The management of diabetes in indigenous Australians from primary care

Thomas, Mark; Weekes, Andrew; Thomas, Merlin C

doi:10.1186/1471-2458-7-303

Cited by 21 publications

(17 citation statements)

References 20 publications

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“…Smoking rates, which have remained stable in NHANES (12), have also proved difficult to change in Australian Aboriginal patients provided with intensified diabetes management in both urban (5) and remote (40) settings. However, the reduction in smoking observed in our Anglo-Celt patients gives some cause for hope.…”

Section: Discussionmentioning

confidence: 99%

Continuing Disparities in Cardiovascular Risk Factors and Complications Between Aboriginal and Anglo-Celt Australians With Type 2 Diabetes

et al. 2012

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OBJECTIVE To determine whether disparities in the nature and management of type 2 diabetes persist between Aboriginal and the majority Anglo-Celt patients in an urban Australian community. RESEARCH DESIGN AND METHODS Baseline data from the observational Fremantle Diabetes Study collected from 1993 to 1996 (phase I) and from 2008 to 2011 (phase II) were analyzed. Patients characterized as Aboriginal or Anglo-Celt by self-report and supporting data underwent comprehensive assessment, including questionnaires, examination, and biochemical testing in a single laboratory. Generalized linear modeling with age/sex adjustment was used to examine differences in changes in variables in the two groups between phases I and II. RESULTS The indigenous participants were younger at entry and at diabetes diagnosis than the Anglo-Celt participants in both phases. They were also less likely to be educated beyond primary level and were more likely to be smokers. HbA 1c decreased in both groups over time (Aboriginal median 9.6% [interquartile range 7.8–10.7%] to 8.4% [6.6–10.6%] vs. Anglo-Celt median 7.1% [6.2–8.4%] to 6.7% [6.2–7.5%]), but the gap persisted ( P = 0.65 for difference between phases I and II by ethnic group). Aboriginal patients were more likely to have microvascular disease in both phases. The prevalence of peripheral arterial disease (ankle-brachial index ≤0.90 or lower-extremity amputation) increased in Aboriginal but decreased in Anglo-Celt participants (15.8–29.7 vs. 30.7–21.5%; P = 0.055). CONCLUSIONS Diabetes management has improved for Aboriginal and Anglo-Celt Australian patients, but disparities in cardiovascular risk factors and complications persist.

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Section: Discussionmentioning

confidence: 99%

Continuing Disparities in Cardiovascular Risk Factors and Complications Between Aboriginal and Anglo-Celt Australians With Type 2 Diabetes

et al. 2012

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“…This is the first study to examine the pharmacokinetics of metformin in Indigenous Australians. Given that T2DM and kidney disease are highly prevalent in the Indigenous population, the adherence to the guideline of a cut‐off down to 30 ml min −1 should allow more Indigenous patients to benefit from metformin therapy . In particular, the product information recommending that metformin should not be used when CL CR is below 60 ml min −1 appears to be overly cautious for both Indigenous and non‐Indigenous Australian patients with T2DM.…”

Section: Discussionmentioning

confidence: 99%

The pharmacokinetics of metformin and concentrations of haemoglobin A_1C and lactate in Indigenous and non‐Indigenous Australians with type 2 diabetes mellitus

Duong

Kumar

Furlong

et al. 2015

Brit J Clinical Pharma

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Aims To compare the pharmacokinetics of metformin between diabetic Indigenous (Aboriginal and Torres Strait Islander) and non‐Indigenous patients. Methods An observational, cross‐sectional study was conducted on type 2 diabetic Indigenous and non‐Indigenous patients treated with metformin. Blood samples were collected to determine metformin, lactate, creatinine and vitamin B12 concentrations and glycosylated haemoglobin levels. A population model was used to determine the pharmacokinetic parameters. Results The Indigenous patients (median age 55 years) were younger than the non‐Indigenous patients (65 years), with a difference of 10 years (95% confidence interval 6–14 years, P < 0.001). The median glycosylated haemoglobin was higher in the Indigenous patients (8.5%) than in the non‐Indigenous patients (7.2%), with a difference of 1.4% (0.8–2.2%, P < 0.001). Indigenous patients had a higher creatinine clearance (4.3 l h−1) than the non‐Indigenous patients (4.0 l h−1), with a median difference of 0.3 l h−1 (0.07–1.17 l h−1; P < 0.05). The ratio of the apparent clearance of metformin to the creatinine clearance in Indigenous patients (13.1, 10.2–15.2; median, interquartile range) was comparable to that in non‐Indigenous patients (12.6, 9.9–14.9). Median lactate concentrations were also similar [1.55 (1.20–1.88) vs. 1.60 (1.35–2.10) mmol l−1] for Indigenous and non‐Indigenous patients, respectively. The median vitamin B12 was 306 pmol l−1 (range 105–920 pmol l−1) for the Indigenous patients. Conclusions There were no significant differences in the pharmacokinetics of metformin or plasma concentrations of lactate between Indigenous and non‐Indigenous patients with type 2 diabetes mellitus. Further studies are required in Indigenous patients with creatinine clearance <30 ml min−1.

