Preventing Diabetes in Australia’s Aboriginal Communities

Diabetes is one of the most serious contemporary health problems confronting Australia’s Aboriginal people. Professor Mark Shephard, Director of the Flinders University International Centre for Point-of-Care Testing, is fighting the disease with education, encouragement, and regular point-of-care haemoglobin A1c (HbA1c) testing in the Australian Outback.

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Before the European arrival Aboriginal people lived on a low-fat, zero-sugar diet through a hunter-gatherer lifestyle. Down Under it’s called “bush tucker”, but few if any Aboriginal people, even those in communities hundreds of kilometers from even the smallest town, now live this way. Today, most Indigenous people in rural and remote areas shop at small stores stocking frozen or canned Western-style foods, including highly-sugared bottled drinks such as Coca-Cola.

Since then great progress has been made in improving education of Aboriginal patients and in their monitoring and treatment. Much of it was the result of a chance meeting 20 years ago between Shephard and a government healthcare official. Shephard told the official of his ideas and was assured funding could be available. A program called Quality Assurance for Aboriginal and Torres Strait Islander Medical Services (QAAMS) was launched and the battle against Aboriginal diabetes took a new turn.

Today QAAMS has 200 Siemens DCA Vantage® Analyzers in service, some among urban Aboriginal people but the vast majority in medical centres in rural and remote areas. With Australian Federal government support and dedicated healthcare staff, QAAMS has made vital, regular, laboratory-standard point-of-care testing available to Indigenous people across the breadth of Australia. QAAMS methods have been hailed around the world and are being used, with the help of Shephard’s centre, in other countries.

“I think that is a remarkable achievement,” Shephard said. “We use exactly the same quality testing material as Australian laboratories and from the same manufacturer, so we can make direct comparisons on the analytical performance of point-of-care testing on the DCA Vantage with those of the laboratory. There is no statistical difference between them in regard to quality.”

While QAAMS itself is not involved in educating patients, the health centre staff working directly with patients on the ground provide encouragement and education during the six-minute waiting time for the POC test result about how to combat diabetes and the life-threatening diseases it can cause, such as heart disease and nerve damage leading to amputation of limbs. It is a vital task, but very complex and difficult, exacerbated by the remoteness of many Outback clinics. However, QAAMS does, in its annual workshops, inform clinical staff members and doctors by hosting speakers, including a range of health professionals working in diabetes-related areas, on the subject. Their most recent workshop attracted more than 90 clinical staff members from rural and remote medical centres.

Another important change in the past decade was moving from only using the HbA1c test for diabetes management to now diagnosing diabetes. “QAAMS is the only POCT network in Australia approved by the Australian Government and Medicare to use HbA1c¹ for diagnosis,” Shephard said. “That’s because of QAAMS’ consistently high standard of analytical quality. There is no difference between the QAAMS test and sending a blood sample to a laboratory.”[1]

But, despite all improvements, Aboriginal people were still fundamentally more vulnerable to diabetes than other Australians, he said. “The prevalence of diabetes is four times higher than in non-aboriginal people and exacerbated in some cases by a combination of obesity, access to poor diet, alcohol, lifestyle factors, poor and overcrowded housing, poor hygiene, and poor water quality. High blood pressure and cardiovascular disease are also problems. “The gap in life expectancy has improved a bit but it is still wide compared with other groups such as New Zealand’s Maoris or Canada’s Indigenous people.” Recent reports show Aboriginal males born in 2012 were estimated to live to 69 and females to 74, about 10 years less than non-indigenous people.

Access to suitable food in remote Aboriginal communities has also improved, Shephard said, “but it’s dependent on the store managers in those places. They have tended to stock high-sugar, high-fat foods because it’s easier than getting fresh vegetables, but there is a strong knowledge base now and a push by the communities for better and fresher foods. Even a one percent reduction in haemoglobin A1c can significantly reduce the risk of complications.”