DM. The latest evidence shows that DM continues to be a significant global health challenge and is likely to continue to grow substantially in the next decades, which would have major implications for healthcare expenditures, particularly in developing countries. Hence, new conceptual and methodological approaches to tackle the epidemic are long overdue. Spatial epidemiology has been a successful approach to control infectious disease epidemics like malaria and human immunodeficiency virus. The implementation of this approach has been expanded to include the study of non-communicable diseases like cancer and cardiovascular diseases. In this review, we discussed the implementation and use of spatial epidemiology and Geographic Information Systems to the study of DM. We reviewed several spatial methods used to understand the spatial structure of the disease and identify the potential geographical drivers of the spatial distribution of DM. Finally, we discussed the use of spatial epidemiology on the design and implementation of geographically targeted prevention and treatment interventions against DM.
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Affiliation(s)
- Diego F Cuadros
- Geography and Geographic Information Systems, University of Cincinnati, Cincinnati, OH 45221, United States
| | - Jingjing Li
- Urban Health Collaborative, Drexel University, Philadelphia, PA 19104, United States
| | | | - Susanne F Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine – Qatar, Cornell University, Doha 24144, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine – Qatar, Cornell University, Doha 24144, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY 10044, United States
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16
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Brazionis L, Keech A, Ryan C, Brown A, O'Neal D, Boffa J, Bursell SE, Jenkins A. Associations with sight-threatening diabetic macular oedema among Indigenous adults with type 2 diabetes attending an Indigenous primary care clinic in remote Australia: a Centre of Research Excellence in Diabetic Retinopathy and Telehealth Eye and Associated Medical Services Network study. BMJ Open Ophthalmol 2021; 6:e000559. [PMID: 34307891 PMCID: PMC8252880 DOI: 10.1136/bmjophth-2020-000559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/07/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To identify factors associated with sight-threatening diabetic macular oedema (STDM) in Indigenous Australians attending an Indigenous primary care clinic in remote Australia. Methods and analysis A cross-sectional study design of retinopathy screening data and routinely-collected clinical data among 236 adult Indigenous participants with type 2 diabetes (35.6% men) set in one Indigenous primary care clinic in remote Australia. The primary outcome variable was STDM assessed from retinal images. Results Age (median (range)) was 48 (21–86) years, and known diabetes duration (median (range)) was 8.0 (0–24) years. Prevalence of STDM was high (14.8%) and similar in men and women. STDM was associated with longer diabetes duration (11.7 vs 7.9 years, respectively; p<0.001) and markers of renal impairment: abnormal estimated Glomerular Filtration Rate (eGFR) (62.9 vs 38.3%, respectively; p=0.007), severe macroalbuminuria (>300 mg/mmol) (20.6 vs 5.7%, respectively; p=0.014) and chronic kidney disease (25.7 vs 12.2%, respectively; p=0.035). Some clinical factors differed by sex: anaemia was more prevalent in women. A higher proportion of men were smokers, prescribed statins and had increased albuminuria. Men had higher blood pressure, but lower glycated Haemoglobin A1c (HbA1c) levels and body mass index, than women. Conclusion STDM prevalence was high and similar in men and women. Markers of renal impairment and longer diabetes duration were associated with STDM in this Indigenous primary care population. Embedded teleretinal screening, known diabetes duration-based risk stratification and targeted interventions may lower the prevalence of STDM in remote Indigenous primary care services. Trial registration number Australia and New Zealand Clinical Trials Register: ACTRN 12616000370404.
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Affiliation(s)
- Laima Brazionis
- Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Keech
- Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Ryan
- Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alex Brown
- Theme Leader Aboriginal Health Equity, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Aboriginal Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - David O'Neal
- Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - John Boffa
- Head Office, Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - Sven-Erik Bursell
- Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alicia Jenkins
- Medicine, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
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17
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Di Domenico EG, De Angelis B, Cavallo I, Sivori F, Orlandi F, Fernandes Lopes Morais D’Autilio M, Di Segni C, Gentile P, Scioli MG, Orlandi A, D’Agosto G, Trento E, Kovacs D, Cardinali G, Stefanile A, Koudriavtseva T, Prignano G, Pimpinelli F, Lesnoni La Parola I, Toma L, Cervelli V, Ensoli F. Silver Sulfadiazine Eradicates Antibiotic-Tolerant Staphylococcus aureus and Pseudomonas aeruginosa Biofilms in Patients with Infected Diabetic Foot Ulcers. J Clin Med 2020; 9:jcm9123807. [PMID: 33255545 PMCID: PMC7760944 DOI: 10.3390/jcm9123807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/23/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022] Open
Abstract
Infections are among the most frequent and challenging events in diabetic foot ulcers (DFUs). Pathogenic bacteria growing in biofilms within host tissue are highly tolerant to environmental and chemical agents, including antibiotics. The present study was aimed at assessing the use of silver sulfadiazine (SSD) for wound healing and infection control in 16 patients with DFUs harboring biofilm-growing Staphylococcus aureus and Pseudomonas aeruginosa. All patients received a treatment based on a dressing protocol including disinfection, cleansing, application of SSD, and application of nonadherent gauze, followed by sterile gauze and tibio-breech bandage, in preparation for toilet surgery after 30 days of treatment. Clinical parameters were analyzed by the T.I.M.E. classification system. In addition, the activity of SSD against biofilm-growing S. aureus and P. aeruginosa isolates was assessed in vitro. A total of 16 patients with S. aureus and P. aeruginosa infected DFUs were included in the study. Clinical data showed a statistically significant (p < 0.002) improvement of patients’ DFUs after 30 days of treatment with SSD with significant amelioration of all the parameters analyzed. Notably, after 30 days of treatment, resolution of infection was observed in all DFUs. In vitro analysis showed that both S. aureus and P. aeruginosa isolates developed complex and highly structured biofilms. Antibiotic susceptibility profiles indicated that biofilm cultures were significantly (p ≤ 0.002) more tolerant to all tested antimicrobials than their planktonic counterparts. However, SSD was found to be effective against fully developed biofilms of both S. aureus and P. aeruginosa at concentrations below those normally used in clinical preparations (10 mg/mL). These results strongly suggest that the topical administration of SSD may represent an effective alternative to conventional antibiotics for the successful treatment of DFUs infected by biofilm-growing S. aureus and P. aeruginosa.
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Affiliation(s)
- Enea Gino Di Domenico
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
- Correspondence: ; Tel.: +39-06-5266-5564
| | - Barbara De Angelis
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Ilaria Cavallo
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Francesca Sivori
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Fabrizio Orlandi
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | | | - Chiara Di Segni
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Pietro Gentile
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Maria Giovanna Scioli
- Department of Anatomic Pathology, University of Rome Tor Vergata, 00144 Rome, Italy; (M.G.S.); (A.O.)
| | - Augusto Orlandi
- Department of Anatomic Pathology, University of Rome Tor Vergata, 00144 Rome, Italy; (M.G.S.); (A.O.)
| | - Giovanna D’Agosto
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Elisabetta Trento
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Daniela Kovacs
- Cutaneous Physiopathology, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (D.K.); (G.C.)
| | - Giorgia Cardinali
- Cutaneous Physiopathology, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy; (D.K.); (G.C.)
| | - Annunziata Stefanile
- Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.S.); (T.K.)
| | - Tatiana Koudriavtseva
- Department of Clinical Experimental Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.S.); (T.K.)
| | - Grazia Prignano
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Fulvia Pimpinelli
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
| | - Ilaria Lesnoni La Parola
- Lichen Sclerosus Unit, Department of Dermatology, STI, Environmental Health, Tropical and Immigration, San Gallicano Dermatological Institute, IRCCS, 00144 Rome, Italy;
| | - Luigi Toma
- Department of Research, Advanced Diagnostics, and Technological Innovation, Translational Research Area, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Valerio Cervelli
- Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, 00144 Rome, Italy; (B.D.A.); (F.O.); (M.F.L.M.D.); (C.D.S.); (P.G.); (V.C.)
| | - Fabrizio Ensoli
- Microbiology and Virology, San Gallicano Dermatological Institute IRCCS, 00144 Rome, Italy; (I.C.); (F.S.); (G.D.); (E.T.); (G.P.); (F.P.); (F.E.)
