Trends in diabetes monitoring and control among Aboriginal and Torres Strait Islander Peoples attending general practice in urban and rural locations in Australia: a repeated cross-sectional study using data from a national general practice database (MedicineInsight).

Abstract

To determine the proportion of Aboriginal and/or Torres Strait Islander Peoples with diabetes who were monitored according to recommended national guidelines and had their clinical parameters within recommended targets. We also examined trends over time (2013-2022) and compared urban and rural areas. A repeated cross-sectional study using data from a national general practice database (MedicineInsight, 2013-2022). De-identified electronic health records (EHR) of people attending 427 mainstream general practices across Australia. This study included all Aboriginal and/or Torres Strait Islander adults (18+ years) diagnosed with diabetes mellitus who were regular patients (attended at least once a year in three consecutive years) within the MedicineInsight database. Outcomes measured were (i) monitoring of blood glucose, lipids, blood pressure (BP), renal function and Body Mass Index (BMI)/waist circumference (WC) and (ii) achieving recommended targets: glycosylated haemoglobin (HbA1c) ≤7.0%, fasting glucose 4-7 mmol/L, random glucose 5-10 mmol/L, total cholesterol ≤4.0 mmol/L, low-density lipoprotein <2.0 mmol/L, BP ≤130/80 mmHg, estimated glomerular filtration rate >60 mL/min/1.73 m², urine albumin-creatinine ratio (uACR) <2.5 mg/mmol (men); <3.5 (women), BMI <25 kg/m², WC <80 cm (men); <94 (women). Adjusted analyses explored trends and differences in outcomes according to practice remoteness using Australian Statistical Geography Standard (ASGS) classifications: major cities (ASGS-1), inner regional (ASGS-2) or rural/remote (ASGS3-5). Between 70% and 90% of individuals were monitored for the clinical parameters above, except for BMI/WC (55%-75%). Trends in monitoring over time were similar across remoteness areas, increasing slightly in 2013-2014 and declining from 2019. Among those monitored, 53%-86% achieved targets for blood glucose, lipids and renal function; 32%-42% for BP; and <10% had normal BMI/WC. In 2022, the proportion achieving targets was lower in rural than urban areas for blood glucose (68.4%, 95% CI: 60.8 to 75.9 vs 86.3%, 95% CI: 81.8 to 90.7) and lipids (61.3%, 95% CI: 54.1 to 68.5 vs 79.5%, 95% CI: 73.8 to 85.3). The risk of diabetes complications among Aboriginal and/or Torres Strait Islander Peoples could be reduced by improving management of blood pressure and overweight/obesity in all areas, and blood glucose and lipids in rural areas.