National Guide

Chapter 17 | Type 2 diabetes







National Guide to preventive healthcare for Aboriginal and <br/>Torres Strait Islander people
Download PDF
    18. Chapter 17 | Type 2 diabetes

Type 2 diabetes

Dr Justin Coleman  

Key messages

  • Type 2 diabetes can be prevented through healthy diet, regular physical activity and maintaining healthy weight.1
  • Aboriginal and Torres Strait Islander people have almost three times the rate of type 2 diabetes than other Australians, with onset at an earlier age.2
  • Primary care clinicians can help prevent type 2 diabetes by offering education and support for a healthy diet, physical activity and weight management; offering regular screening for diabetes from a young age; and advocating for prevention at a community level.
  • Type 2 diabetes is relatively easy to diagnose and early management is associated with long-term benefits through the reversal of diabetes and the prevention or delay of diabetes-related complications.
Type of preventive activity - Screening
Who/target population What When Strength of recommendation Key source(s) and reference(s) Rationale/key considerations informing recommendation
Children/adolescents aged 10 years and over (or at the onset of puberty, whichever occurs first) with one or more of the following risk factors:
  • overweight or obesity (body mass index*  [BMI] ≥85th or ≥95th percentile, respectively, and/or waist circumference to height ratio >0.5)
  • maternal history of diabetes or gestational diabetes
  • first-degree relative with T2D
  • signs of insulin resistance (acanthosis nigricans)
  • other conditions associated with obesity and metabolic syndrome (eg dyslipidaemia, polycystic ovary syndrome)
  • use of psychotropic medication
 Measure HbA1c using point-of-care testing as the preferred method for diagnosis; fasting blood glucose (FBG) is also acceptable

Perform an oral glucose tolerance test (OGTT) in those with equivocal HbA1c or FBG results		 Opportunistically
Repeat annually if HbA1c <5.7%
Repeat in six months if HbA1c 5.7–6.4%		 Strong National guideline3 The high prevalence of diabetes at younger age warrants early screening for at-risk children
All adults aged 18 years and over 1. Measure FBG or HbA1c: A laboratory test is preferable, but fingerprick testing is an alternative. If FBG is impractical, perform a random (non-fasting) venous test, or measure HbA1c (which is not affected by fasting status)
2. Perform an OGTT in those with equivocal results (ie FBG 5.5–6.9 mmol/L or random glucose 5.5–11.0 mmol/L)
Use World Health Organization (WHO)/International Diabetes Federation (IDF) criteria to diagnose T2D, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) (see Box 1)

Given the higher prevalence of T2D in Aboriginal and Torres Strait Islander populations, blood testing rather than the AUSDRISK tool is recommended as the primary screening test		 Opportunistically Strong National guideline4 The high rate of T2D supports screening from age 18 years
All people aged 5–18 years Measure waist circumference (refer to Chapter 15: Overweight and obesity) Opportunistically Strong International consensus statement5 Advice and encouragement around physical activity and diet needs to be tailored to individual and local context
All people aged 18 years and older Measure BMI and waist circumference (refer to  Chapter 15: Overweight and obesity ) Opportunistically Strong National guideline and international consensus statement5,6 Advice and encouragement around physical activity and diet needs to be tailored to individual and local context
Type of preventive activity - Behavioural
Who/target population What When Strength of recommendation Key source(s) and reference(s) Rationale/key considerations informing recommendation
All people Provide healthy living and health risk advice: advise a minimum of 30 minutes moderate-intensity activity on most days

Encourage a diet rich in vegetables, fruits, legumes, high-fibre cereals, fish and lean meats

Limit fats, salt, sugar, alcohol (refer to Chapter 2: Healthy living and health risks, Healthy eating and Physical activity and sedentary behaviour)		 Opportunistically Strong National guideline4 Advice and encouragement around physical activity and diet needs to be tailored to individual and local context
All mothers of infants Encourage breastfeeding for at least six months Discuss antenatally and postnatally Strong National guideline7 Breastfeeding has many benefits for the mother and baby
All people with a BMI greater than 40 kg/m2 (or greater than 35 kg/m2 if they already have T2D or other complications) Recommend intensive dietary and physical activity modification as above; consider a very-low-energy diet