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Drinkwater JJ, Davis WA, Turner AW, McAullay D, Davis TME. Differences in retinopathy prevalence and progression between Anglo-Celt and Aboriginal Australians: the Fremantle Diabetes Study Phase II. Intern Med J 2020; 52:590-598. [PMID: 33040394 DOI: 10.1111/imj.15090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/08/2020] [Accepted: 10/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Indigenous populations have higher rates of diabetes and diabetic complications, yet there is a paucity of contemporary data on diabetic retinopathy (DR) prevalence and incidence in urban dwelling Aboriginal Australians. AIMS The aim of the study was to compare the prevalence of DR and incidence of new or worsening DR between Aboriginal Australians and Anglo-Celts with Type 2 diabetes. METHODS Participants from the community-based Fremantle Diabetes Study Phase II (817 Anglo-Celts, 94 Aboriginal people) recruited between 2008 and 2011 underwent fundus photography at baseline and biennial reviews. The prevalence of any DR and moderate non-proliferative DR (NPDR), and the incidence of new or worsening DR were ascertained using baseline and 4-year follow-up data. RESULTS Compared with Anglo-Celts, the Aboriginal participants had a higher prevalence of any DR (33.0% vs 52.1%) and moderate NPDR or worse (5.1% vs 24.4%), and new or worsening DR during follow up (6.7% vs 23.5%). The unadjusted odds ratios (95% confidence interval) of any DR and moderate NPDR at baseline were 2.21 (1.43, 3.39) and 5.98 (3.40, 10.50), respectively, and of new or worsening DR 4.32 (1.33, 13.98). In adjusted models, Aboriginal ethnicity was only associated with the prevalence of moderate NPDR or worse (5.58 (2.44, 12.76)). CONCLUSIONS Aboriginal participants had a higher prevalence of DR and new or worsening DR, reflecting conventional risk factors including suboptimal glycaemic control. Their significantly higher odds of moderate NPDR or worse in adjusted models suggest ethnic-specific determinants of DR severity. These findings highlight the need for equitable, culturally appropriate diabetes/ophthalmic care.
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Affiliation(s)
- Jocelyn J Drinkwater
- Medical School, The University of Western Australia, Fremantle Hospital, Perth, Western Australia, Australia
| | - Wendy A Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Perth, Western Australia, Australia
| | - Angus W Turner
- Lions Eye Institute, Perth, Western Australia, Australia.,Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
| | - Daniel McAullay
- Kurongkurl Katitjin, Edith Cowan University, Perth, Western Australia, Australia
| | - Timothy M E Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Perth, Western Australia, Australia
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Maple-Brown LJ, Graham S, McKee J, Wicklow B. Walking the path together: incorporating Indigenous knowledge in diabetes research. Lancet Diabetes Endocrinol 2020; 8:559-560. [PMID: 32559468 DOI: 10.1016/s2213-8587(20)30188-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Louise J Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Endocrinology Department, Royal Darwin Hospital, Darwin, NT, Australia.
| | - Sian Graham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Indigenous Reference Group, Diabetes across the Lifecourse Northern Australia Partnership, Menzies School of Health Research, NT, Australia
| | - Jackie McKee
- Participant and Family Advisory Lead, iCARE Cohort Study, Waywayseecappo First Nation, MB, Canada
| | - Brandy Wicklow
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada; Pediatrics and Child Health, Pediatric Endocrinology, University of Manitoba, Winnipeg, MB, Canada
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21
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Maple-Brown LJ, Hampton D. Indigenous cultures in countries with similar colonisation histories share the challenge of intergenerational diabetes. LANCET GLOBAL HEALTH 2020; 8:e619-e620. [PMID: 32353301 DOI: 10.1016/s2214-109x(20)30072-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Louise J Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Charles Darwin University, Darwin, NT 0811, Australia; Menzies School of Health Research, Charles Darwin University, Darwin, NT 0811, Australia; Endocrinology Department, Royal Darwin Hospital, Darwin, NT, Australia.
| | - Denella Hampton
- Indigenous Reference Group, Diabetes across the Lifecourse Northern Australia Partnership, Charles Darwin University, Darwin, NT 0811, Australia; Central Australian Aboriginal Congress Aboriginal Corporation, Alice Springs, NT, Australia
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22
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Maple-Brown L, Lee IL, Longmore D, Barzi F, Connors C, Boyle JA, Moore E, Whitbread C, Kirkwood M, Graham S, Hampton V, Simmonds A, Van Dokkum P, Kelaart J, Thomas S, Chitturi S, Eades S, Corpus S, Lynch M, Lu ZX, O'Dea K, Zimmet P, Oats J, McIntyre HD, Brown ADH, Shaw JE. Pregnancy And Neonatal Diabetes Outcomes in Remote Australia: the PANDORA study-an observational birth cohort. Int J Epidemiol 2020; 48:307-318. [PMID: 30508095 DOI: 10.1093/ije/dyy245] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In Australia's Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)]. METHODS This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited. RESULTS Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5%; DIP, 15 vs 7%; GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002; neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes. CONCLUSIONS Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.
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Affiliation(s)
- Louise Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Danielle Longmore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Christine Connors
- Remote Primary Health Care, Top End Health Services, Northern Territory Department of Health, Darwin, NT, Australia
| | - Jacqueline A Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Moore
- Public Health Unit, Aboriginal Medical Services Alliance, Darwin, NT, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Sian Graham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Vanya Hampton
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Alison Simmonds
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Paula Van Dokkum
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Joanna Kelaart
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Sujatha Thomas
- Division of Maternal and Child Health, Royal Darwin Hospital, Darwin, NT, Australia
| | - Shridhar Chitturi
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Sandra Eades
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Sumaria Corpus
- Clinical Services, Danila Dilba Health Service, Darwin, NT, Australia
| | - Michael Lynch
- Pathology Network, Top End Health and Hospital Services, Darwin, NT, Australia
| | - Zhong X Lu
- Biochemistry Department, Melbourne Pathology, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Kerin O'Dea
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Paul Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Harold D McIntyre
- Faculty of Medicine, Mater Medical Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Alex D H Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
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Wotherspoon C, Williams CM. Exploring the experiences of Aboriginal and Torres Strait Islander patients admitted to a metropolitan health service. AUST HEALTH REV 2019; 43:217-223. [PMID: 29495978 DOI: 10.1071/ah17096] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/04/2017] [Indexed: 11/23/2022]
Abstract
Objective There continue to be disparate health outcomes for people who are Aboriginal and Torres Strait Islander. The aim of the present study was to measure whether there were any differences in in-patient experiences between Aboriginal and Torres Strait Islander people and those without an Aboriginal or Torres Strait Islander background. Methods Random samples of people were invited to complete a survey following admission at the hospitals at Peninsula Health, Victoria, Australia. This survey was based on the Victorian Patient Satisfaction Monitor. Open-ended questions were also asked to gauge perspectives on how the services could better meet needs of Aboriginal and Torres Strait Islander patients. Results A total of 154 responses was obtained. There were differences between the two groups of participants in the following variables: respect of privacy, representation of culture, assistance with meals and access to a culturally specific worker if needed. This was reflected in thematic analysis, with three main themes identified: (1) interactions with staff; (2) the challenging environment; and (3) not just about me, but my family too. Conclusion There were systemic differences in in-patient experiences. Healthcare services have a responsibility to make systemic changes to improve the health care of all Australians by understanding and reforming how services can be appropriately delivered. What is known about the topic? There is a disparity in health outcomes between Aboriginal and Torres Strait Islander Australians and those who do not identify as Aboriginal and/or Torres Strait Islander. In addition, Aboriginal and Torres Strait Islanders have different interactions within healthcare services. Many rural health services have models that aim to deliver culturally appropriate services, but it is unknown whether the same challenges apply for this group of Australians within metropolitan health services. What does this paper add? This paper identifies the structural supports that are required to help close the gap in health care provision inequality. Many of the key issues identified are not people but system based. Healthcare administrators should consider the factors identified and address these at a whole-of-service level. What are the implications for practitioners? Many practitioners are aware of the challenges of providing culturally appropriate services. This research raises awareness of how traditional healthcare is not a one size fits all and flexibility is required to improve health outcomes.
