Diabetes in Aboriginal Australians

Diabetes, in particular, non-insulin dependent diabetes, is prevalent in the Aboriginal and Torres Strait Islander populations of Australia.^[1] As many as 1 in 20^[2] Australians are said to suffer from diabetes, and of this amount, Aboriginals are three times as likely to succumb to this disease, in comparison to non-Aboriginals.^[3] In contrast with Type 1 diabetes, which is a predisposed autoimmune condition,^[4] Type 2 diabetes or insulin resistant diabetes, is a preventable disease, heavily influenced by a multitude of socioeconomic factors.^[5] Sufferers of the disease are consequently more susceptible to chronic health issues, including heart disease and renal failure.^[6] Conclusively, this has contributed to the 17 year life expectancy gap between Aboriginals and non-Aboriginals and inturn, has led to disparity and inequity of health between Aboriginals and non-Aboriginals.^[6]

History of Aboriginals and Diabetes

The history of Aboriginal Australians is said to have spanned some 60,000 years prior to colonization,^[7] yet they were first cited by Europeans in 1606.^[8] Further investigations of the land over the years leading to James Cook’s arrival in 1788, suggested that the Aboriginals were hunter gatherers, who were described as beasts who roamed the land.^[8] Fully utilising the resources at their disposal, the diet of the early Aboriginals was predominantly made up of land animals, fish and shellfish, as well as birds and plant foods.^[7] Post colonisation, the Aboriginals experienced excessive disruptions to their socioeconomic circumstances and thus, this has seen a rapid decline in their health status.^[9] Forced to assimilate into a white, European Society, Aboriginals abandoned their traditional way of living and reluctantly adopted those of the colony.^[9] Over time this has seen the introduction of sugar and refined foods into the diet of Aboriginal Australians, initially to severe existing connections to the land.^[9] Aboriginals have since viewed sugar as an important cultural food, bringing with it, family identities and reinforcing connections.^[9] Hence, Aboriginals have since become highly vulnerable to suffering from conditions such as Diabetes.

Types of Diabetes

Diabetes is defined as being a chronic medical condition that causes increased blood sugar levels.^[10]

Type 1 Diabetes is often referred to as ‘insulin dependent’ diabetes, or juvenile diabetes. Often diagnosed in childhood, Type 1 Diabetes is caused by the inability of the pancreas to produce enough insulin.^[11]

Type 2 Diabetes or ‘insulin resistant’ diabetes is a preventable condition,^[12] often diagnosed in people over 40 years of age,^[13] as well as Aboriginal and Torres Strait Islanders. This condition is often attributed to an increase in obesity and influenced by poor diet and lifestyle factors.^[12]

Gestational Diabetes refers to gluten intolerance diabetes diagnosed during pregnancy and is highly common among Aboriginal Australians.^[14] Gestational diabetes can cause severe complications throughout pregnancy and the birthing process and is identified as a precursor to Type 2 Diabetes in both mother and child.^[14]

Causes

European Influence

The prevalence of Type 2 Diabetes, obesity and the corresponding diseases that are associated with this condition, are often attributed to the European influences at the time of colonisation.^[15] Sugar and refined foods were used at this time as a means of detaching Aboriginals from the land and assimilating them into white society. Consequently, Aboriginal Australians have likened certain traditions and memories to the use of sugar. Thus, the ‘westernisation’ of Aboriginal communities forced the neglect of a nutrient-dense diet and thus, cemented the foundation for this prevailing condition.

Remoteness

Remoteness of Aboriginal communities and disparity in socioeconomic circumstances has also contributed to the prevalence of Diabetes in Aboriginal Australians. Consequently, refined foods have seemingly replaced healthy alternatives, as communities are denied access to fresh and healthy foods due to limited available resources.^[16] Similarly, many Aboriginals are said to live in poverty, with community’s dependant on welfare and most being plagued by unemployment. Thus, recognising their need to be frugal with their money, and in turn, only being able to afford energy dense, filling foods, which are often high in fats and sugar.^[17] Hence, there is a direct correlation between the disparity of wealth, obesity and subsequent morbidity. Consequently, this is a main contributor to Aboriginals and Torres Strait Islanders being 2-4 more times likely to suffer from this condition.^[18]

Health Inequalities

Health inequalities in society and lack of education can also contribute to the higher diagnosis of Diabetes among Aboriginal and Torres Strait Islanders.^[18]

Unutilised Resources

Similarly, Aboriginal people are recognised as not utilising the health resources at their disposal.^[16] As a result, Australian Aboriginals are said to be lacking in diabetes education and the subsequent monitoring of glucose levels,^[18] making them more susceptible to diabetes related problems and ill-informed in making decisions in regards to their health.

