Aboriginal-led study sees 30% achieve diabetes remission

Type 2 diabetes is one of the most common health issues impacting First Nation populations worldwide – and the prevalence is on the rise.
 
In Australia, Aboriginal and Torres Strait Islander people are four times more likely to be diagnosed with the condition compared to non-Aboriginal and Torres Strait Islander people. They are also five times more likely to be hospitalised as a result, and six times more likely to die from it.
 
But new research has signalled there is hope – as long as the approach is informed and led by community members themselves.
 
Co-designed by the South Coast Women’s Health and Wellbeing Aboriginal Corporation (Waminda), of the 25 female participants who had been living with diabetes for more than 10 years, seven (28%) managed to reverse their diabetes to a HbA1c <6.4% (46mmol/l) for at least 12 months. Eighteen participants reduced their blood sugars to a healthier level.
 
While HbA1c was used as the primary outcome measure, the research also found statistically significant improvements in weight, systolic blood pressure, liver enzymes, blood glucose time-in-range, patient activation measure and problem areas in diabetes scores.
 
As part of the study design, participants attended Shared Medical Appointments (SMAs) that included continuous glucose monitoring and culturally responsive food appreciation activities over eight weekly sessions.
 
Associate Professor John Stevens, the study’s lead investigator from Southern Cross University, said by empowering the female participants to make decisions it led to ‘high engagement’ in the program.
 
‘The tailored eight-week lifestyle medicine course used the SMA process, where the clinician – in this case a GP – was just another member of the group, adding their knowledge and skills to the mix, encouraging self-management and pride in the way these women had already managed their health, and offering guidance on behavioural change techniques that really made a difference,’ he said.
 
‘It’s amazing how quickly these group bond with each other because everyone really empathises with where each person is at.’
 
Dr Justin Coleman, who works in Aboriginal and Torres Strait Islander health, is the author of the Diabetes chapter in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.
 
He praised the study design and said, in his experience, a community designed trial translates into future health outcomes that are much more powerful.
 
‘The women in that community have taken ownership of the hard work they put in, in changing their nutrition and their lifestyle, and they will be rightfully proud of the results they’ve achieved,’ Dr Coleman told newsGP.
 
‘They’ll be talking about it within their community in a positive way. Those stories are incredibly powerful.’
 
Dr Coleman has experience with this firsthand.
 
It was 10 years ago that he was part of championing a community jury of 12 local people at the Inala Indigenous Health Service to be responsible for deciding which research projects can be undertaken with Aboriginal people in the area.
 
‘Currently we have 22 projects on the go and every single one of them had to be approved by the community jury or it wouldn’t have gone ahead,’ Dr Coleman said.
 
‘First Nations people in Australia have been studied in a passive sense for so many decades that there quite rightly has been a movement away from that over the last 20 years.
 
‘The days of people coming in and getting their PhDs through a study which gives little, if any, feedback to the community and doesn’t improve their health, but gives someone a doctorate, are rightfully gone.’
 
Southern Cross University is the first in Australia to be trialling the concept of SMAs for the management of chronic disease.
 
It sees groups of between eight and 15 people, who share a common health issue or diagnosis, come together with a healthcare practitioner, such as a GP, who facilitates a discussion about beneficial lifestyle changes. Individual consults also take place within the group setting.
 
Participants gave positive feedback on the format, saying that SMAs ‘are how Aboriginal people have always done healthcare’ and are encouraging them to re-engage with services they had previously been avoiding.
 
Dr Coleman says this is encouraging.
 
‘This is probably foreign to the majority of GPs who don’t work in First Nations health, but familiar to GPs in First Nations health almost by default, because so often we have multiple people attend the one medical appointment,’ he said.
 
‘So, I thought it was great expanding on the concept of multiple people attending the one appointment by using SMAs, which is something I will now take more of an interest in myself.’
 
Meanwhile, Dr Coleman says he is very pleased to see emerging studies on nutrition and lifestyle as treatment for diabetes.
 
‘Traditionally most diabetes research has been done on medication because that’s where the money is and it’s easier to do the funded research,’ he said.
 
‘But the dietary interventions are so powerful in diabetes that once you do study them … you find that the results are extraordinary. But the volume of evidence isn’t out there.’
 
While statistics on the impacts of type 2 diabetes in Aboriginal and Torres Strait Islander communities are concerning, Dr Coleman says studies such as this provide hope for intervention.
 
‘The very fact that a condition is far more prevalent also means that an intervention that works has far more impact,’ he said.
 
‘It’s a very positive story.’
 
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Aboriginal chronic disease continuous glucose monitors SMA type 2 diabetes women