Background

Gap analysis can be defined as a tool that helps in identification and description of contemporary healthcare issue, by clarifying the disparities that exist between present reality, in the domain of health and social care sector, in relation to the optimal or desired healthcare situation. Gap analysis facilitates recognition of an opportunity that needs to be addressed during health promotion. The process of health promotion allows individuals to gain complete power over their health (Eldredge et al., 2016). This assignment will focus on a gap analysis regarding diabetes mellitus in South Australia, by describing its epidemiology, consequences, distribution, and goals will be formulated for health promotion.

Diabetes mellitus refers to a metabolic syndrome that is particularly characterized by an increase in blood sugar level over a prolonged duration. Approximately 1.7 million Australians suffer from the condition. This typically includes 1.2 million diagnosed cases, in addition to an estimated 500,000 undiagnosed cases (Diabetes Australia, 2020). On a global scale, in the year 2013, diabetes accounted for 5.1 million deaths. The inaugural Diabetes Federation of Australia’s (DFA) council meeting had been forced held in October 1957 in Sydney, following which by the year 1982, approximately six diabetes societies associations had been developed that demonstrated a commitment towards diabetes (Diabetes Australia, 2020).

Prevalence of diabetes among Australians in 2017-18 was greater amid males, in comparison to the female counterparts (7% versus 5% respectively). It also demonstrated rapid increase up to the age of 75 years, with 16% prevalence among those aged between 65-74 years, in comparison to the prevalence amongst 45-54 year olds (5%) (AIHW, 2019). According to ABS (2011) socio-economic disadvantage demonstrates strong correlation with inferior health outcomes, decreased life expectancy, and premature mortality, all of which can be associated with an increase susceptibility to diabetes mellitus. Poor socio-economic condition prevents the Australian adults to appropriately access healthcare resources in times of need, thereby creating a significant burden on their health and wellbeing (Huo et al., 2016). Following adjustment of confounding factors, Australian residing in regions that were more marginalised and disadvantaged, demonstrated twice likelihood of suffering from diabetes, compared to those who decided in less disadvantaged area (Burrow & Ride, 2016). Aboriginal and Torres Strait Islanders have almost four times increased susceptibility to suffer from diabetes mellitus, when compared to non-indigenous Australians, after adjustment of differences in their age structures. 13% indigenous Australians accounted for 46,200 adults suffering from diabetes during 2012-13 (AIHW, 2019).

Diabetes associated complications consist of damage to blood vessels that increases the likelihood of suffering from stroke or heart attack, besides resulting in problems with the eyes, kidneys, nerves and feet. Diabetes has been formed to double the risk of suffering from cardiovascular complications, and majority of deaths amongst individuals with diabetes can be accredited to coronary artery disease (Frayling & Stoneman, 2018). While it results in diabetic retinopathy by damaging the blood vessels that are located in retina of the eye, it also increases the risk of suffering from cataract and glaucoma. Diabetic nephropathy results in urine protein loss, tissue scaring, and chronic renal disease, often requiring kidney transplantation or dialysis (Iglay et al., 2016). For management of diabetes, $570 million is the total annual cost, with $4,669 being the average cost for each individual (Diabetes Australia, 2014). It is also estimated that treatment of diabetic foot ulcer in Australia costs roughly $875 million every year. Total annual cost is approximately $14.6 billion (Diabetes Australia, 2020).

Prevalence and Epidemiology of Type 2 Diabetes Mellitus in Australia

Based on the statistical data presented in the previous sections, it has been identified that reducing the health impact and cost of type 2 diabetes among the Aboriginal and Torres Strait Islanders in Australia is the priority health problem. The Aboriginal community has been selected as the target population owing to the fact that they have been found to miss out essential diabetes care that is available to non-indigenous Australians that can be attributed to the population being disadvantaged and marginalized (Titmuss, Davis, Brown & Maple?Brown, 2019). Despite the fact that indigenous Australians are more likely to report death due to diabetes associated complications, compared to non-indigenous Australians, they do not have appropriate access to treatment in remote areas or in cities.

Data published by the Australian Institute of Health and Welfare (2019) highlights the fact that rural and extremely remote areas report greater rates of diabetes hospitalization and associated deaths, when compared to major cities. In addition, poor socio-economic groups report death rate and diabetes hospitalizations twice than the high socio-economic groups. In contrast to the autoimmune condition of Type 1 diabetes, insulin resistance diabetes or type 2 diabetes can be prevented, and is under the direct influence of a range of socioeconomic factors (Hill, Ward, Grace & Gleadle, 2017).

The indigenous population has been found to be more susceptible to a plethora of chronic health elements like kidney failure and heart disease. Consequently this has found to directly contribute to a life expectancy gap between the non-indigenous and Aboriginal individuals, which in turn has resulted in inequity and disparity of health in the population (Burrow & Ride, 2016). The prevalence of type 2 diabetes in this target population can also be accredited to the influence of Europeans at the time of colonization, since it resulted in introduction of refined food and sugar. Disparity in the existing socio-economic conditions and remoteness of the community has also significantly contributed to the high incidence and prevalence of type 2 diabetes in the population.