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Affiliation(s)
- Craig Wotherspoon
- Peninsula Health - Community Health, PO Box 52, Frankston, Vic. 3199, Australia. Email
| | - Cylie M Williams
- Peninsula Health - Community Health, PO Box 52, Frankston, Vic. 3199, Australia. Email
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Maple-Brown LJ, Lindenmayer G, Barzi F, Whitbread C, Connors C, Moore E, Boyle J, Kirkwood M, Lee IL, Longmore D, van Dokkum P, Wicks M, Dowden M, Inglis C, Cotter M, Kirkham R, Corpus S, Chitturi S, Thomas S, O'Dea K, Zimmet P, Oats J, McIntyre HD, Brown A, Shaw JE. Real-world experience of metformin use in pregnancy: Observational data from the Northern Territory Diabetes in Pregnancy Clinical Register. J Diabetes 2019; 11:761-770. [PMID: 30680949 DOI: 10.1111/1753-0407.12905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In Australia's Northern Territory, Indigenous mothers account for 33% of births and have high rates of hyperglycemia in pregnancy. The prevalence of type 2 diabetes (T2D) in pregnancy is up to 10-fold higher in Indigenous than non-Indigenous Australian mothers, and the use of metformin is common. We assessed birth outcomes in relation to metformin use during pregnancy from a clinical register. METHODS The study included women with gestational diabetes (GDM), newly diagnosed diabetes in pregnancy (DIP), or pre-existing T2D from 2012 to 2016. Data were analyzed for metformin use in the third trimester. Regression models were adjusted for maternal age, body mass index, parity, and insulin use. RESULTS Of 1649 pregnancies, 814 (49.4%) were to Indigenous women, of whom 234 (28.7%) had T2D (vs 4.6% non-Indigenous women; P < 0.001). Metformin use was high in Indigenous women (84%-90% T2D, 42%-48% GDM/DIP) and increased over time in non-Indigenous women (43%-100% T2D, 14%-35% GDM/DIP). Among Indigenous women with GDM/DIP, there were no significant differences between groups with and without metformin in cesarean section (51% vs 39%; adjusted odds ratio [aOR] 1.25, 95% confidence interval [CI] 0.87-1.81), large for gestational age (24% vs 13%; aOR 1.5, 95% CI 0.9-2.5), or serious neonatal adverse events (9.4% vs 5.9%; aOR 1.32, 95% CI 0.68-2.57). Metformin use was independently associated with earlier gestational age (37.7 vs 38.5 weeks), but the risk did not remain independently higher after exclusion of women managed with medical nutrition therapy alone, and the increase in births <37 weeks was not significant on multivariate analysis. CONCLUSIONS We found no clear evidence of any adverse outcomes related to the use of metformin for the treatment of hyperglycemia in pregnancy.
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Affiliation(s)
- Louise J Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Greta Lindenmayer
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Christine Connors
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Elizabeth Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia
| | - Jacqueline Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Danielle Longmore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Paula van Dokkum
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- Population Health Research, Baker Heart and Diabetes Institute, Alice Springs, Northern Territory, Australia
| | - Mary Wicks
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | | | | | - Margaret Cotter
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Northern Territory, Australia
| | - Renae Kirkham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Sumaria Corpus
- Danila Dilba Health Service, Darwin, Northern Territory, Australia
| | - Sridhar Chitturi
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sujatha Thomas
- Obstetrics and Gynaecology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Kerin O'Dea
- Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Paul Zimmet
- Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Harold D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Alex Brown
- Obstetrics and Gynaecology Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Jonathan E Shaw
- Population Health Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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25
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Longmore DK, Barr ELM, Lee IL, Barzi F, Kirkwood M, Whitbread C, Hampton V, Graham S, Van Dokkum P, Connors C, Boyle JA, Catalano P, Brown ADH, O'Dea K, Oats J, McIntyre HD, Shaw JE, Maple-Brown LJ. Maternal body mass index, excess gestational weight gain, and diabetes are positively associated with neonatal adiposity in the Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study. Pediatr Obes 2019; 14:e12490. [PMID: 30650263 DOI: 10.1111/ijpo.12490] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/27/2018] [Accepted: 10/03/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND In-utero exposures likely influence the onset and severity of obesity in youth. With increasing rates of type 2 diabetes mellitus (T2DM) and maternal adiposity in pregnancy globally, it is important to assess the impact of these factors on neonatal adipose measures. OBJECTIVES To evaluate the contribution of maternal ethnicity, body mass index (BMI), gestational weight gain, and hyperglycaemia to neonatal adiposity. METHODS Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) is a longitudinal cohort study of Australian mother and neonate pairs. In this analysis, Indigenous (n = 519) and Europid (n = 358) women were included, of whom 644 had hyperglycaemia (type 2 diabetes [T2DM], diabetes in pregnancy [DIP], or gestational diabetes [GDM]). Associations between maternal ethnicity, hyperglycaemia, BMI and gestational weight gain, and the neonatal outcomes of length, head circumference, sum of skinfolds, total body fat, and percentage body fat were examined. Models were adjusted for maternal age, smoking status, parity, education, neonatal gender, and gestational age. RESULTS Among those with hyperglycaemia in pregnancy, Indigenous women had a higher proportion of T2DM and DIP (36%, 13%) compared with Europid women (4%, 3%). In multivariate analysis, maternal T2DM (compared with no hyperglycaemia), BMI during pregnancy, and excess compared with appropriate gestational weight gain, were significantly associated with greater neonatal measures. DIP was associated with greater sum of skinfolds, total body fat, and percentage body fat. Indigenous ethnicity was associated with greater sum of skinfolds. CONCLUSIONS Maternal BMI, excess gestational weight gain, and hyperglycaemia operated as independent factors influencing neonatal adiposity. Interventions addressing these factors are needed to reduce neonatal adiposity.
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Affiliation(s)
- Danielle K Longmore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia.,Department of Paediatrics, Western Health, Melbourne, Australia
| | - Elizabeth L M Barr
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | - I-Lynn Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Vanya Hampton
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Sian Graham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Paula Van Dokkum
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia.,Baker Heart and Diabetes Institute, Alice Springs, Australia
| | | | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Alex D H Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kerin O'Dea
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - H David McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | | | - Louise J Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, Australia
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Nesbitt AL, Goodall K, Bakshi V, Bhutia S. Major lower limb amputations in Far North Queensland. ANZ J Surg 2019; 89:880-884. [DOI: 10.1111/ans.15031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Vrushank Bakshi
- College of Medicine and DentistryJames Cook University Cairns Queensland Australia
| | - Sherab Bhutia
- Department of SurgeryCairns Hospital Cairns Queensland Australia
- College of Medicine and DentistryJames Cook University Cairns Queensland Australia
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Barr EL, Barzi F, Hughes JT, Jerums G, O'Dea K, Brown AD, Ekinci EI, Jones GR, Lawton PD, Sinha A, MacIsaac RJ, Cass A, Maple-Brown LJ. Contribution of cardiometabolic risk factors to estimated glomerular filtration rate decline in Indigenous Australians with and without albuminuria - the eGFR Follow-up Study. Nephrology (Carlton) 2018; 23:682-689. [PMID: 28503768 DOI: 10.1111/nep.13073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 11/26/2022]
Abstract
AIM We assessed associations between cardiometabolic risk factors and estimated glomerular filtration rate (eGFR) decline according to baseline albuminuria to identify potential treatment targets in Indigenous Australians. METHODS The eGFR Follow-up Study is a longitudinal cohort of 520 Indigenous Australians. Linear regression was used to estimate associations between baseline cardiometabolic risk factors and annual Chronic Kidney Disease Epidemiology Collaboration eGFR change (mL/min per 1.73m2 /year), among those classified with baseline normoalbuminuria (urine albumin-to-creatinine ratio (uACR) <3 mg/mmol; n = 297), microalbuminuria (uACR 3-30 mg/mmol; n = 114) and macroalbuminuria (uACR ≥30 mg/mmol; n = 109). RESULTS After a median of 3 years follow-up, progressive declines of the age- and sex-adjusted mean eGFR were observed across albuminuria categories (-2.0 [-2.6 to -1.4], -2.5 [-3.7 to -1.3] and -6.3 [-7.8 to -4.9] mL/min per 1.72m2 /year). Although a borderline association was observed between greater baseline haemoglobin A1c and eGFR decline in those with macroalbuminuria (P = 0.059), relationships were not significant in those with microalbuminuria (P = 0.187) or normoalbuminuria (P = 0.23). Greater baseline blood pressure, C-reactive protein, waist-to-hip ratio and lower high-density lipoprotein cholesterol showed non-significant trends with greater eGFR decline in the presence of albuminuria. CONCLUSION Over a 3 year period, marked eGFR decline was observed with greater baseline albuminuria. Cardiometabolic risk factors were not strong predictors for eGFR decline in Indigenous Australians without albuminuria. Longer follow-up may elucidate the role of these predictors and other mechanisms in chronic kidney disease progression in this population.
