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Cited by 54Indigenous Health, Education, and RightsIndigenous Health and EducationObesity, Physical Activity, Diet

Emerging diabetes and metabolic conditions among Aboriginal and Torres Strait Islander young people

Titmuss, Angela, Davis, Elizabeth A, Brown, Alex, Maple‐Brown, Louise J·2019·Medical Journal of Australia
DOI 10.5694/mja2.13002
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Abstract

Intersectoral collaboration is needed to engage communities and design effective culturally and age-appropriate interventions The gap between the health of Aboriginal and Torres Strait Islander and non-Indigenous Australians is well documented, with many policies and programs currently working towards improving outcomes. Despite these efforts, life expectancy is 10–11 years less than that of non-Indigenous Australians,1 and 65% of deaths occur before 65 years of age, compared with 19% in the non-Indigenous population.1 Cardiovascular and metabolic diseases are responsible for most of the gap in life expectancy and are associated with higher hospitalisation and mortality rates.1 In 2013, hospitalisation rates for cardiovascular disease were 1.6–2.5 times higher in Indigenous people depending on age, and Indigenous adults are six times as likely to die from diabetes as non-Indigenous Australians.1 Indigenous adolescents with type 2 diabetes are over ten times more likely to be hospitalised than non-Indigenous adolescents.2 While we acknowledge that hospitalisations are a poor indicator of the true prevalence of diabetes-related complications within the community, they suggest that the burden of disease associated with a diagnosis of diabetes is greater in the Aboriginal and Torres Strait Islander population.1 Importantly, the age of onset of cardiometabolic conditions, such as diabetes, obesity and cardiovascular disease, is significantly younger in Indigenous than in non-Indigenous Australians, and the incidence of these conditions continues to increase in Indigenous youth.3 With limited national data currently available, however, the prevalence of type 2 diabetes among Indigenous young people is not known. Studies from different states consistently report higher rates, from a younger age, of youth onset type 2 diabetes in the Indigenous Australian population.3-5 While we have seen an increasing prevalence among all Australian youth over the past 20 years, Indigenous young people have experienced a much greater rise in new diagnosis rates. Western Australian data indicate a disturbing discrepancy, with a type 2 diabetes incidence of 12.6 per 100 000 person years in Indigenous youth aged 16 years or less, compared with an incidence of 0.6 in non-Indigenous youth — a striking 20-fold difference.3 A 2007 New South Wales study suggested that type 2 diabetes was 6.1 times as common among Indigenous young people aged 0–19 years than among non-Indigenous young people,4 and a 2013 Northern Territory study reported that Indigenous youth represented 88% of youth type 2 diabetes diagnoses.5 These statistics indicate the extent of the issue despite likely diagnostic underestimation, as many children with type 2 diabetes may be managed in primary care rather than by paediatric or diabetes services, or are not diagnosed until a later age.5 The increasing incidence in the young Indigenous Australian population parallels the global context, where type 2 diabetes in youth has been described as an avoidable "disease of poverty" concentrated in populations of socio-economically disadvantaged young people.6 Risk factors for diabetes and metabolic syndrome have been reported at a significantly earlier age and at much higher frequency among the Indigenous Australian population,7, 8 suggesting that the prevalence of diabetes will continue to rise exponentially in the future without intervention. In Indigenous Australian young people with type 2 diabetes, there are also higher rates of comorbidities, with 59% also having hypertension, 24% having dyslipidaemia and 61% having obesity.3 These comorbidities will have a significant impact on the future burden of disease, and may lead to renal, cardiac, neurological and ophthalmological complications. Canadian data demonstrated that 45% of patients with youth onset type 2 diabetes had reached end-stage renal failure, requiring renal replacement therapy, 20 years after diagnosis, compared with zero people with type 1 diabetes.9 Youth onset type 2 diabetes was associated with a 23 times higher risk of kidney failure and 39 times higher risk of need for dialysis, compared with young people without diabetes.9 This implies that many young people who are being diagnosed with diabetes now will be on dialysis by 30 years of age, with significant effects on Aboriginal and Torres Strait Islander families and communities. Global reports also suggest that the pathophysiology, phenotype, treatment response and prognosis of youth onset diabetes differ significantly from later onset diabetes.10 This contributes to greater concern regarding the future health of young people, as youth onset diabetes (defined as that diagnosed before the age of 25 years) appears to progress more rapidly, be more difficult to treat, have more comorbidities, and have a higher risk of complications. There is also a greater risk of mental health concerns, and the diagnosis of diabetes appears to worsen any pre-existing comorb

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Authors
Titmuss, A., Davis, E. A., Brown, A., & Maple‐Brown, L. J.
Affiliations
  • Menzies School of Health Research (AU)
  • Princess Margaret Hospital for Children (AU)
  • University of South Australia (AU)
  • Royal Darwin Hospital Darwin NT
Corresponding author
Titmuss, Angela
ORCID
Venue
Medical Journal of Australia
Publisher
Wiley
Published
2019-01-18
Volume
210
Issue
3
Pages
111
ISSN
  • 0025-729X (ISSN-L)
  • 1326-5377
DOI
10.5694/mja2.13002
OpenAlex
W2914324501
Cited by
54
References
17
Citations by year
2026: 1 · 2025: 9 · 2024: 8 · 2023: 5 · 2022: 8 · 2021: 11 · 2020: 10 · 2019: 2
FWCI
7.56
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Medical Journal of Australia (publishedVersion)
  • PubMed (publishedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Funders
National Health and Medical Research Council (1131932, 1137563, 1078477)
Topics
  • Social Sciences › Health › Indigenous Health, Education, and Rights
  • Health Sciences › Health Professions › General Health Professions › Indigenous Health and Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
diabetes mellitus, metabolic disorders, Aboriginal and Torres Strait Islander peoples, youth, Indigenous health
MeSH terms
Australian Aboriginal and Torres Strait Islander Peoples, Adolescent, Adult, Australia, Child, Diabetes Mellitus, Type 2, Humans, Hypertension, Obesity, Risk Factors, Native Hawaiian or Other Pacific Islander, Dyslipidemias, Young Adult

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