Type 2 diabetes is the fastest growing chronic disease in Australia. Aboriginal and Torres Strait Islander people are at higher risk of type 2 diabetes than the general population. It’s estimated that the prevalence of type 2 diabetes in Indigenous people is 3 to 4 times that of non-Indigenous Australians.

And not only is type 2 diabetes more common, but it also begins at an earlier age in Indigenous people than in other Australian populations, which means that the risk of developing complications from diabetes also occurs at a younger age.

Type 2 diabetes occurs when the pancreas doesn’t make enough insulin and the body becomes resistant to insulin, resulting in abnormally high blood sugar levels.

Complications of diabetes include:

  • kidney disease;
  • eye disease;
  • a higher risk of heart attack or stroke;
  • erection problems; and
  • nerve damage, which may result in traumatic injury and infection, possibly leading to limb amputation.

Why are Indigenous Australians at greater risk of diabetes?

In Australia, the rising number of people affected by type 2 diabetes is most likely driven by increasing rates of obesity, decreased rates of physical activity, dietary changes and an ageing population.

There is no evidence to show that Aboriginal people had diabetes, or other conditions affected by lifestyle such as heart and blood vessel disease, obesity or high blood pressure, when they lived a traditional lifestyle. Research suggests that the metabolism of Indigenous Australians has been geared towards making them efficient hunter-gatherers, which was vital for a successful traditional lifestyle.

Now, with fewer Aboriginal people living a traditional lifestyle, and more being exposed to today’s Westernised lifestyle, with foods that are low in fibre and rich in fat and sugar, alcohol, cigarette smoking and a sedentary lifestyle, their once-efficient metabolism may now be acting against them.

The genetic make-up that enabled Indigenous people to survive when food was scarce may now be a big disadvantage, promoting weight increases, diabetes, and associated conditions such as high blood pressure and heart disease. Research has shown that Aboriginal people who live a Westernised lifestyle have high rates of obesity, impaired glucose tolerance, high blood pressure, high levels of triglycerides (fats) in the blood, and excessively high insulin levels in the blood.

So, the combination of a genetic predisposition and an unhealthy lifestyle contributes to the high rates of type 2 diabetes in Indigenous Australians.

What can be done for Indigenous people with diabetes?

Treatment of type 2 diabetes involves lifestyle modification (weight loss, dietary changes, increasing physical activity), monitoring blood glucose and, if necessary, medicines to help keep blood sugar under control (oral hypoglycaemic medicines) or, in some cases, insulin injections. Treatment also involves regular screening for complications of diabetes.

Of course, the successful prevention and management of diabetes in Aboriginal and Torres Strait Islander communities encompasses a wider picture, in which economic and social factors and political intervention all play a part.

However, given that a Westernised lifestyle is a big contributor to the development of type 2 diabetes, evidence has shown that adopting the beneficial aspects of the traditional lifestyle can help improve the health of people with diabetes, and could help prevent the development of diabetes in those at risk.

While it’s not practical for many people to adopt a traditional Aboriginal lifestyle, the principles remain true for all of us, whether we’re from an Indigenous or non-Indigenous background: adopt a low-fat, high-fibre eating plan, ensure you are physically active, and maintain a healthy weight to help improve metabolic control.

Last Reviewed: 27/11/2013

myDr



References

1. Diabetes Australia Victoria. Aboriginal and Torres Strait Islander Program. http://www.diabetesvic.org.au/health-professionals/aboriginal-and-torres-strait-islander (accessed Sep 2013).
2. Diabetes Australia. Diabetes in Australia (updated 15 Oct 2012). http://www.diabetesaustralia.com.au/Understanding-Diabetes/Diabetes-in-Australia/ (accessed Oct 2013).
3. Australian Indigenous Health InfoNet. Diabetes background information. http://www.healthinfonet.ecu.edu.au/chronic-conditions/diabetes/reviews/background-information (accessed Sep 2013).
4. Australian Indigenous Health InfoNet. Review of diabetes among Indigenous peoples. http://www.healthinfonet.ecu.edu.au/chronic-conditions/diabetes/reviews/our-review (accessed Sep 2013).
5. Australian Institute of Health and Welfare. Populations of interest. http://www.aihw.gov.au/diabetes/populations-of-interest/ (accessed Sep 2013).
6. Azzopardi P, Brown AD, Zimmet P, et al; Baker IDI Heart and Diabetes Institute. Type 2 diabetes in young Indigenous Australians in rural and remote areas: diagnosis, screening, management and prevention. Med J Aust. 2012;197(1):32-6.