Indigenous Health

Question 1

In Western Sydney, what percentage of Indigenous Australians have diabetes or pre-diabetes?

Answer 1

Up to 50%

Question 2

In Indigenous Australians, what BMI can the diabetic process begin?

Answer 2

BMI of 23

Question 3

How many years can it take for sugars to rise to a labeled diabetic level?

Answer 3

20 years

Question 4

What sort of environment do Indigenous Australians respond well in for T2DM treatment?

Answer 4

A culturally safe environment

Question 5

Is T2DM reversible?

Answer 5

Yes

Question 6

What is HbA1c?

Answer 6

Haemoglobin A1c is a type of red blood cell that is attached to glucose. The lifespan of a red blood cell is roughly 3-4 months.

Question 7

What does HbA1c above 6.5% tell us?

Answer 7

HbA1c >6.5% is indicative of diabetes. HbA1c gives an idea of how much glucose on average is in the bloodstream (RBC life of 3-4 months).

Question 8

What percentage of Indigenous Australians have a HbA1c < 7%?

Answer 8

<50%

Question 9

What is Prof. Roy Tayllor’s Twin Cycle Hypothesis?

Answer 9

Indigenous Australians carry greater amounts of subcutaneous fat and fat around the liver. The underlying mechanism for T2DM is too much fat around the liver. This can happen in 60kg individuals or 260kg individuals (depends on fat storage limit). This results in liver producing excess sugar&raquo_space; pancreas increases insulin production&raquo_space; insulin resistance&raquo_space; pancreas cannot produce enough insulin

Question 10

What were the main findings in the DiRECT trial?

Answer 10

85% of Indigenous Australians included in the study who lost 15kg+ body mass ended in remission. Loss of 10-15kg = 75% remission and loss of 5-10kg = 50% remission.

Question 11

What did the intervention group in the DiRECT trial receive as treatment?

Answer 11

A complete diet replacement (825-853kcal/day) for 3-5 months followed by stepped food reintroduction over 6-8 weeks. Encouragement for participation in physical activity.

Question 12

What is the main take home message of the DiRECT trial?

Answer 12

Weight loss is the dominant factor behind T2DM remission.

Question 13

Virta Trial was a 10 week online/phone program. Only 19.5% of Indigenous were <6.5% HbA1c at the beginning. After 12 months since starting the trial, what percentage of Indigenous Australians in the trial were below 6.5%?

Answer 13

69.8%

Question 14

What is an important thing an allied health professional should do following an appointment with an Indigenous Australian?

Answer 14

Follow up, even after initial success with weight loss and T2DM remission - will put weight back on over time.

Question 15

What should a physiotherapist consider before providing an Indigenous Australian with education about T2DM?

Answer 15

Simple format/plan to follow for the first week, ensure handouts are in patient appropriate language, provide additional phone/email support.

Question 16

Why is the Reconciliation Action Plan necessary in physiotherapy?

Answer 16

Provide Indigenous Australians access to equitable healthcare. There is limited evidence in the physiotherapy area for indigenous Australians, so there is a need to focus on this. To improve the communication between practitioner and Indigenous patient to prevent misinterpretation, misdiagnosis and ineffective treatment.