The Peculiarities Of Diabetes In Older Adults

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Diabetes occurs when one’s blood glucose is too high. Having too much glucose in the body can cause health problems and even death. Diabetes has reached epidemic portion in Indigenous population around the world, and it needs to be improved the health of indigenous people who have diabetes through prevention and management strategies (Harris, Tompkins, & Tehiwi, 2016). Aboriginal people represent the largest minority group with various histories, language, cultures, religions, and traditions. Indigenous People generally have the worst health than the rest of the population according to the 2007 United Nations Declaration on the Rights of Indigenous Peoples. Throughout the years, awareness worldwide has emphasized on the health and socioeconomic, political challenges and inequalities encountered by indigenous peoples. Indigenous population of the pacific islands has the highest rates of diabetes prevalence globally. The prevalence rate in some areas of Australia (Aboriginal and Torres Strait Islanders), is as high as 26-30%, which is six times higher than the general population (Harris, Tompkins, & Tehiwi, 2016). In Australia, type 2 diabetes mellitus (T2DM) has reached an epidemic proportion, and it constitutes a challenge for the health system everywhere (Burrow & Ride, 2016). This essay is going to discuss the social determinants of health and the programs and services available to prevent diabetes.

Understanding diabetes

The health status of rural and remote Australians is worse than other populations on almost every indicator of health status and overall in remote areas. The Australian Government has faced problems in terms of ensuring quality health and accessible health care delivery systems for the Indigenous population. There is a broad health space among the Indigenous and the non-Indigenous Australians, and it has played a vital role in obstructing health prosperity. Indigenous Australians could have access to quality health care if they had better education, incomes and were owners of homes. It would reduce the health gap among the Indigenous and non-Indigenous Australians. Improvements have made in the national Indigenous health approach, such as the Indigenous Allied Health Australia (IAHA). However, Indigenous Australians continue to experience more indigent health services than non-Indigenous Australians.

Many risk factors have influenced the increase in diabetes prevalence around the world. The risk factors consist of biological, environmental, and lifestyle changes that have progressed throughout the last century, structural risk factors and individual risk factors (Harris, Tompkins, & Tehiwi, 2016). Mainly, obesity and age (above 35 years) are the two serious risk factors influencing the prevalence of T2DM in the Aboriginal population. (Brzozowska et al., 2019). Indigenous Australians body status differ from non-Indigenous Australians with abdominal fat deposition, exacerbating their insulin resistance, and leading to a higher risk of diabetes mellitus (DM). Food availability changes and diet composition may have notably influenced the metabolic health of Indigenous Australians. Before the Europeans had arrived, Aboriginal people lived as hunters with a high dependency on animal-based food combined with a low quantity of carbohydrates. The profound changes in the physical activity and nutrition played a vital role in the occurrence of diabetes in the Aboriginal and Torres Strait Islander people during the second half of the 20th century (Burrow & Ride, 2016). Data collected in the 2012-2013 Australian Aboriginal and Torres Strait Islander health survey (AATSIHS), and the risk factors for diabetes include obesity, high blood pressure, high cholesterol, smoking and inadequate intake of fruits and vegetables.

Social Determinants of health

Socioeconomic status such as income, education level, career choices reduces with remoteness causing poorer health outcomes for people living in rural areas and remote Australia. The more leading cause of poorer health in the rural and remote Australia is the lower socioeconomic status of people residing in these areas. Employment, career, and education opportunities are hardly available because of the nature of towns and the communities in those areas. The percentage of workforce who are managers or professionals is around 40% in major cities, 30% in rural or regional areas and 40% in remote areas. While the percentage who are machinery operators, drivers or laborers is 14% in major cities, 20% in rural or regional areas, and 23% in remote areas (Social determinants of health). The inter-regional contrast reflects the nature of available jobs in these areas, affecting the educational status of people living and working there. The employment opportunities available in rural and remote Australia are commonly in companies that are less remunerated than the possibilities in major cities. Moreover, the occupational differences for unemployed people, the unemployment rates fluctuate with remoteness from 5% in major cities to 7% in rural, regional and remote areas, and 12% in very remote areas (Social determinants of health).

