Testing for type 2 diabetes in Indigenous Australians: guideline recommendations and current practice

Christine L Paul, Paul Ishiguchi, Catherine A D'Este, Jonathan E Shaw, Rob W Sanson-Fisher, Kristy Forshaw, Alessandra Bisquera, Jennifer Robinson, Claudia Koller and Sandra J Eades
Med J Aust 2017; 207 (5): 206-210. || doi: 10.5694/mja16.00769


Objectives: To determine the proportion of Aboriginal Controlled Community Health Service (ACCHS) patients tested according to three national diabetes testing guidelines; to investigate whether specific patient characteristics were associated with being tested.

Design, setting and participants: Cross-sectional study of 20 978 adult Indigenous Australians not diagnosed with diabetes attending 18 ACCHSs across Australia. De-identified electronic whole service data for July 2010 – June 2013 were analysed.

Main outcomes measures: Proportions of patients appropriately screened for diabetes according to three national guidelines for Indigenous Australians: National Health and Medical Research Council (at least once every 3 years for those aged 35 years or more); Royal Australian College of General Practitioners and Diabetes Australia (at least once every 3 years for those aged 18 years or more); National Aboriginal Community Controlled Health Organisation (annual testing of those aged 18 years or more at high risk of diabetes).

Results: 74% (95% CI, 74–75%) of Indigenous adults and 77% (95% CI, 76–78%) of 10 760 patients aged 35 or more had been tested for diabetes at least once in the past 3 years. The proportions of patients tested varied between services (range: all adults, 16–90%; people aged 35 years or more, 23–92%). 18% (95% CI, 18–19%) of patients aged 18 or more were tested for diabetes annually (range, 0.1–43%). Patients were less likely to be tested if they were under 50 years of age, were transient rather than current patients of the ACCHS, or attended the service less frequently.

Conclusions: Some services achieved high rates of 3-yearly testing of Indigenous Australians for diabetes, but recommended rates of annual testing were rarely attained. ACCHSs may need assistance to achieve desirable levels of testing.

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  • Christine L Paul1,2,3
  • Paul Ishiguchi4
  • Catherine A D'Este5
  • Jonathan E Shaw4
  • Rob W Sanson-Fisher1
  • Kristy Forshaw1,2
  • Alessandra Bisquera3
  • Jennifer Robinson1
  • Claudia Koller1,2,3
  • Sandra J Eades4

  • 1 University of Newcastle, Newcastle, NSW
  • 2 Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW
  • 3 Hunter Medical Research Institute, Newcastle, NSW
  • 4 Baker IDI Heart and Diabetes Institute, Melbourne, VIC
  • 5 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT


The authors gratefully acknowledge the generous support of the staff and patients from the following Aboriginal Community Controlled Health Services (in alphabetical order): Anyinginyi Health Aboriginal Corporation, Bega Garnbirringu Aboriginal Health Service, Danila Dilba Biluru Butji Binnilutum Health Service, Derbarl Yerrigan Health Service, Dhauwurd-Wurrung Elderly and Community Health Service, Kirrae Aboriginal Health Service, Mawarnkarra Health Service, Mildura Aboriginal Corporation, Mitwatj Health Aboriginal Corporation, Pika Wiya Health Service, Riverina Medical and Dental Aboriginal Corporation, South West Aboriginal Medical Service, Sunrise Health Service Aboriginal Corporation, Umoona Tjutagku Health Service, Winnunga Nimmityajah Aboriginal Health Service, Ampilatwatja Health Centre Aboriginal Corporation, Pius X Aboriginal Corporation, and Victorian Aboriginal Health Service.

Competing interests:

No relevant disclosures.

