Abstract. It is estimated that 5% of Australians over the age of 18 have diabetes, with the number of new cases increasing every year. Type 2 diabetes (T2D) also represents a significant disease burden in the Australian indigenous population, where prevalence is three times greater than that of non-indigenous Australians. Prevalence of T2D has been found to be higher in rural and remote indigenous Australian populations compared with urban indigenous Australian populations. Several studies have also found that body mass index and waist circumference are not appropriate for the prediction of T2D risk in indigenous Australians. Regional and remote areas of Australia are endemic for a variety of mosquito-borne flaviviruses. Studies that have investigated seroprevalence of flaviviruses in remote aboriginal communities have found high proportions of seroconversion. The family Flaviviridae comprises several genera of viruses with nonsegmented single-stranded positive sense RNA genomes, and includes the flaviviruses and hepaciviruses. Hepatitis C virus (HCV) has been shown to be associated with insulin resistance and subsequent development of T2D. Flaviviruses and HCV possess conserved proteins and subgenomic RNA structures that may play similar roles in the development of insulin resistance. Although dietary and lifestyle factors are associated with increased risk of developing T2D, the impact of infectious diseases such as arboviruses has not been assessed. Flaviviruses circulating in indigenous Australian communities may play a significant role in inducing glucose intolerance and exacerbating T2D.
DIABETES MELLITUS TYPE 2 IN INDIGENOUS AUSTRALIANSChronic disease is the epidemic of the new millennium, surpassing infectious disease and injury as the dominant health concern currently facing humanity. It is estimated that, by 2020, 75% of deaths in Australia will be due to chronic diseases, such as diabetes.1 A systematic review of type 2 diabetes (T2D) studies surveying both rural and urban indigenous Australian populations found higher prevalence of T2D in the former compared with the latter.2 This result differs from prevalence surveys conducted with indigenous peoples in North America and the Pacific.2 The onset of T2D in nonindigenous Australians generally occurs in the mid-forties, with prevalence peaking in the age of 75 years and older cohort.2 For indigenous Australians, prevalence is highest in the 35-to 55-year old group. 2 The prevalence of T2D within the indigenous Australian community is three times higher than non-indigenous Australians.3 Development of T2D is predominantly associated with metabolic changes due to obesity, and the increase in T2D in indigenous Australians is primarily attributed to changes in nutrition. However, urbanliving indigenous Australians have similar access to a nontraditional diet and it would be expected they would have similar prevalence of T2D. In addition, several studies on the outcomes of educational and dietary intervention initiatives in remote communities have demonstra...