Colonization on Indigenous people also caused significant social determinant of health affecting Indigenous peoples. The World Health Organization has identified colonization as the most significant social determinant of health, affecting Indigenous population worldwide (Crowshoe et al., 2018). Racism and colonialism have leading roles in the rise of T2DM in the 20th century that countered Indigenous values, cultures, and lifestyle leading to massive inequities and disparities in the Indigenous peoples’ health, inclusive of economic poverty ; income, unemployment, lack of education, food insecurity, poor living conditions, social poverty; cultural identity and isolation. Lack of social support and racism led to adverse stereotyping and stigmatization.

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Preventing Diabetes

There is no known procedure to prevent type 1 diabetes; however, T2DM can be prevented, and the onset can be delayed. Primary preventions such as, utilizing risk assessment tools, providing educational programs, and encouraging lifestyle changes focusing on physical activity, dietary changes, and weight loss. In order to convey prevention programs to high-risk Indigenous Australians, they must first be identified through suitable risk assessment. Australian type 2 diabetes risk assessment tool (AUSDRISK) has been executed to promote the identification of high-risk Indigenous Australians. The tool utilizes necessary clinical information, such as family history, ethnic background, age, gender and anthropometric measurements to determine the danger of developing diabetes over a 5-year period (Burrow & Ride, 2016). However, there are some limitations of the assessment tool as it may not give an accurate representation of the level of risk in the population of Indigenous Australians. Early education and intervention programs are crucial to impede risk factors and diabetes in later life. Children who have a healthy mind and body mature to be resilient and self-regulating and are also bound to make healthy choices as adults. School curriculum can render knowledge for them to make smart decisions about their health. The Deadly Choices Program organized education measures for young Indigenous Australians in Brisbane. The students who participated in the program portrayed enhancement in their knowledge about the disease and the risk factors and increased in their breakfast frequency in contrast to the control group (Burrow & Ride, 2016). Lifestyle adjustments have decreased the prevalence of diabetes among overweight people presenting with diabetes to the extent that is comparable to the use of medications. The Healthy Weight Program was implemented in Queensland in 1997, and it provided health screenings and conducted workshops emphasizing on healthy weight, proper nutrition, and physical activity. The program achieved weight loss, increased intake of fruits and vegetables, and physical activity among the participants. A long-term plan that showed success is the Looma Healthy Lifestyle project which began in a remote WA community in 1993. The aim of the strategy was to decrease the prevalence of obesity, diabetes and coronary heart disease through strategies to increase physical activity and improve diet with promoting traditional cooking methods, store management policy changes, and nutrition education. The program found that the incidence of diabetes has not increased since 2005. A program funded by the Victorian Government called Road to Good Health, which is managed by Aboriginal health workers and other health professionals. The program assists participants in making life long, viable lifestyle changes such as selecting a healthier diet and being more active physically. The organization has established that Indigenous values and health promotion exercises are implemented in the course. The outcomes reveal that the strategy is culturally relevant and meaningful to users (Burrow & Ride, 2016).

Managing diabetes in primary health care

Managing diabetes in the primary health care setting portrays a vital role in the early detection of diabetes. The Royal Australian College of General Practitioners (RACGP) delivers clear guidelines of the management of T2DM; however, there are huge gaps between the care and the care patients actually receive. In order for the management of diabetes to improve, the skills of General Practitioners (GP) need to be upgraded to assist them in handling more complex patients, and access to local services that provide specialized treatment should be provided to Indigenous Australians. Strategies that include organized and holistic patient-centred care plans, care pathology, and care arrangements with appropriate supports and training for staff obtained positive outcomes, which is evidenced by Aboriginal Torres Strait Islander communities. The involvement of Indigenous people in structured management strategies for chronic illness assisted to improvements in their general health status and health consequences. Access to primary health care services and medications for Indigenous population is limited because of certain barriers which are reduced in availability of services in remote areas, lack of transportation and approach to facilities, inefficiency to afford medication and services, difficulty comprehending and the beliefs and behaviour about taking the medication. By enhancing access to primary health care services that implement diabetes care in remote areas would result in better health after effect and be more cost-effective.