Discuss the risks and benefits of bariatric surgery and consider referral if services are available (refer to Chapter 15: Overweight and obesity)		 Opportunistically and as clinically indicated Strong National guidelines4,6 Reducing obesity has a range of individual health benefits and reduces the prevalence of diabetes

*BMI should be calculated using age- and gender-appropriate calculator/percentile growth charts.
  • As part of initial screening, at every visit offer a random fingerpick blood sugar level to monitor blood glucose levels. This is a relatively non-invasive and accepted approach from the community (and is offered routinely in Aboriginal Community Controlled Health Services around the country) that may indicate the need for further investigation (eg fasting blood glucose).
  • Provide healthy eating advice and resources to support the patient to make small changes to their diet to reduce weight. This may include providing access to culturally safe and affordable recipes to encourage self-management.

Clinical guidelines

Community resources

Box 1. Diagnosing type 2 diabetesA
Diabetes is diagnosed based on the presence of any of the following criteria:
  • Fasting plasma glucose (FPG) ≥7.0 mmol/L
  • Two-hour plasma glucose ≥11.1 mmol/L after 75-g oral glucose tolerance test
  • HbA1c ≥6.5% (48 mmol/mol)
  • Random plasma glucose ≥11.1 mmol/L in the presence of classical diabetes symptoms
AAdapted from the RACGP’s Management of type 2 diabetes: A handbook for general practice.4

Background

Type 2 diabetes is a condition where the body cannot produce enough insulin and/or becomes resistant to the effects of insulin. This usually develops slowly over years, providing a substantial pre-diabetes window period of opportunity to offer preventive interventions. Screening for diabetes is safe, accurate and cost-effective, and detects a substantial proportion of people who may not otherwise have been identified and received early intervention.7 There is consistent evidence that appropriate management of diabetes can prevent or delay the progression of complications such as heart attacks, eye disease and kidney failure.8

There is a strong focus on the prevention of type 2 diabetes because healthy living interventions, such as healthy diet, physical activity and healthy weight, can potentially stop diabetes from occurring in the first place1,9 and potentially reverse it after it is diagnosed.10 However, there are many structural barriers to access to and affordability of healthy foods for many Aboriginal and Torres Strait Islander people, and colonisation has disrupted traditional diets and knowledge of food systems (refer to Chapter 2: Healthy living and health risks, Healthy living and health risks, Healthy eating).

The proportion of Aboriginal and Torres Strait Islander people living with type 2 diabetes is 8% overall, and 12% of those who live in remote areas. This is more than three-fold the rate of non-Indigenous Australians after adjustment for age.2 Type 2 diabetes becomes more common with increasing age: 35% of Aboriginal and Torres Strait Islander people aged over 55 years have the condition.2 The prevalence of tye 2 diabetes  varies greatly between communities, affecting up to 40% of adults in some remote areas, and is increasing in adolescents.11 Type 2 diabetes is a direct or indirect cause for 20% of deaths of Aboriginal and Torres Strait Islander people.12

Obesity is a major cause of type 2 diabetes; Aboriginal and Torres Strait Islander adults who are obese are seve-fold more likely as those of healthy weight or underweight to have diabetes (17% versus 2.4%, respectively).12 Obesity is a very strong predictor of who may get type 2 diabetes in the future; a study of non-diabetic Aboriginal adults in Central Australia found that those who were overweight or obese were 3.3-fold more likely to develop diabetes than those who were not.7
Overweight and obesity is increasingly common in childhood and adolescence. In Aboriginal and Torres Strait Islander children aged 2–14 years, the proportion of children who were overweight or obese increased from 30% in 2012–13 to 37% in 2018–19.2
Obesity is not easy to reverse, but it gives health providers a substantial opportunity to encourage and help manage the prevention of type 2 diabetes. (Refer to Chapter 15: Overweight and obesity.)

