Tailoring care for remote communities

Alarmingly, Aboriginal people are almost four times more likely to have diabetes or pre-diabetes than non-Aboriginal Australians, and diabetic complications, including kidney disease and cardiovascular events, are significantly higher among our Indigenous communities.

Following a two-year feasibility study, Associate Professor Neale Cohen is leading a national multi-centre clinical trial for a revolutionary once-weekly intensive model of care for Indigenous diabetes patients living in remote locations.

His small-scale trial conducted in 2019 found that the once-weekly model of care works well in this setting. Proving it at scale and making the necessary changes to treatment guidelines would have a huge economic impact by reducing the burden on the healthcare system. Importantly, this treatment model would also help to ensure that patients don’t need to travel off country for their care, which will lessen the financial and cultural impact on patients needing to travel away from their support systems for treatment.

“The Australian health system spends $2.5 billion per annum directly on diabetes. On top of this diabetes is a leading cause of heart disease, which costs the health system more than $2 billion per annum, chronic kidney disease which costs $1.7 billion and stroke which costs $660 million”.

^{Australian Institute of Health and Welfare.}

The trial is now being conducted across four states, and within ten remote communities. Associate Professor Neale Cohen is collaborating with peers in each state, who are all leaders in the field and hold close relationships with the local Indigenous communities they support.

The frontline healthcare workers will work to integrate with the existing clinics without burdening the already overstretched resources of these facilities. At the conclusion of the trial, knowledge will be shared with Indigenous community leaders, advocacy groups and government, with a view to changing the standard of care guidelines for the management of diabetes in these remote settings.

The prevalence of diabetes in remote communities is four times higher than in suburban areas. Improving health outcomes for patients with diabetes will cause a marked improvement in community health overall.

“What we’re seeing in these communities is not typical type 2 diabetes,” he says. “Its onset is early and its progression to the end stage of complications is rapid. And it’s not solely driven by lifestyle factors like diet and exercise. There are other factors, including genetics, that play a major role. It’s also severely compounded by the remoteness of the local communities, and access to holistic health care.”

_{Project Lead Associate Professor Neale Cohen}

Impactful Outcomes

Project leaders expect that trial participants’ health will improve across all areas of measures – blood glucose levels, retinal, kidney and heart function. It is also anticipated that researchers will see a downward trend in the measures of hospitalisation and complications such as amputations.

The implications of this reach goes far beyond each patient – to their community and the broader Australian population. This impact would be felt in the areas of general wellbeing, improved healthcare, lessening the burden on hospitals and contributing to closing the gap on life expectancy.

The project leaders’ aim is to use these findings to urge the government to change the standard model of care for the management and treatment of diabetes in remote Indigenous communities.

The writing of papers for publication and for advocacy will begin at the completion of the two-year trial.

Opportunities  

The trial has opened more educational and job opportunities within the participating communities. This offers the capacity to hire and train new research staff, including healthcare workers from the Aboriginal community, and local nurses.

Additionally, Associate Professor Neale Cohen is in early discussions with endocrinologists in Canada where similarly high rate of diabetes and its complications exist in its Indigenous population. The potential for knowledge sharing across these two vastly different, and yet inherently similar, populations will be vital in the global challenge to stop diabetes in its tracks.