By Neale Cohen, Baker IDI Heart & Diabetes Institute
Diabetes rates in Australia are high but its prevalence in the Indigenous population is between three and four times higher than the rest of the population. And we are fast running out of time to stop this disease from creating a national disaster.
Complications of diabetes include heart, eye, foot and kidney disease – and the complication rates in the Indigenous population are amongst the highest in the world. Kidney failure is one of the most devastating and it's associated with very high mortality rates.
The risk of kidney failure among Indigenous people with diabetes is ten times higher than in non-Indigenous people with the disease. The higher rate of diabetes in the Indigenous population results from genetics, poverty and the lack of education and resources within this population, particularly in remote communities.
Kidney dialysis is the only way to treat the failure of the organ and it requires patients to attend a dialysis unit on a regular basis. Alice Springs has the unenviable reputation of hosting the largest kidney dialysis unit in the southern hemisphere. There are also a few small dialysis units in remote towns in the Northern Territory, but the number of patients needing dialysis is on the rise.
Dialysis often requires displacement from family, particularly for those living remotely. And many die while waiting for dialysis, or after finding the daily visits to a dialysis unit impossible to manage.
It's little wonder then that resourcing Indigenous health generally and that of people with diabetes in particular is emerging as one of Australia's most urgent health concerns. Despite our best efforts, diabetes is still on the rise and we are seeing many new cases and complications at a younger age.
Of great concern is the nature of diabetes in this population – it appears to be more aggressive and more resistant to conventional therapies. Complex treatment regimes are often needed but even they are rarely successful. Compliance with regular medications, such as once or twice daily insulin injections, and multiple tablets is very challenging, particularly in remote communities.
Seemingly simple issues such as regular meals, storage of insulin and tablets, and disposal of needles are not simple in outreach communities where priorities are more focused on acute health problems and day-to-day social issues. Home monitoring of blood glucose is critical for patients requiring insulin and other complex treatments – but this is not possible for most.
In my travels to remote settlements, I have seen children as young as 12 with type 2 diabetes (usually this is called mature onset diabetes occurring in older age groups). More worrying is the age of patients developing early kidney complications. I know of one young man aged 16 who already has signs of significant kidney disease and will no doubt head towards dialysis and death in the next ten to 15 years.
I have seen a young mother in her 30s progress from normal kidney function to kidney failure in five years. She now faces the prospect of life on dialysis. Many of my patients live with blood glucose levels in the 20 to 30 range (compared to a normal range of four to six), continuously without feeling too unwell. The long-term personal, social and economic consequences of this are, of course, devastating.
There's a tsunami of kidney failure and other complications heading our way with many people having signs of early kidney damage, eye damage and heart disease. All these are associated with very poor control of their diabetes.
We have now reached a crisis point for the devastating effects of diabetes on Indigenous health. And while treatment of chronic disease in remote communities is challenging and complex, we must not be deterred.
Tiny clinics in remote towns need staff devoted to the prevention and treatment of diabetes and its complications. And communities need assistance at every level with the day-to-day management of this very complex disease.
Education and health promotion are critical in the long term but their health benefits may take decades. Clearly, we don't have that sort of time. An emphatic response, firmly grounded in equity, compassion and human rights is needed to turn the tide of what will soon become a national disaster.
Neale Cohen does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.