Screening and diagnosis

T2D can be a condition with few or no symptoms, so is often not diagnosed unless health practitioners specifically look for it. The 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey included blood samples for over 3300 participants and detected one newly diagnosed case for every six people with known diabetes.13

Screening for undetected diabetes is an efficient method of preventing complications from this disease because treatments can be started earlier.7

Type 2 diabetes be a condition with few or no symptoms, so is often not diagnosed unless health practitioners specifically look for it. The 2012–13 Australian Aboriginal and Torres Strait Islander Health Survey included blood samples for over 3300 participants and detected one newly diagnosed case for every six people with known diabetes.13

Screening for undetected diabetes is an efficient method of preventing complications from this disease because treatments can be started earlier.7

Screening for diabetes should be on an opportunistic basis and/or annually in the primary care setting; this is supported by stronger evidence than the use of mass screening programs.7 Aboriginal and Torres Strait Islander people should be screened for diabetes from age 18 years, rather than from 40 years as in the general Australian population.7 Children with additional risk factors should be screened from the onset of puberty (age >10 years). Children are considered to have additional risk factors if they are overweight or obese, have a family history of diabetes, have high lipids, are on psychotropic treatment or whose mothers had diabetes during pregnancy.14 In addition, all women require screening during each pregnancy.15

Screening is via blood testing (fingerprick and/or laboratory testing; see below) and often done at the same time as other screening blood tests, such as cardiovascular risk assessment. In the general population, the AUSDRISK risk assessment tool is recommended as a screening tool in order to identify who needs further assessment, including blood testing; however, given the higher prevalence of type 2 diabetes in Aboriginal and Torres Strait Islander populations, blood testing rather than the AUSDRISK tool is recommended as the primary screening test.4

The three types of diagnostic tests for diabetes are blood glucose (random or fasting), HbA1c and an OGTT. If a person has a strongly positive blood glucose or HbA1c test result and has symptoms of diabetes, one test is enough. However, for everyone else, the diagnosis should be confirmed by retesting on a separate day to reduce error.4

Box 1 explains how to interpret the test results to diagnose diabetes. 

Asymptomatic individuals with a single abnormal test should have the test repeated to confirm the diagnosis unless the result is unequivocally elevated. 

Where a random plasma glucose level ≥5.6 mmol/L and <11.1 mmol/L is detected, fasting plasma glucose should be measured or an OGTT performed or HbA1c measured.

Results that are just below the threshold of diabetes can be called prediabetes; this includes IFG (which can be diagnosed on a fasting sample) or IGT (which, technically, can only be defined by an OGTT; see Box 2). Prediabetes is not a disease and there is some controversy as to the benefits of diagnosing it7,9 because the main recommended interventions involve managing exercise, diet, weight/obesity, smoking and blood pressure rather than commencing diabetes medication, and this cardiovascular risk reduction should ideally be promoted regardless of a label of ‘prediabetes’.

Blood glucose

A fingerprick glucose measurement (a point-of-care test on capillary blood) is easy to do and enables further action on the same visit. However, it is less accurate than sending a venous blood sample to the laboratory.

A laboratory test after fasting overnight is the most reliable, and FBG ≥7.0 mmol/L is diagnostic of diabetes. However, if the person is unlikely to return for a fasting test, then a random (non-fasting) fingerprick test is a practical alternative. The downside is that any result between 5.5 and 11 mmol/L on a random test is considered ‘equivocal’ and will require clarification via further testing 7

HbA1c

HbA1c ≥6.5% (48 mmol/mol) is another method for diagnosing diabetes. This is most accurately measured in a laboratory on a venous sample but can also be done via fingerprick using a point-of-care analyser. Fasting is unnecessary.

Point-of-care HbA1c testing for screening is now rebated through the Medicare Benefit Schedule (MBS). There is an MBS item for all practices accredited against both the RACGP Standards for general practices and Standards for point-of-care testing.16–18 There is also an MBS item, at a higher rebate, for health services enrolled in the Quality Assurance for Aboriginal and Torres Strait Islander Medical Services (QAAMS) pathology program.19 In remote settings particularly, a practical and accurate method is to do a fingerprick HbA1c test and, if the result is equivocal (just above or just below 6.5%), to confirm this with a laboratory HbA1c test.