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Affiliation(s)
- Elizabeth Lm Barr
- Menzies School of Health Research, Darwin, North Territory, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Federica Barzi
- Menzies School of Health Research, Darwin, North Territory, Australia
| | - Jaquelyne T Hughes
- Menzies School of Health Research, Darwin, North Territory, Australia.,Department of Medicine, Royal Darwin Hospital, Darwin, North Territory, Australia
| | - George Jerums
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Kerin O'Dea
- Nutrition and Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Alex Dh Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Sansom Institute Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Elif I Ekinci
- Menzies School of Health Research, Darwin, North Territory, Australia.,Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Graham Rd Jones
- SydPath, St Vincent's Hospital, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales, Sydney, Australia
| | - Paul D Lawton
- Menzies School of Health Research, Darwin, North Territory, Australia
| | - Ashim Sinha
- Diabetes and Endocrinology, Cairns Base Hospital, Cairns, Australia
| | - Richard J MacIsaac
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,St Vincent's Hospital, Melbourne, Melbourne, Victoria, Australia
| | - Alan Cass
- Menzies School of Health Research, Darwin, North Territory, Australia
| | - Louise J Maple-Brown
- Menzies School of Health Research, Darwin, North Territory, Australia.,Department of Medicine, Royal Darwin Hospital, Darwin, North Territory, Australia
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Early-life origins of disparities in chronic diseases among Indigenous youth: pathways to recovering health disparities from intergenerational trauma. J Dev Orig Health Dis 2018; 10:115-122. [PMID: 30223914 DOI: 10.1017/s2040174418000661] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Indigenous women and children experience some of the most profound health disparities globally. These disparities are grounded in historical and contemporary trauma secondary to colonial atrocities perpetuated by settler society. The health disparities that exist for chronic diseases may have their origins in early-life exposures that Indigenous women and children face. Mechanistically, there is evidence that these adverse exposures epigenetically modify genes associated with cardiometabolic disease risk. Interventions designed to support a resilient pregnancy and first 1000 days of life should abrogate disparities in early-life socioeconomic status. Breastfeeding, prenatal care and early child education are key targets for governments and health care providers to start addressing current health disparities in cardiometabolic diseases among Indigenous youth. Programmes grounded in cultural safety and co-developed with communities have successfully reduced health disparities. More works of this kind are needed to reduce inequities in cardiometabolic diseases among Indigenous women and children worldwide.
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Abstract
INTRODUCTION Research on non-communicable diseases (NCD) in Indigenous Australians has mostly focused on diabetes mellitus and chronic kidney or cardiovascular disease. Osteoporosis, characterised by low bone mass and structural deterioration of bone tissue, and sarcopenia, the age-related loss of muscle mass and strength, often co-exist with these common NCDs-the combination of which will disproportionately increase bone fragility and fracture risk and negatively influence cortical and trabecular bone. Furthermore, the social gradient of NCDs, including osteoporosis and fracture, is well-documented, meaning that specific population groups are likely to be at greater risk of poorer health outcomes: Indigenous Australians are one such group. PURPOSE This review summarises the findings reported in the literature regarding the muscle and bone health of Indigenous Australians. FINDINGS There are limited data regarding the musculoskeletal health of Indigenous Australians; however, areal bone mineral density (aBMD) measured by dual-energy X-ray absorptiometry (DXA) is reported to be greater at the hip compared to non-Indigenous Australians. Falls are the leading cause of injury-related hospitalisations in older Australians, particularly Indigenous Australians, with a great proportion suffering from fall-related fractures. Despite sparse data, it appears that Indigenous men and women have a substantially higher risk of hip fracture at a much younger age compared to non-Indigenous Australians. CONCLUSION Data on more detailed musculoskeletal health outcomes are required in Indigenous Australians to better understand fracture risk and to formulate evidence-based strategies for fracture prevention and to minimise the risk of falls.
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Singh TP, Skalina T, Nour D, Murali A, Morrison S, Moxon JV, Golledge J. A meta-analysis of the efficacy of allopurinol in reducing the incidence of myocardial infarction following coronary artery bypass grafting. BMC Cardiovasc Disord 2018; 18:143. [PMID: 29996770 PMCID: PMC6042232 DOI: 10.1186/s12872-018-0881-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/03/2018] [Indexed: 01/28/2023] Open
Abstract
Background The xanthine oxidase inhibitor allopurinol that is commonly used to treat gout, has been suggested to have pleiotropic effects that are likely to reduce the incidence of myocardial infarction (MI) in at risk individuals. The aim of this meta-analysis was to assess the efficacy of allopurinol treatment in reducing the incidence of MI. Method MEDLINE, Scopus, Web of Science, and Cochrane Library databases were searched for randomised controlled trials examining the efficacy of allopurinol in reducing the incidence of MI. The quality of study methodology was assessed by two independent reviewers using the Cochrane Collaboration’s tool for assessing risk of bias. This meta-analysis was conducted using a fixed-effects model, and heterogeneity was assessed with the I2 index. Results One thousand one hundred twenty-three citations were screened and only six studies satisfied the inclusion criterion. Published between 1988 and 1995, all studies examined the cardioprotective efficacy of allopurinol in the setting of coronary artery bypass graft (CABG). From a total pooled sample size of 229, MI was reported in 2 (1.77%) allopurinol and 14 (12.07%) control patients. A fixed-effects meta-analysis (I2 = 0%) identified a statistically significant reduced incidence of myocardial infarction (RR 0.21, 95% CI: 0.06, 0.70, p = 0.01) in patients allocated to allopurinol. However, in the leave-one-out sensitivity analyses, the treatment effect became non-significant with the removal of one of the studies. Conclusion Based on the limited evidence available, allopurinol appears to reduce the incidence of perioperative MI following CABG. Further research is required to confirm these findings. Electronic supplementary material The online version of this article (10.1186/s12872-018-0881-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tejas P Singh
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia.,The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia
| | - Tristan Skalina
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Daniel Nour
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Aarya Murali
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Sean Morrison
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Joseph V Moxon
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, 4811, Australia. .,The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia.
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31
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Koye DN, Magliano DJ, Nelson RG, Pavkov ME. The Global Epidemiology of Diabetes and Kidney Disease. Adv Chronic Kidney Dis 2018; 25:121-132. [PMID: 29580576 PMCID: PMC11000253 DOI: 10.1053/j.ackd.2017.10.011] [Citation(s) in RCA: 301] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/17/2017] [Accepted: 10/23/2017] [Indexed: 12/21/2022]
Abstract
The prevalence of diabetes is increasing worldwide, with the greatest increases occurring in low- and middle-income countries. In most developed countries, type 2 diabetes is presently the leading cause of end-stage renal disease and also contributes substantially to cardiovascular disease. In countries with weaker economies type 2 diabetes is rapidly replacing communicable diseases as a leading cause of kidney disease and is increasingly competing for scarce health care resources. Here, we present a narrative review of the prevalence and incidence of diabetes-related kidney disease worldwide. Mortality among those with diabetes and kidney disease will also be explored. Given the high morbidity and mortality associated with chronic kidney disease, we will also examine the level of awareness of this disease among people who have it.
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Affiliation(s)
- Digsu N Koye
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ; and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dianna J Magliano
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ; and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Robert G Nelson
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ; and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Meda E Pavkov
- Department of Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; Chronic Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ; and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
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Klein J, Boyle JA, Kirkham R, Connors C, Whitbread C, Oats J, Barzi F, McIntyre D, Lee I, Luey M, Shaw J, Brown ADH, Maple-Brown LJ. Preconception care for women with type 2 diabetes mellitus: A mixed-methods study of provider knowledge and practice. Diabetes Res Clin Pract 2017; 129:105-115. [PMID: 28521194 DOI: 10.1016/j.diabres.2017.03.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/03/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
AIMS Preconception care may decrease adverse pregnancy outcomes associated with pre-existing diabetes mellitus. Aboriginal Australians are at high risk of type 2 diabetes mellitus (T2DM), with earlier onset. We explored practitioner views on preconception care delivery for women with T2DM in the Northern Territory, where 31% of births are to Aboriginal women. METHODS Mixed-methods study including cross-sectional survey of 156 health practitioners and 11 semi-structured interviews. RESULTS Practitioners reported low attendance for preconception care however, 51% provided counselling on an opportunistic basis. Rural/remote practitioners were most likely to find counselling feasible. The majority (69%) utilised appropriate guidelines and addressed lifestyle modifications including smoking (81%), weight management (79%), and change medications appropriately such as ceasing ACE inhibitors (69%). Fewer (40%) prescribed the recommended dose of folate (5mg) or felt comfortable recommending delaying pregnancy to achieve optimal preconception glucose control (42%). Themes identified as barriers to care included the complexity of care setting and infrequent preconception consultations. There was a focus on motivation of women to make informed choices about conception, including birth spacing, timing and contraception. Preconception care enablers included cross-cultural communication, a multi-disciplinary care team and strong client-based relationships. CONCLUSIONS Health practitioners are keen to provide preconception counselling and reported knowledge of evidence-based guidelines. Improvements are needed in recommending high dose folate and optimising glucose control. Cross-cultural communication and team-based care were reported as fundamental to successful preconception care in women with T2DM. Continued education and policy changes are required to support practitioners in opportunities to enhance pregnancy planning.
