ia Marley
- Erica Spry
- Prof Lynette Henderson-Yates, DAHS
- Prof David Atkinson
- Jamilah Bin Omar
- Dr Kimberley Seear
- Ms Emma Carlin
- Dr Sarah Straw
Progression to diabetes among Aboriginal people in the Kimberley: Identifying opportunities to enhance intervention for prevention within primary health care
Regular screening for T2D is standard in the Kimberley and this process can also detect people at high risk for diabetes; that is, people with “pre-diabetes”. Large studies have demonstrated that interventions supporting healthy lifestyle behaviours for people with pre-diabetes can prevent or delay T2D. The recently-published position statement on screening and management of pre-diabetes in primary care in Australia recommended the HbA1c range 6.0–6.4% for pre-diabetes. Identified individuals should be provided with healthy lifestyle education, strategies and support within primary care, including consideration of psychosocial factors. This is particularly important in the Kimberley, where there are limited referral options and few structured prevention programs.
This study will improve understanding of the quality of screening for diabetes in the Kimberley region, and the factors influencing progression to T2D. This will enable the development and implementation of clinical guidelines for best practice for pre-diabetes in remote Aboriginal settings that emphasise both physical and psychosocial factors. The Kimberley Lead Clinicians Forum and Kimberley Aboriginal Community Controlled Health Services recognise and support the need to investigate progression to T2D regionally with a view to improved interventions for diabetes prevention and more timely diagnoses to minimise complications. Findings will also be highly relevant to other settings with a high T2D burden in Australia and internationally.
- Assoc Prof Julia Marley, RCSWA Broome / KAMS
- Prof David Atkinson, RCSWA Broome
- Dr Kim Seear, KAMS
- Erica Spry, KAMS / RCSWA Broome
- Dr Caitlyn White, KAMS
Young-onset diabetes refers to type 2 diabetes mellitus (T2DM) that is first diagnosed at a young age (less than 25 years old). The number of people being diagnosed with young onset diabetes is increasing around Australia, particularly in Aboriginal or Torres Strait Islander youth. This is concerning because young-onset diabetes has been shown to be a more aggressive version of diabetes than the later-onset type, and is associated with earlier progression to complications. These complications can include damage to the eyes (retinopathy), kidneys (nephropathy), nerves (neuropathy) and the heart and brain (cardiovascular disease). Importantly, there are things that can be done, which can prevent or slow down the onset of these complications.
We are concerned at some of the preventable early complications that we are seeing in young people with diabetes in the Region. We would like to be able to work out the best way to support young people with young-onset diabetes across the Kimberley.
What will this evaluation project involve?:
- Describing the current situation of young-onset diabetes in the Kimberley
- Identifying best practice screening guidelines for young-onset diabetes in our region
Progress so far:
We piloted a locally developed evidence-based screening algorithm in a remote Western Australian Kimberley town for 6-month. A retrospective audit of electronic health records for the pilot period and a 6-month period before the screening algorithm was introduced was conducted. Interviews were held with 30 PHC staff at participating services, an Aboriginal Community Controlled Health Service (ACCHS) and a hospital-based general practice service.
During the pilot, significantly more patients received an initial T2D screening test at the ACCHS (22% v. 36%, P = 0.011), but there was no change at the hospital (0.02% v. 0.02%). Staff feedback suggested measures to improve screening: simple guidelines, targeted screening, patient and staff education, point-of-care HbA1c tests and a whole-of-clinic approach to implementation. Implementing a screening algorithm for y