Using HbA1c as a screening tool is less reliable in those with iron deficiency, recent iron or blood transfusions, haemoglobin variants or alterations in red blood cell turnover (including pregnancy).20 A ‘borderline’ HbA1c result in the range 6.0–6.4% (42–46 mmol/mol) suggests someone at future high risk of developing diabetes.21 

Oral glucose tolerance test

An OGTT involves a venous blood sample after overnight fasting, then another sample two hours after drinking 75-g glucose solution. Besides being the preferred screening test in pregnancy, its other main use is to clarify an ‘equivocal’ FBG result. An OGTT is less convenient than an HbA1c test, but it can help sort out the diagnosis where there is uncertainty. 

Obesity should be screened for opportunistically. The three common ways to measure obesity are BMI, waist circumference and the waist-to-hip ratio. A study in a remote Northern Territory community showed that waist circumference is a more accurate predictor of mortality risk than BMI.22 (Refer to Chapter 15: Overweight and obesity.)

There is no role for routinely testing insulin levels to assess insulin resistance.4

There is very strong evidence that health risk modifications that focus on weight loss, healthy diet and increased physical activity should be offered to all individuals at high risk of developing type 2 diabetes.7
 
These key behavioural interventions are effective in both preventing the onset of type 2 diabetes (particularly in those with prediabetes) and in treating established type 2 diabetes. A realistic possibility for those whose type 2 diabetes has been diagnosed in the past six years is that an intensive reduction in dietary intake will reverse the diagnosis altogether; that is, send the diabetes into remission, where hypoglycaemic medications are no longer required.10 However, intensive weight reduction is difficult to achieve and maintain, and those who successfully achieve remission should still be monitored over subsequent years for recurrence of type 2 diabetes.
 
For those with pre-diabetes, dietary and physical activity interventions can halve the incidence of type 2 diabetes at four years compared with a control group (number needed to treat [NNT]=8), and most of this benefit is maintained for at least three years after the initial intervention is ceased.10,23 For those who already have type 2 diabetes, these interventions can halve their mortality risk.24

The Diabetes Australia website has a number of resources developed for Aboriginal and Torres Strait Islander people, looking at diet and exercise, prevention and risk reduction25 (see Useful resources). 

Diet

Dietary advice can support healthy eating, and healthy eating can effectively delay or prevent diabetes.2,7

Dietary recommendations are found in the Australian dietary guidelines:

  • encourage nutrient-dense foods (eg vegetables, fruit, wholegrain cereals)
  • limit energy-dense foods (fatty, greasy, deep-fried, sugary, highly processed foods).26

(Refer to Chapter 2: Healthy living and health risks, Healthy eating.)

For all those at high risk of type 2 diabetes, referral to an accredited practising dietician should be considered. Successful completion of an annual Aboriginal and Torres Strait Islander health check (Medicare Item 715) enables access to 10 dietician or other allied health visits each year.27

A very low energy diet supervised by a dietician is a reasonable option to consider for those who wish to initially lose 10–15 kg over a few months, before reverting to more sustainable long-term healthy eating patterns. The Diabetes Remission Clinical Trial (DiRECT) trial found that two-thirds of those who lost at least 10 kg maintained remission of T2D (ie HbA1c <6.5% [48 mmol/mol] on no hypoglycaemic medication) for at least two years.10

Physical activity

Increasing physical activity is an important and effective method of preventing diabetes. As well as contributing to healthy weight/weight loss, physical activity has extensive health and wellbeing benefits, including for cardiovascular, metabolic, musculoskeletal and brain health, as well as social and emotional wellbeing.

The diabetes-related benefits of regular exercise are not limited to people who are successful in losing weight. One study found that those who exercised for at least four hours per week but did not lose any weight still had a four-fifths relative reduction in the incidence of diabetes at one year compared with those who were sedentary.28

Ideally, a diabetes prevention strategy involves the combined interventions of diet modification and increased exercise.2,11 A seven-year follow-up study in a remote Aboriginal community involving diet and physical activity interventions found that, despite an increase in average BMI, the prevalence of prediabetes (IGT) decreased and diabetes prevalence did not increase, possibly due to improved physical activity.29

Sedentary activities, such as watching television, are associated with diabetes; in Australia, those who watch television for more than 14 hours per week are 2.3-fold more likely to develop new diabetes as those who watch less than 14 hours of television.30 Although this does not prove a direct causative effect, it is reasonable to encourage a reduction in screen time, particularly if replaced by a non-sedentary activity.