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Affiliation(s)
- J Klein
- Royal Darwin Hospital, Darwin, Australia; Department of Obstetrics and Gynaecology, Eastern Health, Melbourne, Australia
| | - J A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Menzies School of Health Research, Darwin, Australia
| | - R Kirkham
- Menzies School of Health Research, Darwin, Australia
| | - C Connors
- Northern Territory Department of Health, Darwin, Australia
| | - C Whitbread
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - F Barzi
- Menzies School of Health Research, Darwin, Australia
| | - D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - I Lee
- Menzies School of Health Research, Darwin, Australia
| | - M Luey
- Central Australian Aboriginal Congress, Alice Springs, Australia
| | - J Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A D H Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia; University of South Australia, Adelaide, Australia
| | - L J Maple-Brown
- Royal Darwin Hospital, Darwin, Australia; Menzies School of Health Research, Darwin, Australia.
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33
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Barr ELM, Cunningham J, Tatipata S, Dunbar T, Kangaharan N, Guthridge S, Li SQ, Condon JR, Shaw JE, O'Dea K, Maple-Brown LJ. Associations of mortality and cardiovascular disease risks with diabetes and albuminuria in urban Indigenous Australians: the DRUID follow-up study. Diabet Med 2017; 34:946-957. [PMID: 28375555 DOI: 10.1111/dme.13360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2017] [Indexed: 12/01/2022]
Abstract
AIM To assess the relationships of diabetes and albuminuria with all-cause mortality and cardiovascular disease outcomes in a population without prior cardiovascular disease using data from the Darwin Region Urban Indigenous Diabetes (DRUID) study. METHODS We conducted a prospective cohort study of 706 participants (aged 15-81 years, 68% women) without prior cardiovascular disease who underwent a 75-g oral glucose tolerance test. Deaths and fatal or non-fatal cardiovascular disease were determined over 7 years, and hazard ratios with 95% CIs and population attributable risks were estimated for baseline glycaemia and albuminuria. RESULTS Compared with normoglycaemia and after adjustment for age, sex, hypertension, dyslipidaemia and smoking, known diabetes was associated with an adjusted hazard ratio of 4.8 (95% CI 1.5-14.7) for all-cause mortality and 5.6 (95% CI 2.1-15.2) for cardiovascular disease. Compared with normoalbuminuria, the respective adjusted risks for macroalbuminuria were 10.9 (95% CI 3.7-32.1) and 3.9 (95% CI 1.4-10.8). The Adjusted all-cause mortality and cardiovascular disease estimated population attributable risks for diabetes were 27% and 32%, and for albuminuria they were 32% and 21%, respectively. CONCLUSIONS In our study population, the burden of mortality and cardiovascular disease was largely driven by diabetes and albuminuria. This finding on the influence of diabetes and albuminuria is consistent with reports in other high-risk Indigenous populations and should be better reflected in risk scores and intervention programmes.
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Affiliation(s)
- E L M Barr
- Menzies School of Health Research, Darwin, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - J Cunningham
- Menzies School of Health Research, Darwin, Australia
| | - S Tatipata
- Menzies School of Health Research, Darwin, Australia
| | - T Dunbar
- Charles Darwin University, Darwin, Australia
| | | | - S Guthridge
- Menzies School of Health Research, Darwin, Australia
- Health Gains Planning, Northern Territory Department of Health, Darwin, Australia
| | - S Q Li
- Health Gains Planning, Northern Territory Department of Health, Darwin, Australia
| | - J R Condon
- Menzies School of Health Research, Darwin, Australia
| | - J E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - K O'Dea
- University of South Australia, Adelaide, Australia
- University of Melbourne, Melbourne, Australia
| | - L J Maple-Brown
- Menzies School of Health Research, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
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Estevez J, Kaidonis G, Henderson T, Craig JE, Landers J. Association of disease-specific causes of visual impairment and 10-year mortality amongst Indigenous Australians: the Central Australian Ocular Health Study. Clin Exp Ophthalmol 2017. [PMID: 28621840 DOI: 10.1111/ceo.13009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
IMPORTANCE Visual impairment significantly impairs the length and quality of life, but little is known of its impact in Indigenous Australians. BACKGROUND To investigate the association of disease-specific causes of visual impairment with all-cause mortality. DESIGN A retrospective cohort analysis. PARTICIPANTS A total of 1347 Indigenous Australians aged over 40 years. METHODS Participants visiting remote medical clinics underwent clinical examinations including visual acuity, subjective refraction and slit-lamp examination of the anterior and posterior segments. The major ocular cause of visual impairment was determined. Patients were assessed periodically in these remote clinics for the succeeding 10 years after recruitment. Mortality rates were obtained from relevant departments. MAIN OUTCOME MEASURES All-cause 10-year mortality and its association with disease-specific causes of visual impairment. RESULTS The all-cause mortality rate for the entire cohort was 29.3% at the 10-year completion of follow-up. Of those with visual impairment, the overall mortality rate was 44.9%. The mortality rates differed for those with visual impairment due to cataract (59.8%), diabetic retinopathy (48.4%), trachoma (46.6%), 'other' (36.2%) and refractive error (33.4%) (P < 0.0001). Only those with visual impairment from diabetic retinopathy were any more likely to die during the 10 years of follow-up when compared with those without visual impairment (HR 1.70; 95% CI, 1.00-2.87; P = 0.049). CONCLUSIONS AND RELEVANCE Visual impairment was associated with all-cause mortality in a cohort of Indigenous Australians. However, diabetic retinopathy was the only ocular disease that significantly increased the risk of mortality. Visual impairment secondary to diabetic retinopathy may be an important predictor of mortality.
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Affiliation(s)
- José Estevez
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Georgia Kaidonis
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Tim Henderson
- Department of Ophthalmology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Jamie E Craig
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - John Landers
- Department of Ophthalmology, Flinders Medical Centre, Adelaide, South Australia, Australia
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35
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Kinchin I, Mccalman J, Bainbridge R, Tsey K, Lui FW. Does Indigenous health research have impact? A systematic review of reviews. Int J Equity Health 2017; 16:52. [PMID: 28327137 PMCID: PMC5361858 DOI: 10.1186/s12939-017-0548-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/13/2017] [Indexed: 12/18/2022] Open
Abstract
Background Aboriginal and Torres Strait Islander Australians (hereafter respectfully Indigenous Australians) claim that they have been over-researched without corresponding research benefit. This claim raises two questions. The first, which has been covered to some extent in the literature, is about what type(s) of research are likely to achieve benefits for Indigenous people. The second is how researchers report the impact of their research for Indigenous people. This systematic review of Indigenous health reviews addresses the second enquiry. Methods Fourteen electronic databases were systematically searched for Indigenous health reviews which met eligibility criteria. Two reviewers assessed their characteristics and methodological rigour using an a priori protocol. Three research hypotheses were stated and tested: (1) reviews address Indigenous health priority needs; (2) reviews adopt best practice guidelines on research conduct and reporting in respect to methodological transparency and rigour, as well as acceptability and appropriateness of research implementation to Indigenous people; and (3) reviews explicitly report the incremental impacts of the included studies and translation of research. We argue that if review authors explicitly address each of these three hypotheses, then the impact of research for Indigenous peoples’ health would be explicated. Results Seventy-six reviews were included; comprising 55 journal articles and 21 Australian Government commissioned evidence review reports. While reviews are gaining prominence and recognition in Indigenous health research and increasing in number, breadth and complexity, there is little reporting of the impact of health research for Indigenous people. This finding raises questions about the relevance of these reviews for Indigenous people, their impact on policy and practice and how reviews have been commissioned, reported and evaluated. Conclusions The findings of our study serve two main purposes. First, we have identified knowledge and methodological gaps in documenting Indigenous health research impact that can be addressed by researchers and policy makers. Second, the findings provide the justification for developing a framework allowing researchers and funding bodies to structure future Indigenous health research to improve the reporting and assessment of impact over time. Electronic supplementary material The online version of this article (doi:10.1186/s12939-017-0548-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Irina Kinchin
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia. .,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia.
| | - Janya Mccalman
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia.,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Roxanne Bainbridge
- Centre for Indigenous Health Equity Research, School of Health, Medical and Applied Sciences, Psychology and Public Health Department, CQUniversity Australia, Cairns Square, Corner Abbott and Shields Streets, Cairns, Qld, 4870, Australia.,The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Komla Tsey
- The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
| | - Felecia Watkin Lui
- The Cairns Institute, James Cook University, Building D3, Smithfield, Qld, 4870, Australia
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Harris SB, Tompkins JW, TeHiwi B. Call to action: A new path for improving diabetes care for Indigenous peoples, a global review. Diabetes Res Clin Pract 2017; 123:120-133. [PMID: 28011411 DOI: 10.1016/j.diabres.2016.11.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/23/2016] [Accepted: 11/30/2016] [Indexed: 12/13/2022]
Abstract
Diabetes has reached epidemic proportions in Indigenous populations around the globe, and there is an urgent need to improve the health and health equity of Indigenous peoples with diabetes through timely and appropriate diabetes prevention and management strategies. This review describes the evolution of the diabetes epidemic in Indigenous populations and associated risk factors, highlighting gestational diabetes and intergenerational risk, lifestyle risk factors and social determinants as having particular importance and impact on Indigenous peoples. This review further describes the impact of chronic disease and diabetes on Indigenous peoples and communities, specifically diabetes-related comorbidities and complications. This review provides continued evidence that dramatic changes are necessary to reduce diabetes-related inequities in Indigenous populations, with a call to action to support programmatic primary healthcare transformation capable of empowering Indigenous peoples and communities and improving chronic disease prevention and management. Promising strategies for transforming health services and care for Indigenous peoples include quality improvement initiatives, facilitating diabetes and chronic disease registry and surveillance systems to identify care gaps, and prioritizing evaluation to build the evidence-base necessary to guide future health policy and planning locally and on a global scale.