Government programs and services

The Australian Government Department of Health programs contributes to the prevention and management of diabetes and other chronic illness among Aboriginal and Torres Strait Islander people at a national level (Burrow & Ride, 2016). The programs consist of the Medicare benefits schedule (MBS), Pharmaceutical Benefits Scheme (PBS), and National Diabetes Services Scheme (NDSS). MBS provides subsidies for a patient acre and includes Medicare item for planning and management of chronic conditions. Qualified patients can be referred by GP for up to five Medicare subsided allied health services that are directly connected to the treatment of their chronic condition, including diabetes. PBS provides subsidies for medicines used in the treatment of diabetes. The NDSS provides subsided diabetes products and services to people diagnosed with diabetes who are registered with the scheme. Other programs include healthy lifestyle promotion programs, including those that address smoking, care coordination, outreach, and support workforce based on Medicare Locals and Aboriginal community-controlled health. Organizations (ACCHOs).

Culturally appropriate primary health care

In order to meet the needs of indigenous Australians, primary health care service needs to provide both component and culturally suitable chronic disease care. It is crucial that the health care services provided should be culturally appropriate and identify the importance of community values such as related to culture, family and land, and opportunities. Indigenous health workers have shown to assisted patients feel comfortable, help break down communication and cultural barriers that come between patients and non-Indigenous health staff. Health workers assist the patient to follow-up with appointments, understand medications, and learn about nutrition. They have also assisted families to maintain the patient’s self-management. Home visits and out of clinic care were provided as well as preferred by the patients. However, there are barriers that hinder Indigenous health workers in diabetes care such as; inadequate training, lack of clear position divisions between health professionals, lack of steady relationships with non-Indigenous workers and increased demand for acute care. Non-Indigenous health workers need more training and monitoring and explanation and aid for the role of the health worker. National initiatives to improve diabetes care in Indigenous population such as the Healthy for Life program (HfL) focuses on early detection and management of chronic disease among Indigenous population. The program is assessible to Aboriginal community-controlled health services and other primary health care services that provide health care to Indigenous Australians. As a result of mostly positive findings from the HfL program, the Australian Government has committed funding to widen the program into an additional 32 Indigenous community-controlled health services (Burrow & Ride, 2016). In 2015, a new strategy was introduced called the Australian national diabetes strategy 2016-2020. It outlines a national response to diabetes that consists of a targeted goal to decrease the effect of diabetes among the Indigenous population. The strategy recognises the possible areas for action and measures of progress but notes that additional work is required to develop policy options to implement the strategy. The Government, health sector, relevant organizations, and Indigenous communities need to work together to develop an implementation plan.


The Indigenous population in Australia are disproportionately affected by diabetes compared to non-Indigenous Australians. This is due to a complex interaction between acquired and inherited risk factors. The elevated levels of diabetes in Indigenous Australians reflect a wide range of historical, social, and cultural determinants and the improvement of lifestyle and other health risk factors (Burrow & Ride, 2016). The prevention and management for diabetes are crucial for the current and future Indigenous population and requires strategies that are altered to community needs and are culturally appropriate. The importance of alleviating the impact of the diabetes epidemic is recognized by experts and Australian Government, but the high incidence of T2DM and the related burden of early deaths and serious complications experienced by Indigenous Population continues. A national approach is required in order to provide effective and culturally appropriate health care. The new Australian national diabetes strategy 2016-2020 may be a vital step towards the goal. Long term commitment to culturally suitable precaution and management interventions catering to the Indigenous population is required; otherwise, they will continue to suffer high levels of diabetes.

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