Prevention of type 2 diabetes amongst young Aboriginal people in Derby

Background

Type 2 diabetes (T2D) is a largely preventable disease that involves a significant burden on individuals and communities. Aboriginal and Torres Strait Islander people have higher rates of T2D than other Australians in all age groups, with larger differences in younger age groups – a time when the onset of diabetes is associated with earlier progression to serious health complications.

Aim

In collaboration with the Derby Aboriginal Health Service (DAHS), the broad aim of this project was to develop and enact appropriate approaches to support healthy lifestyle changes as part of longer-term diabetes prevention among younger Aboriginal people in Derby.

Methods and findings

De‐identified electronic patient medical record data were analysed, focusing on glycated haemoglobin (HbA1c) measurements along with body weight and age. Results were suggestive of increasing T2D risk by mid-20s, with some young people found to have T2D earlier than this. The minimum T2D prevalence among people aged in their 30s was 10%. This reinforces the need for regular universal T2D screening from a young age. Consistent with previous studies with other populations, results were also suggestive of increased risk of progression to T2D from high-range pre-diabetes (HbA1c 42–47 mmol/mol, 6–6.4%), particularly for people who gained weight.

We sought insights and advice from Derby residents who had made successful healthy lifestyle changes before this project started. Four men aged 20–35 years were interviewed; three had diabetes, with diagnosis occurring in their early 20s. Participants with diabetes were highly motivated to avoid diabetes complications and had a strong belief that their actions could achieve this. The findings from this study highlighted that lifestyle modification programs that foster internal motivation, enhance key health knowledge, and modify health beliefs and risk perception are needed.

A diabetes prevention / healthy lifestyle program for young people was developed, based on the ideas and advice of Derby community members and previous research evidence. Ten Aboriginal women and men aged 18–38 years participated in the pilot program at DAHS, which had local young Aboriginal facilitators. The 8-week program highlighted causes and consequences of diabetes, incorporated physical activity and healthy eating topics with a focus on practical activities, and included stress management to support healthy lifestyles. The program was found to be acceptable and appropriate, and other community members and organisations expressed interest in future participation. Participants reported that they gained important new knowledge and made changes in behaviours including shopping choices, portioning and soft drink consumption. While this program was designed to be sustainable, and there were indications of feasibility, resource constraints impeded its integration into routine primary health care.

Conclusions

The high T2D prevalence and common presence of risk factors from an early age supports the need for enhanced prevention efforts for young Aboriginal people. Achievable actions for T2D prevention in this setting in the short term are increased screening at younger ages and, with dedicated modest funding, ongoing provision of tailored group programs to support healthy lifestyle changes. This example of a community-directed process to develop a localised, evidence based prevention program that can be run by a range of community members may be useful in other relatively low-resource settings. Community-led programs can be a successful means to communicate key health information that builds a crucial foundation for change.

Many thanks to DAHS and Derby community members for involvement in this project.

Publications:

Seear KH, Lelievre MP, Atkinson DN, Marley JV. ‘It’s important to make changes.’ Insights about motivators and enablers of healthy lifestyle modification from young Aboriginal men in Western Australia. International Journal of Environmental Research and Public Health. 2019; 16:1063. Available from: https://www.mdpi.com/1660-4601/16/6/1063

Seear KH, Atkinson DN, Henderson-Yates LM, Lelievre MP, Marley JV. Maboo wirriya, be healthy: Community-directed development of an evidence-based diabetes prevention program for young Aboriginal people in a remote Australian town. Evaluation and Program Planning. 2020; 81:10808. Available from: https://doi.org/10.1016/j.evalprogplan.2020.101818

Seear KH, Atkinson DN, Henderson-Yates LM, Lelievre MP, Marley JV. Piloting a culturally appropriate, localised diabetes prevention program for young Aboriginal people in a remote town. Australian Journal of Primary Health. 2019; 25:495–500. Available from: https://doi.org/10.1071/PY19024

PhD thesis available from: https://research-repository.uwa.edu.au/en/publications/supporting-healthy-lifestyle-changes-for-type-2-diabetes-preventi

Download:

‘Maboo wirriya, be healthy’ program facilitator manual (7MB)

It’s important to make changes – peer reviewed publication (416 KB)

It’s important to make changes – plain language report (164 KB)

Be Healthy Program Development – plain language report (165 KB)

Be Healthy Program Pilot – plain language report (166 KB)

Researchers:

  • Dr Kimberley Seear, RCSWA Broome (formerly Derby)
  • Assoc Prof Julia Marley, RCSWA Broome
  • Matthew Lelievre (formerly DAHS)
  • Prof Lynette Henderson-Yates, DAHS
  • Prof David Atkinson, RCSWA Broome