DRUID: Diabetes and related disorders in urban Indigenous people in the Darwin region

CRCAH Project No: IKCD54

Administering Organisation:
Menzies School of Health Research

Project Leader:
Joan Cunningham
(Menzies School of Health Research)

Contact Details:
druid@menzies.edu.au

Team Members:
Joan Cunningham, Terry Dunbar, Kerin O'Dea, Louise Maple-Brown, Yin Paradies, Jacqui Boyle, Kalinda Griffiths, Tarun Weeramanthri, Jonathan Shaw, Paul Zimmet and a further 15 DRUID staff members.

Program Manager:
Arwen Nikolof
Chronic Conditions

Funding Sources:

• National Health & Medical Research Council

• Vincent Fairfax Family Foundation

Partners Involved:
The DRUID Study worked in partnership with researchers, health service providers, an Indigenous steering group and local Indigenous people

• Menzies School of Health Research
• NT Dept of Health and Community Services
• Danila Dilba Health Service
• International Diabetes Institute
• CRC for Aboriginal Health
• Yilli Rreung ATSIC Regional Council
• Diabetes Australia NT
• Top End Division of General Practice
• National Heart Foundation (NT)

This project is endorsed as an in-kind project of the CRCAH.

Project Summary:

The DRUID Study was started to find out about diabetes and other chronic diseases in Aboriginal and Torres Strait Islander people living in and around Darwin. Most Indigenous Australians live in cities and towns, but most of what we know about the health of Indigenous people comes from remote communities. This study involved two phases. The first phase started in mid-2003 and finished in mid-2005, involving free health checks for eligible peopled aged 15 years and over. We also asked people about their health and their lives.

Just over a thousand people took part in the Study.

• More women than men participated. More people aged 35 years and over took part than did younger people.
• People came from the Yili Rerung ATSIC region, including Darwin, Palmerston, Litchfield and Coomalie.
• To make it easier for people to take part, we did health checks in a variety of places, such as homes, schools, offices, community health centre's and other facilities.
• There was a good mix of people from a wide range of backgrounds and lots of different families.
• The Study included people who identified as Aboriginal, as Torres Strait Islander, and as both Aboriginal and Torres Strait Islander.

The study’s second phase has looked more closely at some markers of diet, called cartenoids, that were measured in the blood. As part of the second phase we also developed a new tool for measuring people’s experiences of racism and the responses they had to it when it happened.

Summary of Projected Outcomes:

Diabetes and Cardiovascular risk factors
Diabetes was common among people who took part in the study. There was more diabetes as people get older, but it was seen even in young people.

• About 1 in 3 people (32%) aged 35 years and over had diabetes. Among people aged 55 years or more, over half (52%) had diabetes.
• Diabetes was more common among people with lower incomes, those living in rented housing and those not working.
• More than 2 out of 3 people aged 35 years or more (and about 1 in 3, or 30%, of those aged 15-34) said they had been tested for diabetes before being in the study. This means that many people are aware of the importance of getting checked. However because the chances of getting diabetes go up as you get older, it is important to keep getting checked regularly.
• Risk factors for heart disease – being overweight, high blood pressure, problems with cholesterol or triglycerides (fats in the blood), smoking, kidney damage, and diabetes or pre-diabetes – were common, even among young people.

• Among those aged 15-34 years old without diabetes, nearly half (45%) had at least two risk factors for heart disease, while less than 1 in 5 (18%) had no risk factors.

Perceived versus Actual Weight

• In general, most people in the study who were overweight or obese described themselves as being overweight. This means that lack of awareness is not likely to be a barrier to weight loss.
• We need to look at other barriers, not only at the individual level, but at the larger structural and environmental level.

• Males and people with diabetes were more likely to underestimate their weight than women and people without diabetes, so special efforts might be needed for these groups.

Experiences of Racism
As part of the study we developed a new tool for measuring people's experiences of racism and the responses they had to it when it happened.

• Experiences of racism were very commonly reported across a range of settings, such as at home, work or in public places, by the police or by staff of government agencies, or while shopping or playing sport.

Complications of Diabetes
Some people who participated in the study already knew they had diabetes, while others found out they had diabetes as a result of having the health check. For everyone else with diabetes, we did some extra health checks to look for common problems that can go with diabetes, such as problems with the eyes, kidneys, heart and feet.

• About 2 out of 5 people with diabetes (39%) showed signs of kidney damage, 1 in 5 (21%) had eye problems related to diabetes, 1 in 10 (9%) had nerve damage and a similar number (12%) had circulation problems in their feet or legs.
• Of those people who already knew they had diabetes, the majority (74%) were being treated by their GP or local clinic.

Management of Diabetes

• Less than 1 in 3 people with known diabetes (29%) had HbA1c in the target range of less than 7%. (HbA1c measures longer-term control of blood sugar).
• Just under half (45%) had their blood pressure under control (less than 130/80), and about 2 out of 3 people (65%) had their total blood cholesterol under control (less than 5.5).

Timeline:

The first phase of the study started in the middle of 2003 and finished in mid-2005. The second phase of the study is still underway.

Related Publications/Links:

Publications from the DRUID Study so far include:

• Cunningham J, O’Dea K, Dunbar T, Weeramanthri T, Zimmet P, Shaw J. Study Protocol – Diabetes and related conditions in urban Indigenous people in the Darwin, Australia region: aims, methods and participation in the DRUID Study. BMC Public Health 2006,6:8.
• Cunningham J. Diversity of primary health care providers for urban Indigenous Australians (research letter). Australian and New Zealand Journal of Public Health 2006; 30:580-581.
• Maple-Brown L, Cunningham J, Celermajer DS, O’Dea K. Increased carotid intima-media thickness in remote and urban Indigenous Australians: impact of diabetes and components of the metabolic syndrome. Clinical Endocrinology 2007; 66: 419-425.
• Cunningham J, Dunbar T. Consent for long-term blood samples by Indigenous Australian research participants: the DRUID Study experience. Epidemiologic Perspectives & Innovations 2007;4:7.
• Cunningham J, O’Dea K, Dunbar T, Weeramanthri T, Shaw J, Zimmet P. Socioeconomic status and diabetes among urban Indigenous Australians aged 15-64 in the DRUID Study. Ethnicity & Health 2008; 13:23-37.
• Paradies YC, Cunningham J. Development and validation of the Measure of Indigenous Racism Experiences (MIRE). Int J Equity Health 2008;7:9.
• Cunningham J, O’Dea K, Dunbar T, Maple-Brown L. Perceived weight versus body mass index among urban Aboriginal Australians: Do perceptions and measurements match? Aust NZ J Public Health 2008; 32:135-138.
• O’Dea K, Cunningham J, Maple-Brown L, Weeramanthi T, Shaw J, Dunbar T, Zimmet P. Diabetes and cardiovascular risk in urban Indigenous Australians: Results from the DRUID Study. Diab Res Clin Pract 2008;

80:483-489.

• Maple-Brown L, Cunningham J, Dunne K, Whitbread C, Howard D, Weeramanthri T, Tatipata S, Dunbar T, Harper CA, Taylor H, Zimmet P, O’Dea K, Shaw J. Complications of diabetes in urban Indigenous Australians: the DRUID Study. Diab Res Clin Pract 2008; 80:455-462.
  
  

Article in Discover Menzies, Issue 02: Wet Season 2008, pages 10-12

[Last updated 23.03.2009]