The Australian national physical activity guidelines recommend a gradual increase in activity intensity to a goal of at least 30 minutes of moderate-intensity physical activity on most, and preferably all, days, as well as recommendations regarding reduced sitting time31 (refer to Chapter 2: Healthy living and health risks, Physical activity and sedentary behaviour).

The type of physical activity encouraged will depend on the individual’s capacity and interest in sustaining the activity long term. Aboriginal and Torres Strait Islander people have fewer opportunities to use healthy lifestyle programs due to issues with their suitability, cultural issues, family obligations and a range of social and economic barriers that increase cardiovascular risks but also limit participation. Many Aboriginal and Torres Strait Islander people are already involved in physically demanding sporting and cultural activities, which should be encouraged.4 

Many individuals find it more rewarding to commit to activity done with other people. Most local communities have activities, sports or programs that are free or low-cost.

Many of the medications used in diabetes prevention studies have established side effects, so potential benefits and harms should be taken into account before considering pharmacotherapy.7
 
Using metformin at the pre-diabetes stage can delay or prevent progression to diabetes. However, metformin is not licenced for this use by the Therapeutic Goods Administration in Australia and cannot be offered as a Pharmaceutical Benefits Scheme (PBS)-subsidised prescription until after diabetes is diagnosed.32

For those with pre-diabetes, metformin improves weight and lipid profiles, and reduces new-onset diabetes by 40%.32 However, it is less effective than intensive diet and exercise modification. A large US trial found that to prevent one extra person getting type 2 diabetes, around 14 people with pre-diabetes need to be treated with metformin for three years (NNT=13.9), whereas only seven require intensive ‘lifestyle’ intervention (NNT=6.9).33 That trial was prematurely discontinued on the basis that it was unethical not to offer all participants the intensive diet and exercise program.

As of January 2023, four medications had been approved by the Therapeutic Goods Administration to assist with weight loss (phentermine, orlistat, liraglutide and combined naltrexone and bupropion), but all require a private (non-PBS) prescription.4 All four medications have significant risks, and none is commonly used in the Aboriginal and Torres Strait Islander context. It is likely that other glutides (glucagon-like peptide-1 agonists, currently approved and PBS-subsidised for diabetes) will be approved for weight loss. However, compared with weight loss medication, medications used to control glucose, blood pressure and lipids are cheaper, safer and currently have more evidence of benefits to health and the prevention of diabetes complications.

Surgical weight loss interventions for severe obesity can result in a marked reduction in diabetes.34,35 One study found that 1845 subjects who had bariatric surgery had a 32-fold reduction in the incidence of newly diagnosed diabetes compared with a matched control group.36 A prospective study of 30 obese Aboriginal adults diagnosed with diabetes who underwent gastric banding found that 66% had diabetes remission at two years.37

People with obesity, particularly those with a BMI >35 kg/m2 and potentially suitable for bariatric surgery, should be encouraged to consider surgical referral, if available. Access to surgery in the public health system remains a significant barrier and a low percentage of Aboriginal and Torres Strait Islander people have private health insurance.

Health professionals may be in a position to help prevent type 2 diabetes not only at the individual level, but also at a community level. The risk factors for obesity and diabetes and their complications are strongly influenced by the social, commercial and political environment. Advocacy for health may involve working with governing bodies, the media, food outlets, activity organisations and community groups and Elders.

In remote and rural areas, community stores are frequently the only food source outside traditional ‘bush’ food. Various programs to influence the quality and cost of high-nutrition foods in community stores have had some success; a retail cooperative in Arnhem Land provided 100% freight-subsidised fruit and vegetables and doubled the intake of these foods per person at three years.38 An analysis of 29 years of community store interventions in remote South Australia found that some schemes successfully improved access to healthy fresh foods, but overall diet quality worsened over time.39 

