Impacts and outcomes of diabetes care in a high risk remote Indigenous community over time: implications for practice

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doi:10.1071/PY11144

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Impacts and outcomes of diabetes care in a high risk remote Indigenous community over time: implications for practice

Malcolm P. Forbes ^A ^D, James Ling ^A, Sam Jones ^B and Robyn McDermott ^C

^A Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia.
^B Badu Island Health Centre, Thursday Island, Qld 4875, Australia.
^C Division of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide, SA 5000, Australia.
^D Corresponding author. Email: Malcolm.Forbes@my.jcu.edu.au

Australian Journal of Primary Health 19(2) 107-112 http://dx.doi.org/10.1071/PY11144
Submitted: 22 November 2011 Accepted: 14 February 2012 Published: 5 April 2012





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Abstract

The aim of this study was to determine diabetes care processes and intermediate clinical outcomes in a remote primary care service in 2009 compared with 2004. A retrospective review of diabetes care from January 2009 to January 2010 was conducted using a chronic disease register (Project Ferret). Completeness of ascertainment was verified by a manual audit of charts. The results from this audit were compared with a similar study conducted in this community in 2004. The main outcome measure was diabetic management: in terms of (a) regular monitoring of diabetic care processes, and (b) compliance with national optimal management guidelines and comparison with diabetic outcomes data from a 2004 audit and the National data from 2009. People with diabetes on the register increased from 60 in 2004 to 77 in 2009. They were younger and heavier with a shorter duration of diagnosed diabetes. Recording of diabetic care processes in 2009 decreased between 5 and 32% compared with 2004 data. Intermediate clinical measures (e.g. glycosylated haemoglobin, blood pressure, triglycerides, albumin creatinine ratio) indicate stable or poorer diabetic control across all measures except total cholesterol. When compared with non-Indigenous diabetics, diabetes is diagnosed earlier and rates of smoking, hypertension, dyslipidaemia and diabetic nephropathy are higher in this population. Insulin use appears to be lower in the study population than reported in the national sample. Improved diabetic care processes and outcomes reported from 1999 to 2003 have not been sustained, and intermediate clinical measures have become more adverse over a 5 year period in this high risk remote community. Chronic care systems, including quality improvement, require renewed investment.

References

ABS (2006a) Census of population and housing. Available at http://www.censusdata.abs.gov.au/ABSNavigation/prenav/ProductSelect?newproducttype=QuickStats&btnSelectProduct=View+QuickStats+%3E&collection=Census&period=2006&areacode=350100270&geography=&method=&productlabel=&producttype=&topic=&navmapdisplayed=true&javascript=true&breadcrumb=LP&topholder=0&leftholder=0&currentaction=201&action=401&textversion=false [Verified 9 June 2010]

ABS (2006b) Census of population and housing. Available at http://www.censusdata.abs.gov.au/ABSNavigation/prenav/ProductSelect?newproducttype=QuickStats&btnSelectProduct=View+QuickStats+%3E&collection=Census&period=2006&areacode=IREG15&geography=&method=&productlabel=&producttype=&topic=&navmapdisplayed=true&javascript=true&breadcrumb=LP&topholder=0&leftholder=0&currentaction=201&action=401&textversion=false [Verified 9 June 2010]

Australian Government Department of Health and Ageing (2009) Australian National Diabetes Information Audit and Benchmarking (ANDIAB) Study: National Association of Diabetes Centres. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/pq-diabetes-pubs-andiab09 [Verified 1 August 2011]

Bonfiglioli CM, Smith BJ, King LA, Chapman SF, Holding SJ (2007) Choice and voice: obesity debates in television news. The Medical Journal of Australia 187, 442–445.