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Affiliation(s)
- Stewart B Harris
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Jordan W Tompkins
- Centre for Studies in Family Medicine, Western Centre for Public Health and Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Braden TeHiwi
- School of Kinesiology, Lakehead University, Thunder Bay, Ontario, Canada.
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Nguyen HD, Chitturi S, Maple-Brown LJ. Management of diabetes in Indigenous communities: lessons from the Australian Aboriginal population. Intern Med J 2016; 46:1252-1259. [DOI: 10.1111/imj.13123] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/08/2016] [Accepted: 04/17/2016] [Indexed: 11/30/2022]
Affiliation(s)
- H. D. Nguyen
- Department of Endocrinology, Division of Medicine; Royal Darwin Hospital; Tiwi Northern Territory Australia
| | - S. Chitturi
- Department of Endocrinology, Division of Medicine; Royal Darwin Hospital; Tiwi Northern Territory Australia
| | - L. J. Maple-Brown
- Department of Endocrinology, Division of Medicine; Royal Darwin Hospital; Tiwi Northern Territory Australia
- Menzies School of Health Research; Charles Darwin University; Casuarina Northern Territory Australia
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Crinall B, Boyle J, Gibson-Helm M, Esler D, Larkins S, Bailie R. Cardiovascular disease risk in young Indigenous Australians: a snapshot of current preventive health care. Aust N Z J Public Health 2016; 41:460-466. [PMID: 27372907 DOI: 10.1111/1753-6405.12547] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/01/2015] [Accepted: 03/01/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine preventive health attendance and recording of type 2 diabetes and cardiovascular disease risk factors and their management in young Aboriginal peoples and Torres Strait Islanders (Indigenous Australians) at primary health care centres (PHCs). METHODS This descriptive cross-sectional study audited medical records of 1,986 Indigenous people aged 15-34 years attending 93 Australian PHCs. Measurements included blood pressure (BP), blood glucose level (BGL), smoking status, body mass index (BMI) and lipid profile. RESULTS Last attendance was most commonly for acute care (46%); 12% attended for preventive assessment. BP was recorded in 85% (1,686/1,986), BGL 63% (1,244/1,986), smoking status 52% (1,033/1,986), BMI 37% (743/1,986) and lipids 31% (625/1,986). Of those with a recorded assessment, elevated BGL (39%, 479/1,244), smoking (63%, 649/1,033), overweight/obesity (51%, 381/743) and dyslipidaemia (73%, 458/625) were common. Follow-up of abnormal results was documented for elevated BP 28% (34/120), elevated BGL 17% (79/479), smoking 65% (421/649), overweight/obesity 11% (40/381) and abnormal lipids 16% (75/458). CONCLUSIONS These findings highlight the importance of raising awareness and assessment of chronic disease risk factors in young Indigenous people and implementing preventive health care strategies. IMPLICATIONS Strengthening the capacity of PHCs to provide preventive health care may contribute to reducing the chronic disease burden experienced by young Indigenous people.
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Affiliation(s)
- Bethany Crinall
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria.,Monash Health, Diabetes and Vascular Medicine, Victoria.,School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Queensland
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria.,Menzies School of Health Research, Charles Darwin University, Queensland
| | - Melanie Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria
| | - Danielle Esler
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Queensland
| | - Sarah Larkins
- Anton Breinl Research Centre for Health Systems Strengthening, College of Medicine and Dentistry, James Cook University, Queensland
| | - Ross Bailie
- Menzies School of Health Research, Charles Darwin University, Queensland
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Sorenson A, Owens L, Caltabiano M, Cadet-James Y, Hall R, Govan B, Clancy P. The Impact of Prior Flavivirus Infections on the Development of Type 2 Diabetes Among the Indigenous Australians. Am J Trop Med Hyg 2016; 95:265-8. [PMID: 27001762 DOI: 10.4269/ajtmh.15-0727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/22/2016] [Indexed: 12/21/2022] Open
Abstract
It is estimated that 5% of Australians over the age of 18 have diabetes, with the number of new cases increasing every year. Type 2 diabetes (T2D) also represents a significant disease burden in the Australian indigenous population, where prevalence is three times greater than that of non-indigenous Australians. Prevalence of T2D has been found to be higher in rural and remote indigenous Australian populations compared with urban indigenous Australian populations. Several studies have also found that body mass index and waist circumference are not appropriate for the prediction of T2D risk in indigenous Australians. Regional and remote areas of Australia are endemic for a variety of mosquito-borne flaviviruses. Studies that have investigated seroprevalence of flaviviruses in remote aboriginal communities have found high proportions of seroconversion. The family Flaviviridae comprises several genera of viruses with non-segmented single-stranded positive sense RNA genomes, and includes the flaviviruses and hepaciviruses. Hepatitis C virus (HCV) has been shown to be associated with insulin resistance and subsequent development of T2D. Flaviviruses and HCV possess conserved proteins and subgenomic RNA structures that may play similar roles in the development of insulin resistance. Although dietary and lifestyle factors are associated with increased risk of developing T2D, the impact of infectious diseases such as arboviruses has not been assessed. Flaviviruses circulating in indigenous Australian communities may play a significant role in inducing glucose intolerance and exacerbating T2D.
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Affiliation(s)
- Alanna Sorenson
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia.
| | - Leigh Owens
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia
| | - Marie Caltabiano
- College of Healthcare Sciences, James Cook University, Queensland, Australia
| | - Yvonne Cadet-James
- Anton Breinl Research Centre for Health Systems Strengthening, James Cook University, Queensland, Australia
| | - Roy Hall
- School of Chemistry and Molecular Biosciences, University of Queensland, Queensland, Australia
| | - Brenda Govan
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia
| | - Paula Clancy
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland, Australia
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40
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Gomersall JS, Canuto K, Aromataris E, Braunack-Mayer A, Brown A. Systematic review to inform prevention and management of chronic disease for Indigenous Australians: overview and priorities. Aust N Z J Public Health 2015; 40:22-9. [DOI: 10.1111/1753-6405.12476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 05/01/2015] [Accepted: 07/01/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- Judith Streak Gomersall
- Joanna Briggs Institute; University of Adelaide; South Australia
- SAHMRI Wardliparingga Aboriginal Research Unit; South Australia
- School of Public Health; University of Adelaide; South Australia
| | - Karla Canuto
- SAHMRI Wardliparingga Aboriginal Research Unit; South Australia
| | | | | | - Alex Brown
- SAHMRI Wardliparingga Aboriginal Research Unit; South Australia
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Commons RJ, Robinson CH, Gawler D, Davis JS, Price RN. High burden of diabetic foot infections in the top end of Australia: An emerging health crisis (DEFINE study). Diabetes Res Clin Pract 2015; 110:147-57. [PMID: 26453263 PMCID: PMC4684095 DOI: 10.1016/j.diabres.2015.09.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/07/2015] [Accepted: 09/12/2015] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The risk of diabetes mellitus is increasing worldwide, and is particularly high in Indigenous Australians. Complicated foot infection is one of the most common sequelae of diabetes. We describe the incidence and associations of Indigenous and non-Indigenous inpatients with diabetic foot infections at Royal Darwin Hospital. METHODS All adult Royal Darwin Hospital inpatients with diabetic foot infections were enrolled prospectively from September 2012 to November 2013. Incidence, demographics, microbiology, management and clinical outcomes were analysed by Indigenous status, and association with methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa. RESULTS There were 245 separate hospital admissions in 177 patients with an incidence of 79 admissions per 100,000 person years. Patients occupied a mean of 19.4 hospital beds each day. Compared to the non-Indigenous population, Indigenous patients had a greater incidence of admission (Rate Ratio (RR)=5.1, [95%CI=3.8, 7.0]), were younger (mean difference of 11.1 years; p<0.001), and more likely to undergo major and minor amputations (RR=4.1 [95%CI=1.6, 10.7], and 6.2 [95%CI=3.5, 11.1] respectively). Non-multiresistant methicillin resistant S. aureus was present in 44.7% of wounds from Indigenous patients versus 20.6% of non-Indigenous patients (Odds Ratio (OR)=3.1, [95%CI=1.5, 6.4]), whereas P. aeruginosa presence was significantly lower (15.8% versus 46.0%; OR=0.22; [95%CI=0.11, 0.45]). Methicillin resistant S. aureus or P. aeruginosa infections were associated with longer antibiotic courses and durations of stay. CONCLUSIONS This study highlights a rising burden of diabetic foot infections in the Top End of Australia, with a four-fold increase in bed days since 2002 and an overrepresentation in the Indigenous population.