In addition, the replacement of healthy alternatives with refined food and the fact that Aboriginal Australians are largely dependent on alcohol and tobacco increases their likelihood of acquiring the metabolic syndrome (Canuto, Aromataris, Lockwood, Tufanaru & Brown, 2017). Lack of educational attainment and inability of the Aboriginals to appropriately utilise resources that are present at their disposal also make them more likely to suffer from the condition (Schembri et al., 2016). They are also found to lack appropriate diabetes education and are ill informed about strategies that should be adopted. Therefore, there exists a direct correlation between morbidity due to type 2 diabetes and disparity of health. 

Complications Associated with Type 2 Diabetes Mellitus

The primary goal for the health promotion would be to increase diabetes awareness amongst Aboriginal Australians, which in turn will encourage them to access the healthcare resources existing in their community, and participate in self-management of the disease, thereby decreasing the burden of the disease on the community. The bigger picture of this health promotion project would be to improve health literacy in the indigenous community, which would play a significant role in enhancing health outcomes, and decreasing rates of mortality and morbidity.

References

Australian Bureau of Statistics. (2011). 4820.0.55.001 – Diabetes in Australia: A Snapshot, 2007-08. Retrieved from https://www.abs.gov.au/ausstats/[email protected]/Lookup/4820.0.55.001main+features42007-08

Australian Institute of Health and Welfare. (2019). Diabetes. Retrieved from https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/diabetes/overview

Australian Institute of Health and Welfare. (2019). Diabetes. Retrieved from https://www.aihw.gov.au/reports/diabetes/diabetes-snapshot/contents/how-many-australians-have-diabetes

Burrow, S., & Ride, K. (2016). Review of diabetes among Aboriginal and Torres Strait Islander people. Retrieved from https://ro.ecu.edu.au/cgi/viewcontent.cgi?referer=https://scholar.google.com/&httpsredir=1&article=3229&context=ecuworkspost2013

Canuto, K., Aromataris, E., Lockwood, C., Tufanaru, C., & Brown, A. (2017). Aboriginal and Torres Strait Islander health promotion programs for the prevention and management of chronic diseases: a scoping review protocol. JBI database of systematic reviews and implementation reports, 15(1), 10-14. doi: 10.11124/JBISRIR-2016-003021

Diabetes Australia. (2014). Diabetes: the silent pandemic and its impact on Australia. Retrieved from https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/e7282521-472b-4313-b18e-be84c3d5d907.pdf

Diabetes Australia. (2020). About Diabetes. Retrieved from https://www.diabetesaustralia.com.au/about-diabetes

Diabetes Australia. (2020). Diabetes in Australia. Retrieved from https://www.diabetesaustralia.com.au/diabetes-in-australia

Diabetes Australia. (2020). History. Retrieved from https://www.diabetesaustralia.com.au/history

Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., Fernández, M. E., Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: an intervention mapping approach. John Wiley & Sons. https://books.google.co.in/books?hl=en&lr=&id=UyrdCQAAQBAJ&oi=fnd&pg=PR11&dq=health+promotion&ots=OdbB1EKOwv&sig=-ginKt6-26JgSZEpvl2GHJeZCV0&redir_esc=y#v=onepage&q=health%20promotion&f=false

Frayling, T. M., & Stoneman, C. E. (2018). Mendelian randomisation in type 2 diabetes and coronary artery disease. Current opinion in genetics & development, 50, 111-120. https://doi.org/10.1016/j.gde.2018.05.010 

Hill, K., Ward, P., Grace, B. S., & Gleadle, J. (2017). Social disparities in the prevalence of diabetes in Australia and in the development of end stage renal disease due to diabetes for Aboriginal and Torres Strait Islanders in Australia and Maori and Pacific Islanders in New Zealand. BMC public health, 17(1), 802. https://doi.org/10.1186/s12889-017-4807-5

Huo, L., Shaw, J. E., Wong, E., Harding, J. L., Peeters, A., & Magliano, D. J. (2016). Burden of diabetes in Australia: life expectancy and disability-free life expectancy in adults with diabetes. Diabetologia, 59(7), 1437-1445. https://doi.org/10.1007/s00125-016-3948-x

Iglay, K., Hannachi, H., Joseph Howie, P., Xu, J., Li, X., Engel, S. S., … & Rajpathak, S. (2016). Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus. Current Medical Research and Opinion, 32(7), 1243-1252. https://doi.org/10.1185/03007995.2016.1168291 

Schembri, L., Curran, J., Collins, L., Pelinovskaia, M., Bell, H., Richardson, C., & Palermo, C. (2016). The effect of nutrition education on nutrition?related health outcomes of Aboriginal and Torres Strait Islander people: a systematic review. Australian and New Zealand journal of public health, 40(S1), S42-S47. https://doi.org/10.1111/1753-6405.12392

Titmuss, A., Davis, E. A., Brown, A., & Maple?Brown, L. J. (2019). Emerging diabetes and metabolic conditions among Aboriginal and Torres Strait Islander young people. Medical Journal of Australia, 210(3), 111-113. https://staging.mja.com.au/system/files/issues/210_03/mja213002.pdf