Chronic Kidney Disease Prognosis Consortium 2010 Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 375 2073 2081

Coory M (2000) Is birthweight an appropriate health-outcome measure for Torres Strait Islander babies? Aust N Z J Public Health 24, 60–63.
| CAS |

Currie CJ, Peters JR, Tynan A, Evans M, Heine R, Bracco OL, Zagar T, Poole CD (2010) Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet 375, 481–489.
| CrossRef | CAS |

Daniel M, Rowley K, McDermott R, O’Dea K (2002) Diabetes and impaired glucose tolerance in Aboriginal Australians: prevalence and risk. Diabetes Research and Clinical Practice 57, 23–33.
| CrossRef | CAS |

de Boo HA, Harding JE (2006) The developmental origins of adult disease (Barker) hypothesis. Australian and New Zealand Journal of Obstetrics and Gynaecology 46, 4–14.
| CrossRef |

Harper TA, Mooney G (2010) Prevention before profits: a levy on food and alcohol advertising. The Medical Journal of Australia 192, 400–402.

Hoy WE, Nicol JL (2010) Birthweight and natural deaths in a remote Australian Aboriginal community. The Medical Journal of Australia 192, 14–19.

Leonard D, McDermott R, Odea K, Rowley KG, Pensio P, Sambo E, Twist A, Toolis R, Lowson S, Best JD (2002) Obesity, diabetes and associated cardiovascular risk factors among Torres Strait Islander people. Australian and New Zealand Journal of Public Health 26, 144–149.
| CrossRef |

Magliano DJ, Barr ELM, Zimmet PZ, Cameron AJ, Dunstan DW, Colagiuri S, Jolley D, Owen N, Phillips P, Tapp RJ, Welborn TA, Shaw JE (2008) Glucose indices, health behaviors, and incidence of diabetes in Australia: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 31, 267–272.
| CrossRef |

McDermott RA, Schmidt BA, Sinha A, Mills P (2001) Improving diabetes care in the primary healthcare setting: a randomised cluster trial in remote Indigenous communities. The Medical Journal of Australia 174, 497–502.
| CAS |

McDermott R, Tulip F, Schmidt B, Sinha A (2003) Sustaining better diabetes care in remote indigenous Australian communities. BMJ (Clinical Research Ed.) 327, 428–430.
| CrossRef |

McDermott RA, McCulloch BG, Campbell SK, Young DM (2007) Diabetes in the Torres Strait Islands of Australia: better clinical systems but significant increase in weight and other risk conditions among adults, 1999–2005. The Medical Journal of Australia 186, 505–508.

RACGP (2009a) ‘Diabetes management in general practice 2009/10: Guidelines for type 2 diabetes.’ 15th edn. Available at http://www.racgp.org.au/Content/NavigationMenu/ClinicalResources/RACGPGuidelines/Diabetesmanagement/200910diabetesmanagementingeneralpractice.pdf [Verified 1 August 2011]

RACGP (2009b) ‘Guidelines for preventive activities in general practice.’ 7th edn. Available at http://www.racgp.org.au/Content/NavigationMenu/ClinicalResources/RACGPGuidelines/TheRedBook/redbook_7th_edition_May_2009.pdf [Verified 1 August 2011]

Shankar A, Klein R, Klein B, Moss S (2007) Association between glycosylated hemoglobin level and cardiovascular and all-cause mortality in type 1 diabetes. American Journal of Epidemiology 166, 393–402.
| CrossRef |

The Torres Strait and Northern Peninsula Area District Health Council (1996) ‘Meriba zageth for diabetes: our work for diabetes.’ (Queensland Health: Cairns)

Turnbull FM, Abraira C, Anderson RJ, Byington RP, Chalmers JP, Duckworth WC, Evans GW, Gerstein HC, Holman RR, Moritz TE, Neal BC, Ninomiya T, Patel AA, Paul SK, Travert E, Woodward M (2009) Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 52, 2288–2298.
| CrossRef | CAS |

Wang Z, Hoy W (2005) Is the Framingham coronary heart disease absolute risk function applicable to Aboriginal people? The Medical Journal of Australia 182, 66–69.

Wong M, Haswell-Elkins M, Tamwoy E, McDermott R, d’Abbs P (2005) Perspectives on clinic attendance, medication and foot-care among people with diabetes in the Torres Strait Islands and Northern Peninsula Area. The Australian Journal of Rural Health 13, 172–177.
| CrossRef |

Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G (2000) Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. The New England Journal of Medicine 342, 145–153.
| CAS |

Zimmet PZ, James WP (2006) The unstoppable Australian obesity and diabetes juggernaut. What should politicians do? The Medical Journal of Australia 185, 187–188.

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