The management of diabetes in indigenous Australians from primary care

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. Methods: Diabetes management and outcomes in Indigenous patients enrolled in the NEFRON study (n = 144) was systematically compared with that in non-Indigenous patients presenting consecutively to the same practitioner (n = 449), and the NEFRON cohort as a whole (n = 3893). Results: Indigenous Australians with diabetes had high rates of micro-and macrovascular disease. 60% of Indigenous patients had an abnormal albumin to creatinine ratio compared to 33% of non-Indigenous patients (p < 0.01). When compared to non-Indigenous patients, Indigenous patients were more likely to have established macrovascular disease (adjusted Odds ratio 2.7). This excess in complications was associated with poor glycemic control, with an HbA(lc) >= 8.0%, observed in 55% of all Indigenous patients, despite the similar frequency use of oral antidiabetic agents and insulin. Smoking was also more common in Indigenous patients (38% vs 10%, p < 0.01). However, the achievement of LDL and blood pressure targets was the same or better in Indigenous patients. Conclusion: Although seeing the same doctors and receiving the same medications, glycaemic and smoking cessation targets remain unfulfilled in Indigenous patients. This cross-sectional study confirms Aboriginal ethnicity as a powerful risk factor for microvascular and macrovascular disease, which practitioners should use to identify candidates for intensive multifactorial intervention.