  • 1. Australian Institute of Health and Welfare. Diabetes and disability: impairments, activity limitations, participation restrictions and comorbidities (AIHW Cat. No. CVD 63; Diabetes Series No. 20). Canberra: AIHW, 2013.
  • 2. Public Health Agency of Canada. Diabetes in Canada: facts and figures from a public health perspective. Ottawa: Chronic Disease Surveillance and Monitoring Division, 2011. (accessed June 2017).
  • 3. Centers for Disease Control and Prevention. 2014 National diabetes statistics report. Atlanta: US Department of Health and Human Services, 2014. (accessed June 2017).
  • 4. Holman N, Young B, Gadsby R. Current prevalence of type 1 and type 2 diabetes in adults and children in the UK. Diabet Med 2015; 32: 1190-1120.
  • 5. Zimmet P, Alberti K, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001; 414: 782-787.
  • 6. Young TK, Reading J, Elias B. Type 2 diabetes mellitus in Canada’s First Nations: status of an epidemic in progress. CMAJ 2000; 163: 561-566.
  • 7. Acton KJ, Ríos Burrows N, Moore K, et al. Trends in diabetes prevalence among American Indian and Alaska native children, adolescents, and young adults. Am J Public Health 2002; 92: 1485-1490.
  • 8. Australian Institute of Health and Welfare. National key performance indicators for Aboriginal and Torres Strait Islander primary health care: results from December 2013 (AIHW Cat. No. IHW 146). Canberra: AIHW, 2014.
  • 9. Australian Bureau of Statistics. 4727.0.55.003. Australian Aboriginal and Torres Strait Islander health survey: biomedical results, 2012–13. Sept 2014. (accessed June 2017).
  • 10. Australian Bureau of Statistics. 4364.0.55.001. National Health Survey: first results, 2014–15. Dec 2015. (accessed June 2017).
  • 11. Dunstan DW, Zimmet PZ, Welborn TA, et al. The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle study. Diabetes Care 2002; 25: 829-834.
  • 12. O’Dea K, Cunningham J, Maple-Brown L, et al. Diabetes and cardiovascular risk factors in urban Indigenous adults: results from the DRUID study. Diabetes Res Clin Pract 2008; 80: 483-489.
  • 13. Engelgau MM, Narayan K, Herman WH. Screening for type 2 diabetes. Diabetes Care 2000; 23: 1563-1580.
  • 14. Waugh N, Scotland G, McNamee P, et al. Screening for type 2 diabetes: literature review and economic modelling. Health Technol Assess 2007; 11: iii-iv, ix-xi, 1-125.
  • 15. Colagiuri S, Davies D, Girgis S, Colagiuri R. National evidence based guideline for case detection and diagnosis of type 2 diabetes. Canberra: Diabetes Australia, NHMRC, 2009. (accessed July 2017).
  • 16. Bell K, Couzos S, Daniels J, et al. Aboriginal community controlled health services. In: Department of Health and Aged Care. General practice in Australia, 2000. Canberra: General Practice Branch, Health Services Division, Department of Health and Aged Care, 2000; pp. 74-103.
  • 17. Diabetes Australia Guideline Development Consortium. National evidence based guidelines for the management of type 2 diabetes mellitus. Canberra: NHMRC, 2004. (accessed June 2017).
  • 18. Royal Australian College of General Practitioners, Diabetes Australia. General practice management of type 2 diabetes — 2014–15. Melbourne: RACGP/DA, 2014. (accessed June 2017).
  • 19. Coleman J. Type 2 diabetes prevention and early detection. In: NACCHO/RACGP. National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. 2nd edition. Melbourne: RACGP, 2012; pp. 229-238. (accessed June 2017).
  • 20. Australian Institute of Health and Welfare. Indigenous health check (MBS 715) data tool. (accessed Dec 2016).
  • 21. Australian Bureau of Statistics. 4727.0.55.001. Australian Aboriginal and Torres Strait islander health survey: first results, Australia (2012–2013). Nov 2013. (accessed July 2015).
  • 22. Bloomgarden ZT. Type 2 diabetes in the young: the evolving epidemic. Diabetes Care 2004; 27: 998-1010.


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