The South Australian Aboriginal Diabetes Strategy 2017 – 2021

Odette Pearson, Frances Eltridge, Zoe Luz, Harold Stewart, Seth Westhead, Paul Zimmet, Alex Brown

Research output: Book/ReportCommissioned report


Diabetes mellitus is serious health condition that affects a growing number of people daily across the world. It is a significant health concern in Australia, where one person every five minutes is diagnosed with diabetes. This long-term condition, disproportionately affects Australia’s Indigenous people. In 2012, one in 20 Australian adults had diabetes and for every one, three Aboriginal and Torres Strait Islander adults had diabetes. Gestational diabetes disproportionately affects Aboriginal and Torres Strait Islander women and is increasing within the population. Indigenous children are eight times more likely to develop diabetes than non-Indigenous children, and are also more likely to have type 1 diabetes. It is a leading cause of death and disability in the Australian population and the annual cost impact of diabetes is $14.6 billion.1 Diabetes not only affects the individual, but their family and the community.
There are three types of diabetes; type 1 diabetes, type 2 diabetes and gestational diabetes. Each is increasing in prevalence. Type 2 diabetes accounts for over 85% of all diabetes. This strategy addresses type 2 diabetes and gestational diabetes.
This Strategy has been designed to specifically meet the needs of Aboriginal people in South Australia. It was developed by Aboriginal people and people in policy and service provision positions. The development was governed by a multi-disciplinary, multi-sector Diabetes Steering Committee that included Aboriginal community representatives. Wardliparingga Aboriginal Research Unit of the South Australian Health and Medical Research Institute coordinated the development and undertook the research that informed the Strategy.
The recommendations in this Strategy prioritise a state-wide response to diabetes and guide potential health care reforms for diabetes and related conditions. South Australia has a world class health system, however, it does need to improve its ability to serve the Aboriginal population. This Strategy recommends enhanced use of existing infrastructure, systems and initiatives, complete implementation of evidence based guidelines, and strengthening the enablers to achieving these. Whilst many of the recommendations are becoming established or are established and need improvement, there are recommendations that will require new investment including the mechanisms to implement this Strategy.
Successful implementation of this Strategy will require a responsible governance structure and people who are committed and demonstrate the will to make a positive difference in the lives of Aboriginal people in South Australia. It will only be achieved through a coordinated approach across the South Australian Department for Health and Aging, the Aboriginal community controlled health sector, the peak body of which is the Aboriginal Health Council of South Australia, Adelaide and Country SA Primary Health Networks, and non-government organisations, particularly Diabetes SA. Success will require building and maintaining relationships with the Aboriginal community in South Australia and partnering with them to implement this Strategy. The implementation will be diverse, reflective of the Aboriginal population.
The SA Aboriginal Diabetes Strategy has six high-level goals, 23 recommendations with suggested pathways to achieve them and nine enablers. The six goals are aligned with the National Diabetes Strategy and the pathways to achieve these goals have been informed by scientific and cultural evidence and knowledge, the SA Aboriginal community and service providers. The six goals are:
 Goal 1. Reduce the incidence of type 2 diabetes and gestational diabetes. It is essential that a diabetes strategy for Aboriginal people includes prevention. To achieve this goal, population-based diabetes prevention campaigns specifically developed with and for the Aboriginal population will need to be implemented. Prevention efforts must have a particular focus on reducing early life exposure to diabetes in utero as a major intervention for preventing the ‘vicious’ intergenerational cycle of this condition. Improving pre-conception health and care during and after pregnancy will contribute to achieving this. Prevention efforts must also focus on all age groups, increase the consumption of fruits and vegetables and water rather than sugary drinks, increase the health knowledge base of the Aboriginal population, and increase the use of primary health care health services for health maintenance. There is strong support for pre-diabetes programs among the Aboriginal community. Tailored initiatives for groups within the Aboriginal population that are at higher risk of developing type 2 diabetes and associated complications must be considered. It is imperative that the incidence of diabetes in pregnancy is reduced within this population group to reduce the pre-disposition to diabetes later in life.
