Diabetes and related disorders in urban Indigenous people in the Darwin region

DRUID: Diabetes and related disorders in urban Indigenous people in the Darwin region

The DRUID Study was started to find out about diabetes and other chronic diseases in Aboriginal and Torres Strait Islander people living in and around Darwin. Most Indigenous Australians live in cities and towns, but most of what we know about the health of Indigenous people comes from remote communities. This study involved two phases. The first phase started in mid-2003 and finished in mid-2005, involving free health checks for eligible peopled aged 15 years and over. We also asked people about their health and their lives. Just over a thousand people took part in the study.

• More women than men participated, with more people aged 35 years plus taking part than younger people.
• People came from the Yili Rerung ATSIC region, including Darwin, Palmerston, Litchfield and Coomalie.
• To make it easier for people to take part, health checks were undertaken in a variety of places, such as homes, schools, offices, community health centres and other facilities.
• There was a mix of people from a wide range of backgrounds and lots of different families.
• The study included people who identified as Aboriginal, as Torres Strait Islander, and as both Aboriginal and Torres Strait Islander.

The study’s second phase has looked more closely at some markers of diet, called cartenoids, that were measured in the blood. As part of the second phase we also developed a new tool for measuring people’s experiences of racism and the responses they had to it when it happened.

Summary of outcomes

Diabetes and Cardiovascular risk factors

Diabetes was common among people who took part in the study. The incidence was higher as people got older.

• About 1 in 3 people (32%) aged 35 years and over had diabetes. Among people aged 55 years or more, over half (52%) had diabetes.
• Diabetes was more common among people with lower incomes, those living in rented housing and those not working.
• More than 2 out of 3 people aged 35 years or more (and about 1 in 3, or 30%, of those aged 15–34) said they had been tested for diabetes before being in the study. This means that many people are aware of the importance of getting checked. 
• Risk factors for heart disease – being overweight, high blood pressure, problems with cholesterol or triglycerides (fats in the blood), smoking, kidney damage, and diabetes or pre-diabetes – were common, even among young people.
• Among those aged 15–34 years old without diabetes, nearly half (45%) had at least two risk factors for heart disease, while less than 1 in 5 (18%) had no risk factors.

Perceived versus actual weight

• In general, most people in the study who were overweight or obese described themselves as being overweight. This means that lack of awareness is not likely to be a barrier to weight loss.
• We need to look at other barriers, not only at the individual level, but at the larger structural and environmental level.
• Males and people with diabetes were more likely to underestimate their weight than women and people without diabetes, so special efforts might be needed for these groups.

Experiences of racism

As part of the study we developed a new tool for measuring people’s experiences of racism and the responses they had to it when it happened. Experiences of racism were very commonly reported across a range of settings, such as at home, work or in public places, by the police or by staff of government agencies, or while shopping or playing sport.

Complications of diabetes

Some people who participated in the study already knew they had diabetes, while others found out they had diabetes as a result of having the health check. For everyone else with diabetes, we did some extra health checks to look for common problems that can go with diabetes, such as problems with the eyes, kidneys, heart and feet.

• About 2 out of 5 people with diabetes (39%) showed signs of kidney damage, 1 in 5 (21%) had eye problems related to diabetes, 1 in 10 (9%) had nerve damage and a similar number (12%) had circulation problems in their feet or legs.
• Of those people who already knew they had diabetes, the majority (74%) were being treated by their GP or local clinic.

Management of diabetes

• Less than 1 in 3 people with known diabetes (29%) had HbA1c in the target range of less than 7%. (HbA1c measures longer-term control of blood sugar).
• Just under half (45%) had their blood pressure under control (less than 130/80), and about 2 out of 3 people (65%) had their total blood cholesterol under control (less than 5.5).

The first phase of the study started in the middle of 2003 and finished in mid-2005. The second phase of the study was completed under the Lowitja Institute.

Related resources:

• Cunningham, J., O’Dea, K., Dunbar, T., Weeramanthri, T., Zimmet, P. & Shaw, J. 2006, ‘Study Protocol – Diabetes and related conditions in urban Indigenous people in the Darwin, Australia region: Aims, methods and participation in the DRUID Study’, BMC Public Health, vol. 6, p. 8. 
• Cunningham, J. 2006, ‘Diversity of Primary Health Care Providers for Urban Indigenous Australians (Research Letter)’, Australian and New Zealand Journal of Public Health, vol. 30, p. 580–1.
• Maple-Brown, L., Cunningham, J., Celermajer, D. S. & O’Dea, K. 2007, ‘Increased Carotid Intima-media Thickness in Remote and Urban Indigenous Australians: impact of diabetes and components of the metabolic syndrome’, Clinical Endocrinology, vol. 66, pp. 419–25.
• Cunningham, J. & Dunbar, T. 2007, ‘Consent for Long-term Blood Samples by Indigenous Australian Research Participants: The DRUID Study experience’, Epidemiologic Perspectives & Innovations, vol. 4, p. 7.
• Cunningham, J., O’Dea, K., Dunbar, T., Weeramanthri, T., Shaw, J. & Zimmet, P. 2008, ‘Socioeconomic Status and Diabetes among Urban Indigenous Australians Aged 15–64 in the DRUID Study’, Ethnicity & Health, vol. 13, pp. 23–37.
• Paradies, Y. C. & Cunningham, J. 2008, ‘Development and Validation of the Measure of Indigenous Racism Experiences (MIRE)’, Int J Equity Health, vol. 7, p. 9.
• Cunningham, J., O’Dea, K., Dunbar, T. & Maple-Brown, L. 2008, ‘Perceived Weight Versus Body Mass Index among Urban Aboriginal Australians: Do perceptions and measurements match?’, Aust NZ J Public Health, vol. 32, pp. 135–8.
• O’Dea, K., Cunningham, J., Maple-Brown, L., Weeramanthi, T., Shaw, J., Dunbar, T. & Zimmet P. 2008, ‘Diabetes and Cardiovascular Risk in Urban Indigenous Australians: Results from the DRUID Study’, Diab Res Clin Pract, vol. 80, pp. 483–9.
• Maple-Brown, L., Cunningham, J., Dunne, K., Whitbread, C., Howard, D., Weeramanthri, T., Tatipata, S., Dunbar, T., Harper, C. A., Taylor, H., Zimmet, P., O’Dea, K. & Shaw, J. 2008, ‘Complications of Diabetes in Urban Indigenous Australians: The DRUID Study’, Diab Res Clin Pract, vol. 80, pp. 455–62