Box 2. World Health Organization/International Diabetes Federation criteria to diagnose type 2 diabetes, impaired glucose tolerance and impaired fasting glucose40
Diabetes  
Fasting plasma glucose ≥7.0 mmol/L (126 mg/dL)
  or
Two-hour plasma glucoseA ≥11.1 mmol/L (200 mg/dL)
Impaired glucose tolerance  
Fasting plasma glucose 7.0 mmol/L (126 mg/dL)
  and  
Two-hour plasma glucoseA ≥7.8 and <11.1 mmol/L (≥140 mg/dL and <200 mg/dL)  
Impaired fasting glucose  
Plasma glucose 6.1–6.9 mmol/L (110–125 mg/dL)
  and (if measured)  
Two-hour plasma glucoseA <7.8 mmol/L (140 mg/dL)  
A75g oral glucose tolerance test  
  1. Diabetes Australia. Prevention. Diabetes Australia, n.d [Accessed 19 April 2024].
  2. Australian Bureau of Statistics (ABS). National Aboriginal and Torres Strait Islander health survey 2018–19. ABS, 2019 [Accessed 19 April 2024].
  3. Peña AS, Curran JA, Fuery M, et al. Screening, assessment and management of type 2 diabetes mellitus in children and adolescents: Australasian Paediatric Endocrine Group guidelines. Med J Aust 2020;213(1):30–43. doi: 10.5694/mja2.50666.
  4. The Royal Australian College of General Practitioners (RACGP). Management of type 2 diabetes: A handbook for general practice. RACGP, 2020 [Accessed 19 April 2024].
  5. Ross R, Neeland IJ, Yamashita S, et al. Waist circumference as a vital sign in clinical practice: A Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nat Rev Endocrinol 2020;16(3):177–89. doi: 10.1038/s41574-019-0310-7.
  6. Markovic TP, Proietto J, Dixon JB, et al. The Australian Obesity Management Algorithm: A simple tool to guide the management of obesity in primary care. Obes Res Clin Pract 2022;16(5):353–63. doi: 10.1016/j.orcp.2022.08.003.
  7. Colagiuri S DD, Girgis S, Colagiuri R. National evidence based guideline for case detection and diagnosis of type 2 diabetes. Diabetes Australia, 2009 [Accessed 19 April 2024].
  8. Australian Institute of Health and Welfare (AIHW). Diabetes: Australian facts. AIHW, 2023 [Accessed 19 April 2024].
  9. Australian Institute of Health and Welfare (AIHW). Type 2 diabetes. In: Aboriginal and Torres Strait Islander health performance framework. AIHW, 2023 [Accessed 19 April 2024].
  10. Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 2019;7(5):344–55. doi: 10.1016/S2213-8587(19)30068-3.
  11. Hare MJL, Zhao Y, Guthridge S, et al. Prevalence and incidence of diabetes among Aboriginal people in remote communities of the Northern Territory, Australia: A retrospective, longitudinal data-linkage study. BMJ Open 2022;12(5):e059716. doi: 10.1136/bmjopen-2021-059716.
  12. Australian Institute of Health and Welfare (AIHW). The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples: 2015. AIHW; 2015 [Accessed 2 May 2024].
  13. Australian Bureau of Statistics (ABS). Australian Aboriginal and Torres Strait Islander health survey: Biomedical results, 2012–13. ABS, 2015 [Accessed 19 April 2024].
  14. Azzopardi P, Brown AD, Zimmet P, et al. Type 2 diabetes in young Indigenous Australians in rural and remote areas: Diagnosis, screening, management and prevention. Med J Aust 2012;197(1):32–36. doi: 10.5694/mja12.10036.
  15. Department of Health. Clinical practice guidelines: Pregnancy care. Australian Government Department of Health, 2020 [Accessed 19 April 2024].
  16. Department of Health and Aged Care. Medicare Benefits Schedule – Item 73812. Australian Government, 2023 [Accessed 19 April 2024].
  17. The Royal Australian College of General Practitioners (RACGP). Standards for general practices. 5th edn. RACGP, 2020 [Accessed 2 May 2024].
  18. The Royal Australian College of General Practitioners (RACGP). Standards for point-of-care testing. 5th edition. RACGP, 2018 [Accessed 2 May 2024].
  19. Department of Health. Medicare Benefits Schedule – Item 73839. Australian Government, 2023 [Accessed 19 April 2024].