Low Birth Weights

Aboriginal infants are also said to have relatively lower birth weights than normal, which can also contribute to early incidences of Type 2 Diabetes.^[18]

Lifestyle

As well as being genetically predisposed to the condition, Type 2 Diabetes is also associated with obesity and other cardiovascular factors and lifestyle influences.^[19] Thus, those with high blood pressure, a poor diet, insufficient physical activity and are overweight/ obese, and in the case of Aboriginal Australians, are over the age of 35, are increasingly more susceptible to suffering from Type 2 Diabetes.^[20]

Symptoms

There are often no obvious symptoms associated with type 2 diabetes and thus, it can remain undiagnosed for many years.^[19]

However, symptoms that indicate diabetes, yet are often ignored, include:

• excessive thirst
• frequent uriniation
• feelings of tiredness and lethargy
• cuts that are slow to heal.^[20]

Complications

Type 2 diabetes is a detrimental condition commonly affecting Aboriginal Australians. It is closely associated with obesity and is often a precursor for subsequent preventable diseases, including cardiovascular and renal disease. Hence, Diabetes is a major cause of the premature mortality of many Aboriginal Australians.^[15]

Increased occurrence of renal complications among Aboriginals is attributed to environmental and genetic factors,^[21] as well as poor monitoring of glucose levels.^[22] Low birth weight causing lower renal volume, post infectious renal damage and obesity are also characteristically associated with chronic kidney disease and end stage renal failure.^[21] Consequently, Australian Aboriginals are 8 times more likely to suffer from incidences of kidney failure than non-Aboriginal Australians.^[23]

Similarly, cardiovascular disease is the single greatest contributor to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians.^[24] Obesity and increased waist circumference is an important risk factor,^[24] along with other modifiable influences including smoking, high blood pressure, high cholesterol levels, low levels of physical activity.^[24] All of which contribute to the incidence of Diabetes and consequently, Cardiovascular disease.

The prevalence of Type 2 Diabetes in Aboriginal Australians can also lead to retinotherapy, whereby blood vessels in the eye are damaged^[25] as a direct result of this condition. Peripheral neuropathy is also common in diabetes patients and in some cases can lead to chronic foot problems and even amputations.^[26]

Management

Diabetes management is reliant on reducing the effects of the contributing factors for the condition. Weight loss, dietary changes, increasing physical activity, cessation of smoking, controlling alcohol intake and monitoring of blood glucose levels are all essential. So to, the prompt treatment of infections and the control of blood pressure are also critical.^[26]

Prevention

Health issues affecting Aboriginal Australians, including the incidence of Type 2 diabetes, are often likened to disparities in socioeconomic status.^[26] Often, the greater the social and economic disadvantage, the greater the occurrence of diabetes and other associated conditions.^[26] Thus, improvements in the socioeconomic status and the decrease in disparity and health inequality are detrimental if the incidence of diabetes and the associated conditions are to be reduced.

Early detection programs and diabetes screenings are essential in reducing the frequency of diabetes and its long-term effects.^[26] Promotion of healthy eating and physical activity, smoking cessation and the safe consumption of alcohol^[27] are also vital to reduce and prevent type 2 diabetes. The Australian government has addressed the need for such intervention by implementing the National Prevention of Type 2 diabetes program. Arguably, such programs need to be supported by efforts to provide greater employment and educational opportunities for Aboriginal Australians and health programs tailored to their favoured holistic approach to health and wellbeing.^[27]

Statistics

One in 20 Australian adults had diabetes in 2011–2012.^[2]

Aboriginals and Torres Strait Islanders are 2–4 times more likely to suffer from diabetes than other non-indigenous groups.^[18]

Evidence of diabetes among Aboriginals is apparent as early as 25 years of age. Approximately 18% of Aboriginal and Torres Strait Islanders over the age of 25 reported having diabetes or high blood sugar levels. The rates range from 5% for those in the 25 years age bracket and increasing to 39% for those aged 55 years and over.^[28]

In 2012–2013, approximately 8% of Aboriginal and Torres Strait Islanders reported that they had diabetes or high blood sugar levels. Females were more likely than men to suffer from diabetes, with 10% claiming to suffer from the condition, in comparison to 7% of males.^[28]

References