 Goal 2. Detect type 2 diabetes early. Earlier detection of type 2 diabetes results in earlier management of the condition which can prevent or slow progress to diabetes-related complications. Increasing the number of Aboriginal people receiving annual health checks with necessary referrals and/or follow-ups will help achieve this goal. Having vailable Point of Care Testing for intermediate health outcomes including HbA1c will allow for immediate diagnosis and referrals for the appropriate management of type 2 diabetes. To successfully achieve this goal, the workforce and the Aboriginal community must have a shared understanding of signs and symptoms of diabetes, the importance of early detection and how it is performed. Innovative approaches to increasing access to primary care services will need to be implemented, there will need to be an increase in the use of, and optimising, existing care arrangements and incentives and services must be equipped to manage the findings.
 Goal 3. Improve diabetes care and reduce complications. Correct management of type 2 diabetes can significantly improve quality of life for individuals and their families, and increase life expectancy. It requires a multi-disciplinary approach, involving family and well-functioning social and welfare support structures. A state-wide diabetes model of care that is flexible to account for diversity across the population and geographical areas will facilitate the implementation of this goal. There is an urgent need to improve and strengthen the way diabetes and its associated complications is managed. Patients must be invited to become more involved in their care, and including families is key to successful management. The primary care system must continually improve and innovate and technology must support the workforce to achieve evidence-based diabetes care and continuity of care between primary care providers, and hospitals. Increasing access to culturally safe health and social services for Aboriginal people, and a strong multi-disciplinary workforce is a priority.
 Goal 4. Reduce the incidence and impact of diabetes in pregnancy. Everyone in SA must have an opportunity for the best start in life. Evidence shows that babies born to mothers with diabetes in pregnancy are at increased risk of developing type 2 diabetes later in life compared to those born to mothers without diabetes in pregnancy. Gestational diabetes also increases the likelihood of mothers developing type 2 diabetes. This goal focuses on both women who have diabetes and become pregnant and those who develop diabetes in pregnancy. A comprehensive, state-wide evidence-based approach to preventing and managing lifestyle risk factors and diabetes in both parents preconception and in pregnancy is necessary and should be a component of the state-wide model of diabetes care. Aboriginal women who are pregnant must be supported to self-monitor their blood glucose at home. Service providers and mothers must together identify and have a clear understanding of the care pathway during pregnancy. Continuing care post pregnancy for both the mother and the baby must be offered and the uptake of this increased. It will be important to build on the success of the Aboriginal Family Birthing Program.
 Goal 5. Reduce the incidence of and better manage type 2 diabetes among priority groups. Aboriginal children and adolescents, those with an intellectual and/or physical disability, those who have mental health conditions, prisoners, the homeless and frequent hospital users have been identified as priority groups within the Aboriginal community. To achieve this goal, it will be important to gain a better understanding of the diabetes prevention and management needs of these priority groups. This will help with tailoring programs that reduce incidence, increase early detection and improve on-going management among these groups. It will be necessary to work with multiple organisations, including for example, the education department, disability services, correctional services, and with Aboriginal organisations and Leaders. Different healthcare responses will need to be considered for people living in remote areas and the diversity of the Aboriginal population will require innovative and flexible approaches to reducing diabetes incidence in this population.
 Goal 6. Strengthen research, data usage and population health monitoring. South Australia is well positioned to become a world leader in research. In order to implement evidence-based practices and make informed health policy decisions, SA needs to progress diabetes research with the Aboriginal community for a better understanding of the drivers of the diabetes epidemic and why the outcomes of diabetes in the Aboriginal community in terms of premature ill-health and mortality are much worse than those in the non-Aboriginal community. Enhancing data capacity and usability, particularly within the primary health care sector and connectivity between primary care and the hospital will be essential to improving the continuum of care, using existing knowledge to inform practice, and to monitor and evaluate efforts at a state-wide population level.
Original languageEnglish
Place of PublicationAdelaide
Commissioning bodySA Health
Number of pages72
Publication statusPublished or Issued - 2016

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