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Affiliation(s)
- Robert J Commons
- Department of Infectious Diseases, Royal Darwin Hospital, PO Box 41326, Casuarina, Northern Territory, Australia.
| | - Claire H Robinson
- High Risk Foot Service, Royal Darwin Hospital, PO Box 41326, Casuarina, Northern Territory, Australia
| | - David Gawler
- Division of Surgery, Royal Darwin Hospital, PO Box 41326, Casuarina, Northern Territory, Australia
| | - Joshua S Davis
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia
| | - Ric N Price
- Department of Infectious Diseases, Royal Darwin Hospital, PO Box 41326, Casuarina, Northern Territory, Australia; Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, OX3 7LJ, UK
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Physical Functional Limitations among Aboriginal and Non-Aboriginal Older Adults: Associations with Socio-Demographic Factors and Health. PLoS One 2015; 10:e0139364. [PMID: 26422239 PMCID: PMC4589378 DOI: 10.1371/journal.pone.0139364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 09/11/2015] [Indexed: 11/19/2022] Open
Abstract
Background Australian Aboriginal people are disproportionately affected by physical disability; the reasons for this are unclear. This study aimed to quantify associations between severe physical functional limitations and socio-demographic and health-related factors among older Aboriginal and non-Aboriginal adults. Methods Questionnaire data from 1,563 Aboriginal and 226,802 non-Aboriginal participants aged ≥45 years from the Sax Institute’s 45 and Up Study (New South Wales, Australia) were used to calculate age- and sex-adjusted prevalence ratios (aPRs) for severe limitation [MOS-PF score <60] according to socio-demographic and health-related factors. Results Overall, 26% (410/1563) of Aboriginal participants and 13% (29,569/226,802) of non-Aboriginal participants had severe limitations (aPR 2.8, 95%CI 2.5–3.0). In both Aboriginal and non-Aboriginal participants, severe limitation was significantly associated with: being ≥70 vs <70 years old (aPRs 1.8, 1.3–2.4 and 5.3, 5.0–5.5, within Aboriginal and non-Aboriginal participants, respectively), none vs tertiary educational qualifications (aPRs 2.4, 1.7–3.3 and 3.1, 3.0–3.2), lower vs higher income (aPRs 6.6, 4.2–10.5 and 5.5, 5.2–5.8), current vs never-smoking (aPRs 2.0, 1.6–2.5 and 2.2, 2.1–2.3), obese vs normal weight (aPRs 1.7, 1.3–2.2 and 2.7, 2.7–2.8) and sitting for ≥7 vs <7 hours/day (aPRs 1.6, 1.2–2.0 and 1.6, 1.6–1.7). Severe limitations increased with increasing ill-health, with aPRs rising to 5–6 for ≥5 versus no chronic conditions. It was significantly higher in those with few vs many social contacts (aPRs 1.7, 1.4–2.0 and 1.4, 1.4–1.4) and with very high vs low psychological distress (aPRs 4.4, 3.6–5.4 and 5.7, 5.5–5.9). Conclusions Although the prevalence of severe physical limitation among Aboriginal people in this study is around three-fold that of non-Aboriginal people, the factors related to it are similar, indicating that Aboriginal people have higher levels of risk factors for and consequences of severe limitations. Effective management of chronic disease and reducing the prevalence of obesity and smoking are important areas for attention.
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Bu S, Ruan D, Yang Z, Xing X, Zhao W, Wang N, Xie L, Yang W. Sex-Specific Prevalence of Diabetes and Cardiovascular Risk Factors in the Middle-Aged Population of China: A Subgroup Analysis of the 2007-2008 China National Diabetes and Metabolic Disorders Study. PLoS One 2015; 10:e0139039. [PMID: 26406982 PMCID: PMC4583471 DOI: 10.1371/journal.pone.0139039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 09/07/2015] [Indexed: 01/19/2023] Open
Abstract
The sex difference in the prevalence rates of diabetes and cardiovascular diseases (CVDs) among the middle-aged population in China remain largely unknown. Therefore, we analyzed differences in the prevalence of diabetes, self-reported CVDs, and some CVD risk factors among men and women in the middle-aged population (30-49 years) and in individuals aged 50 years and older using data from the China National Diabetes and Metabolic Disorders Study of 2007-2008. Middle-aged men appeared to have significantly a higher prevalence of diabetes and self-reported CVDs than middle-aged women (8.07% vs 5.06% for diabetes, P < 0.001; 0.64% vs 0.22% for CVDs, P < 0.001). Men also showed higher rates of central obesity, hypertension, and dyslipidemia than women (all P < 0.01). Compared with women, men were more likely to drink alcohol and smoke cigarettes but less likely to be under diet control. The sex-specific differences in prediabetes, CVD, and CVD risk factors between men and women were diminished or even reversed in the population aged 50 years and older. No sex-specific differences were found in the prevalences of a family history of diabetes, coronary heart disease, and hypertension (P > 0.05) in middle-aged population. Specific strategies to reduce modifiable risk factors for the prevention and control of diabetes and CVD may be warranted in this population.
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Affiliation(s)
- Shi Bu
- Department of Endocrinology, China–Japan Friendship Hospital, Beijing 100029, PR China
| | - Danjie Ruan
- Department of Endocrinology, the 1 Hospital of Huairou District, Beijing 101400, PR China
| | - Zhaojun Yang
- Department of Endocrinology, China–Japan Friendship Hospital, Beijing 100029, PR China
| | - Xiaoyan Xing
- Department of Endocrinology, China–Japan Friendship Hospital, Beijing 100029, PR China
| | - Wenhui Zhao
- Department of Endocrinology, China–Japan Friendship Hospital, Beijing 100029, PR China
| | - Na Wang
- Department of Endocrinology, China–Japan Friendship Hospital, Beijing 100029, PR China
| | - Lingding Xie
- Department of Endocrinology, China–Japan Friendship Hospital, Beijing 100029, PR China
| | - Wenying Yang
- Department of Endocrinology, China–Japan Friendship Hospital, Beijing 100029, PR China
- * E-mail:
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Nicholson AK, Borland R, Couzos S, Stevens M, Thomas DP. Smoking-related knowledge and health risk beliefs in a national sample of Aboriginal and Torres Strait Islander people. Med J Aust 2015; 202:S45-50. [PMID: 26017256 DOI: 10.5694/mja14.00877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 02/12/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe general knowledge and perceived risk of the health consequences of smoking among Aboriginal and Torres Strait Islander people; and to assess whether knowledge varies among smokers and whether higher knowledge and perceived risk are associated with quitting. DESIGN, SETTING AND PARTICIPANTS The Talking About The Smokes project used quota sampling to recruit participants from communities served by 34 Aboriginal community-controlled health services and one community in the Torres Strait. Baseline survey data were collected from 2522 Aboriginal and Torres Strait Islander adults from April 2012 to October 2013. MAIN OUTCOME MEASURES Knowledge of direct effects of smoking and harms of second-hand smoke (SHS), risk minimisation, health worry, and wanting and attempting to quit. RESULTS Most Aboriginal and Torres Strait Islander participants who were daily smokers demonstrated knowledge that smoking causes lung cancer (94%), heart disease (89%) and low birthweight (82%), but fewer were aware that it makes diabetes worse (68%). Similarly, almost all daily smokers knew of the harms of SHS: that it is dangerous to non-smokers (90%) and children (95%) and that it causes asthma in children (91%). Levels of knowledge among daily smokers were lower than among non-daily smokers, ex-smokers and never-smokers. Among smokers, greater knowledge of SHS harms was associated with health worry, wanting to quit and having attempted to quit in the past year, but knowledge of direct harms of smoking was not. CONCLUSION Lack of basic knowledge about the health consequences of smoking is not an important barrier to trying to quit for Aboriginal and Torres Strait Islander smokers. Framing new messages about the negative health effects of smoking in ways that encompass the health of others is likely to contribute to goal setting and prioritising quitting among Aboriginal and Torres Strait Islander people.