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“…Suggested reasons for these poorer outcomes include poor physician compliance with CPGs, family or cultural needs, affordability and access to culturally appropriate care, education, income, housing and health literacy [16,17]. Considering explicitly the mix of health and welfare workers best able to find solutions to these issues will be important to improving health outcomes in indigenous and ethnic minority groups with diabetes.…”

Section: Discussionmentioning

confidence: 99%

Patient attributes warranting consideration in clinical practice guidelines, health workforce planning and policy

Leach

Segal

2011

BMC Health Serv Res

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BackgroundIn order for clinical practice guidelines (CPGs) to meet their broad objective of enhancing the quality of care and supporting improved patient outcomes, they must address the needs of diverse patient populations. We set out to explore the patient attributes that are likely to demand a unique approach to the management of chronic disease, and which are crucial if evidence or services planning is to reflect clinic populations. These were incorporated into a new conceptual framework; using diabetes mellitus as an exemplar.MethodsThe patient attributes that informed the framework were identified from CPGs, the diabetes literature, an expert academic panel, and two cross-disciplinary panels; and agreed upon using a modified nominal group technique.ResultsFull consensus was reached on twenty-four attributes. These factors fell into one of three themes: (1) type/stage of disease, (2) morbid events, and (3) factors impacting on capacity to self-care. These three themes were incorporated in a convenient way in the workforce evidence-based (WEB) model.ConclusionsWhile biomedical factors are frequently recognised in published clinical practice guidelines, little attention is given to attributes influencing a person's capacity to self-care. Paying explicit attention to predictable threats to effective self-care in clinical practice guidelines, by drawing on the WEB model, may assist in refinements that would address observed disparities in health outcomes across socio-economic groups. The WEB model also provides a framework to inform clinical training, and health services and workforce planning and research; including the assessment of healthcare needs, and the allocation of healthcare resources.

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The management of diabetes in indigenous Australians from primary care

Abstract: Background: Indigenous Australians have high rates of diabetes and its complications. This study examines ethnic differences in the management of patients with type 2 diabetes in Australian primary care.

Cited by 21 publications

References 20 publications

Continuing Disparities in Cardiovascular Risk Factors and Complications Between Aboriginal and Anglo-Celt Australians With Type 2 Diabetes

Continuing Disparities in Cardiovascular Risk Factors and Complications Between Aboriginal and Anglo-Celt Australians With Type 2 Diabetes

The pharmacokinetics of metformin and concentrations of haemoglobin A_1C and lactate in Indigenous and non‐Indigenous Australians with type 2 diabetes mellitus

Patient attributes warranting consideration in clinical practice guidelines, health workforce planning and policy

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The management of diabetes in indigenous Australians from primary care

Abstract: Background: Indigenous Australians have high rates of diabetes and its complications. This study examines ethnic differences in the management of patients with type 2 diabetes in Australian primary care.

Cited by 21 publications

References 20 publications

Continuing Disparities in Cardiovascular Risk Factors and Complications Between Aboriginal and Anglo-Celt Australians With Type 2 Diabetes

Continuing Disparities in Cardiovascular Risk Factors and Complications Between Aboriginal and Anglo-Celt Australians With Type 2 Diabetes

The pharmacokinetics of metformin and concentrations of haemoglobin A1C and lactate in Indigenous and non‐Indigenous Australians with type 2 diabetes mellitus

Patient attributes warranting consideration in clinical practice guidelines, health workforce planning and policy

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The pharmacokinetics of metformin and concentrations of haemoglobin A_1C and lactate in Indigenous and non‐Indigenous Australians with type 2 diabetes mellitus