  20. Kester LM, Hey H, Hannon TS. Using hemoglobin A1c for prediabetes and diabetes diagnosis in adolescents: Can adult recommendations be upheld for pediatric use? J Adolesc Health 2012;50(4):321–23. doi: 10.1016/j.jadohealth.2012.02.009.
  21. Barry E, Roberts S, Oke J, Vijayaraghavan S, Normansell R, Greenhalgh T. Efficacy and effectiveness of screen and treat policies in prevention of type 2 diabetes: Systematic review and meta-analysis of screening tests and interventions. BMJ 2017;356:i6538. doi: 10.1136/bmj.i6538.
  22. Adegbija O, Hoy WE, Dong B, Wang Z. Body mass index and waist circumference as predictors of all-cause mortality in an Aboriginal Australian community. Obes Res Clin Pract 2017;11(1):19–26. doi: 10.1016/j.orcp.2016.06.003.
  23. Cunningham J, O’Dea K, Dunbar T, Weeramanthri T, Shaw J, Zimmet P. Socioeconomic status and diabetes among urban Indigenous Australians aged 15–64 years in the DRUID study. Ethn Health 2008;13(1):23–37. doi: 10.1080/13557850701803130.
  24. Couzos S, Murray RB. Aboriginal primary health care: An evidence-based approach. 3rd edn. Oxford University Press, 2008.
  25. Diabetes Australia. Diabetes resources for Aboriginal and Torres Strait Islander people. Diabetes Australia, 2023 [Accessed 19 April 2024].
  26. National Health and Medical Research Council (NHMRC). Australian dietary guidelines. NHMRC, 2013 [Accessed 19 April 2024].
  27. Services Australia. Aboriginal and Torres Strait Islander health assessments and follow-up services. Services Australia, 2022 [Accessed 19 April 2024].
  28. Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344(18):1343–50. doi: 10.1056/nejm200105033441801.
  29. Rowley KG, Gault A, McDermott R, Knight S, McLeay T, O’Dea K. Reduced prevalence of impaired glucose tolerance and no change in prevalence of diabetes despite increasing BMI among Aboriginal people from a group of remote homeland communities. Diabetes Care 2000;23(7):898–904. doi: 10.2337/diacare.23.7.898.
  30. 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(5):829–34. doi: 10.2337/diacare.25.5.829.
  31. Department of Health and Aged Care. Physical activity and exercise guidelines for all Australians. Australian Government, 2021 [Accessed 19 April 2024].
  32. Salpeter SR, Buckley NS, Kahn JA, Salpeter EE. Meta-analysis: Metformin treatment in persons at risk for diabetes mellitus. Am J Med 2008;121(2):149–57.e2. doi: 10.1016/j.amjmed.2007.09.016.
  33. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346(6):393–403. doi: 10.1056/NEJMoa012512.
  34. Booth H, Khan O, Prevost T, et al. Incidence of type 2 diabetes after bariatric surgery: Population-based matched cohort study. Lancet Diabetes Endocrinol 2014;2(12):963–68. doi: 10.1016/S2213-8587(14)70214-1.
  35. Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014;8:CD003641. doi: 10.1002/14651858.CD003641.pub4.
  36. Sjöström CD, Peltonen M, Wedel H, Sjöström L. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2000;36(1):20–25. doi: 10.1161/01.hyp.36.1.20.
  37. O'Brien PE, DeWitt DE, Laurie C, et al. The effect of weight loss on Indigenous Australians with diabetes: A study of feasibility, acceptability and effectiveness of laparoscopic adjustable gastric banding. Obes Surg 2016;26(1):45–53. doi: 10.1007/s11695-015-1733-4.
  38. Lee AJ, Hobson V, Katarski L. Review of the nutrition policy of the Arnhem Land Progress Association. Aust N Z J Public Health 1996;20(5):538–44. doi: 10.1111/j.1467-842X.1996.tb01636.x.
  39. Lee A, Rainow S, Tregenza J, et al. Nutrition in remote aboriginal communities: Lessons from Mai Wiru and the Anangu Pitjantjatjara Yankunytjatjara lands. Aust N Z J Public Health 2016;40:S81–8. doi: 10.1111:1753-6405.12419.
  40. World Health Organization (WHO), International Diabetes Federation (IDF). Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: Report of a WHO/IDF consultation. WHO, 2006 [Accessed 19 April 2024].




 

Advertising