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Affiliation(s)
| | - Ron Borland
- Cancer Council Victoria, Melbourne, VIC, Australia
| | | | | | - David P Thomas
- Menzies School of Health Research, Darwin, NT, Australia
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Petrak F, Baumeister H, Skinner TC, Brown A, Holt RIG. Depression and diabetes: treatment and health-care delivery. Lancet Diabetes Endocrinol 2015; 3:472-485. [PMID: 25995125 DOI: 10.1016/s2213-8587(15)00045-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 03/05/2015] [Indexed: 12/12/2022]
Abstract
Despite research efforts in the past 20 years, scientific evidence about screening and treatment for depression in diabetes remains incomplete and is mostly focused on North American and European health-care systems. Validated instruments to detect depression in diabetes, although widely available, only become effective and thus recommended if subsequent treatment pathways are accessible, which is often not the case. Because of the well known adverse effects of the interaction between depression and diabetes, treatment goals should focus on the remission or improvement of depression as well as improvement in glycaemic control as a marker for subsequent diabetes outcome. Scientific evidence evaluating treatment for depression in type 1 and type 2 diabetes shows that depression can be treated with moderate success by various psychological and pharmacological interventions, which are often implemented through collaborative care and stepped-care approaches. The evidence for improved glycaemic control in the treatment of depression by use of selective serotonin reuptake inhibitors or psychological approaches is conflicting; only some analyses show small to moderate improvements in glycaemic control. More research is needed to evaluate treatment of different depression subtypes in people with diabetes, the cost-effectiveness of treatments, the use of health-care resources, the need to account for cultural differences and different health-care systems, and new treatment and prevention approaches.
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Affiliation(s)
- Frank Petrak
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum and Centre for Psychotherapy Wiesbaden, Wiesbaden Germany.
| | - Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology and Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Timothy C Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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Johnson DR, McDermott RA, Clifton PM, D'Onise K, Taylor SM, Preece CL, Schmidt BA. Characteristics of Indigenous adults with poorly controlled diabetes in north Queensland: implications for services. BMC Public Health 2015; 15:325. [PMID: 25884441 PMCID: PMC4405873 DOI: 10.1186/s12889-015-1660-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 03/19/2015] [Indexed: 01/15/2023] Open
Abstract
Background Indigenous 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. Methods Indigenous 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. Results One 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. Conclusion These 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.
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Affiliation(s)
- David Ross Johnson
- Aboriginal Health Council of South Australia, 9 King William Road, Adelaide, SA, 5061, Australia.
| | - Robyn Anne McDermott
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia.
| | - Peter Marshall Clifton
- School of Pharmacy and Medical Sciences, University of South Australia, Baker IDI Heart and Diabetes Institute, Adelaide, Australia.
| | - Katina D'Onise
- School of Population Health, University of South Australia, Adelaide, Australia. Katina.D'
| | - Sean Matthew Taylor
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia.
| | - Cilla Louise Preece
- School of Population Health, University of South Australia, Adelaide, Australia.
| | - Barbara Anne Schmidt
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia. .,School of Population Health, University of South Australia, Adelaide, Australia.
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Davis TME, Hunt K, Bruce DG, Starkstein S, Skinner T, McAullay D, Davis WA. Prevalence of depression and its associations with cardio-metabolic control in Aboriginal and Anglo-Celt patients with type 2 diabetes: the Fremantle Diabetes Study Phase II. Diabetes Res Clin Pract 2015; 107:384-91. [PMID: 25656760 DOI: 10.1016/j.diabres.2014.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 10/14/2014] [Accepted: 12/26/2014] [Indexed: 01/23/2023]
Abstract
AIMS To determine the prevalence and associates of depression in Aboriginal and Anglo-Celt (AC) Australians with type 2 diabetes. METHODS Community-based patients were screened using the Patient Health Questionnaire (PHQ-9) as part of detailed assessment. The prevalence of any current depression, major depression and antidepressant use by racial group was compared after adjustment for age, sex, educational attainment and marital status. Multiple logistic regression was used to determine associates of current depression. RESULTS The 107 Aboriginal participants were younger (mean±SD 54.3±11.8 vs. 67.2±10.6 years), less often male (34.6% vs. 50.9%) and married (39.3% vs. 61.7%), and more likely to smoke (44.6% vs. 8.1%) than the 793 AC subjects (P≤0.002). Fifty-two Aboriginal (48.5%) and 772 AC participants (97.4%) completed the PHQ-9; these Aboriginals had similar socio-demographic, anthropometric and diabetes-related characteristics to those without PHQ-9 data. A quarter of the Aboriginals had current depression vs 10.6% of ACs (P=0.16), 15.4% vs. 4.1% had major depression (P=0.029), and 68.8% vs. 29.7% had untreated depression (P=0.032). Compared with non-depressed participants, patients with current depression were younger and more likely to smoke, to be overweight/obese and to have worse glycaemic control (P≤0.024). Significant independent associates of current depression were educational attainment (inversely), smoking status, body mass index and fasting plasma glucose in the AC group and alcohol use in the Aboriginal group. CONCLUSIONS Although prevalence of depression was not significantly increased in the Aboriginal patients, it was more likely to be major and untreated. Depression complicating type 2 diabetes is associated with adverse cardiovascular risk.
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Affiliation(s)
- Timothy M E Davis
- University of Western Australia, School of Medicine & Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia.
| | - Kerry Hunt
- University of Western Australia, School of Medicine & Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - David G Bruce
- University of Western Australia, School of Medicine & Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Sergio Starkstein
- University of Western Australia, School of Psychiatry and Clinical Neurosciences, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Timothy Skinner
- Charles Darwin University, School of Psychological and Clinical Sciences, Casuarina, Northern Territory, Australia
| | - Daniel McAullay
- Edith Cowan University, Kurongkurl Katitjin Centre for Indigenous Australian Education and Research, Mt Lawley, Western Australia, Australia; Australian National University, Australian Primary Health Care Research Institute, Canberra, Australian Capital Territory, Australia
| | - Wendy A Davis
- University of Western Australia, School of Medicine & Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia
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Chamberlain C, Joshy G, Li H, Oats J, Eades S, Banks E. The prevalence of gestational diabetes mellitus among Aboriginal and Torres Strait Islander women in Australia: a systematic review and meta-analysis. Diabetes Metab Res Rev 2015; 31:234-47. [PMID: 24912127 DOI: 10.1002/dmrr.2570] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/12/2014] [Accepted: 05/27/2014] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is an important and increasing health problem. This study aims to investigate and explain the marked variation in reported GDM prevalence among Australian Indigenous women. MATERIALS AND METHODS We searched five databases to August 2013 for studies of GDM prevalence; two people independently assessed search results, extracted data, and appraised risk of bias. Meta-analysis was conducted, and between-study heterogeneity examined using subgroup analyses. Within-study findings were synthesized narratively. RESULTS The pooled GDM prevalence from 23 of the 25 total studies (5.74%, 4.78-6.71) was similar to that reported in national studies, but heterogeneity was substantial (I(2) = 97%), making conclusions from between-study comparisons difficult. The greatest reductions in heterogeneity were seen within subgroups using localized diagnostic criteria (I(2) = 43%, 3 studies), universal screening (I(2) = 58%) and some jurisdictions, probably reflecting proxy measures of increased consistency in diagnostic and screening methods. Insufficient data were available to assess the effect of factors such as rurality, diagnostic criteria, study design and data sources on prevalence. Synthesis of within-study findings showed: higher age-adjusted prevalences of GDM in Indigenous versus non-Indigenous women; Indigenous women have greater increases in prevalence with maternal age; and non-Indigenous women appear to have a steeper increase in GDM prevalence over time. Prevalence increased almost fourfold in two studies following introduction of universal screening when compared with selective risk-based screening, although numbers were small. DISCUSSION/CONCLUSIONS The published GDM prevalence among Indigenous women varies markedly, probably due to variation in diagnostic and screening practices.
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Affiliation(s)
- Catherine Chamberlain
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia
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Davis TME, Davis WA, McAullay D. Re: Essential service standards for equitable national cardiovascular care for Aboriginal and Torres Strait Islander people. Heart Lung Circ 2015; 24:626. [PMID: 25666999 DOI: 10.1016/j.hlc.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Timothy M E Davis
- University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Australia
| | - Wendy A Davis
- University of Western Australia, School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Australia
| | - Daniel McAullay
- Edith Cowan University, Kurongkurl Katitjin Centre for Indigenous Australian Education and Research, Mt Lawley, Western Australia, Australia and Australian National University, Australian Primary Health Care Research Institute, Canberra, Australian Capital Territory, Australia
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