7001HSV: Type 2 Diabetes Research Proposal Part 1, Literature Review

This report is a research proposal, specifically Part 1, focusing on Type 2 Diabetes in North Queensland, Australia. The introduction highlights the high prevalence of type 2 diabetes in the region and the increasing complications, particularly among adult males and older populations, emphasizing the influence of lifestyle, genetics, and healthcare access in rural areas. The literature review synthesizes existing research, including the Australian National Diabetes Strategy 2016-2020, to explore the disease's prevalence, diagnosis, and management, with a focus on the challenges faced by remote communities. The critical analysis examines studies on diabetes prevalence, socioeconomic factors, and health disparities among Indigenous and Aboriginal populations. The logical assessment examines the link between the disease and the health-related aspects of the male population. The report concludes by emphasizing the need for improved health literacy and socioeconomic development to improve diabetes care and outcomes. The report uses figures to support the arguments and includes a comprehensive reference list.

Running head: PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW
PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW

PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW 1
Table of Contents
Introduction......................................................................................................................................2
Evidence from literature..................................................................................................................2
Critical analysis...............................................................................................................................5
Logical assessment..........................................................................................................................9
Conclusion.....................................................................................................................................10
Reference list.................................................................................................................................11

PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW 2
Introduction
The communities in North Queensland in Australia have the highest type 2 diabetes rate
and its complications are increasing too both internationally and nationally. It has been
diagnosed in children, young adults, adolescents, and old people but the prevalence of severity
due to the disease and complications related to it is seen mostly in adult males and older people.
Diabetes is a disease that is a reflection of the lifestyle choices of people but in the rural regions,
people suffering from it is often lead towards it due to genetic predisposition, poor social or
economic aspects and inadequate supply oh health-related care. Therefore, understanding the
issues, prevalence, spread, diagnosis and management for care of the diabetic male population in
the region is assessed in the paper while referring to previous works of literature. Analyzing the
reports and assumptions made by the articles and understanding the method in which it is done is
the aim of the paper.
Evidence from literature
Australian National Diabetes Strategy 2016–2020 states that there are three specific
types of diabetes and type II diabetes is a very common form of the disease. It is mostly
preventable and is associated with the kind of lifestyle an individual leads. In this type of
diabetes, the production of insulin becomes slower progressively in the pancreas leading to the
key organs of the human body resist the impact or effect brought about by insulin (Libianto,
Davis & Ekinci, 2020). The organs' ability to utilize the glucose content in blood decreases.
While this type of diabetes has been recorded in people over the age of 50 in the past, it is
becoming common in an increasing manner in adolescents, young adults and children too. The

PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW 3
article by Azzopardi et al., 2012 states methods of diagnosing and dealing with the issue of
T2DM. There are challenges faced by people in remote areas concerning health care delivery.
Food insecurity, remote settings, inadequate staffing, and basic resource absence commences
reluctance to get a diagnosis, continue with insulin therapy or screening for complications
(Australian National Diabetes Strategy 2016–2020. 2016). Therefore, engaging young adults,
developing psychosocial health, initial management to stabilize issues ketosis and
hyperglycemia, modifying lifestyles, monitoring blood glucose, agents of oral hypoglycaemic
and insulin, treatment targets and more can be practiced to prevent the issue.

PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW 4
Figure 1: Principal health condition
(Source: Diabetes and disability Impairments, activity limitations, participation restrictions, and
comorbidities. 2013)
Reports suggest that during 2012-2013 renal complications related to type 2 diabetes
hospitalizations for Aboriginal and Torres Strait Islander people were 10 times higher than the
non-Indigenous population (Crowshoe et al., 2018). The adverse form of changes in the
nutritional aspects and physical activities of these people resulted in diabetes with the first case
recorded in 1923-24 in Adelaide. The factors present within these people resulting in diabetes in
contemporary times involve a combination of cultural and social determinants, broader
influences of history and proximal factors of health risk. Furthermore, inadequate intake of
vegetables or fruits, abnormal triglycerides and cholesterol, and smoking leads to risk factors of
chronic diabetes including HDL cholesterol being at a high level in males over 15 years as well
as BMI, weight, and systolic blood pressure increase in the same group (Burrow & Ride, 2016).
Various works of literature from the peers help to identify the same.

PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW 5
Figure 2: Educational standards
(Source: Diabetes and disability Impairments, activity limitations, participation restrictions, and
comorbidities. 2013)
Critical analysis
A study carried out in the year 2009 reported that about 827,020 people in Australia are
affected by diabetes as the disease prevails mostly among people who are old between the ages
of 65 and 84 while numbers are low for people affected by diabetes under the age of 40. It is
significantly more prevalent in the group of people who have lower educational standards
(Crowshoe et al., 2018). The numbers were suggested by the Australian Bureau of Statistics
(ABS) Survey of Disability Ageing and Carers or SDAC along with the idea that about 43% of
people reported with diabetes is the health-related issue that causes problems in their lives. Of
the 3.9% of people in Australia suffering from diabetes 53% are male; however, the estimates
can be regarded as conservative as many individuals are not aware of their condition while others
fail to report it. There are certain factors associated with the development of the disease such as
age, race, obesity, ethnicity, family history or poor diet (Davis et al., 2016). In rural men as well
as among the Indigenous and Aboriginals of Australia it has become common due to low-income
rates, limited transportation access, health insurance access being inadequate and the health
literacy of these people are low as well.

PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW 6
Figure 3: Reporting T2DM
(Source: Diabetes and disability Impairments, activity limitations, participation restrictions, and
comorbidities. 2013)
The socioeconomic status of people along with the level of education affects the
development of the disease (Davis et al., 2016). It is common mostly in people who did not
complete their high school education or have finished Year 10 or under. The prevalence of it
among people with low educational levels relates to the high-risk factors associated with Type II
diabetes with people in groups involved in alcohol consumption, physical inactivity or smoking.
The men who have been diagnosed with type II diabetes have a greater risk to develop foot
morbidity due to diabetes. This has been identified by recruiting adults for testing from the non-
metropolitan areas of Australia (Perrin et al., 2019). Another aspect of the disease affecting the
adult male population of Australia among the communities of Northern Queensland was assessed
by the Well Person’s Health Check or WPHC through a survey conducted in a cross-sectional
manner in 26 different remote communities of the mentioned area. Only 32% of the population

PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW 7
self-reported the disease and the sample involved a male population of age 15 years or more.
Blood samples were collected and statistical analysis was performed through SPSS statistical
software for an appropriate outcome. Men in remote Queensland who have diabetes consume
fruits and actively exercise similar to the other members of the community. They abstain from
any form of tobacco smoking as well as alcohol consumption mostly, however, diabetic male
drinkers are recorded to consume alcohol at a hazardous and harmful level that is similar to the
non-diabetic people of the community (McCulloch et al., 2003). Studying the literature helps in
the assessment of the notion that the problems of the development of risk behavior in diabetic
patients are in abundance. Male tobacco smokers with or without the disease smoke in a similar
manner and the rate of smokers among the indigenous population is high too (Perrin et al., 2015).
Figure 4: Principal diagnosis of T2DM
(Source: Australian National Diabetes Strategy 2016–2020. 2016)
In the Northern Queensland communities of the Indigenous and Aboriginals, the adults
that have diabetes have poorer results and suboptimal clinical controls in comparison to the non-
Indigenous population. Analysis performed on the Aboriginal or Torres Strait Islander ethnicity
reported the presence of type II diabetes between ages 18 and 65 involving variables such as
health literacy, blood pressure, smoking status, socio-demographic indicators, BMI, renal

PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW 8
functions, measures concerning the quality of life and lipids (Johnson et al., 2015). The “Getting
Better at Chronic Care” or GBACC research by the Indigenous Health Workers or IHWs plays a
significant role in providing a randomized cluster trial, which is able to identify community-
based chronic diseases. The population of diabetic patients in the Indigenous community
involves younger generations too and about 40% of the participants were advised to intake
insulin despite their high levels of glycemia. There is the presence of albuminuria in high rates
among the male population along with high smoking rates, hypertension, elevated BMI and
dyslipidemia too (Diabetes and disability Impairments, activity limitations, participation
restrictions, and comorbidities. 2013).
Figure 5: Principal diagnosis of T2DM
(Source: Australian National Diabetes Strategy 2016–2020. 2016)
Between the years 2006 and 2011 it was identified that age-specific type II diabetes rates higher
in the young people of Aboriginal and Torres Strait Islanders in Queensland. They were also
found to be four times likely to get hospitalized due to it. Furthermore, between the years 2012
and 2013 hospitalization rates that were age-standardized for type II diabetes complications for
these people were six times higher than non-Indigenous folks. The effects of the medicines due
to diabetes can result in fits, consciousness loss or blackouts too (Libianto, Davis & Ekinci,

PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW 9
2020). Prevalence of disability due to diabetes increases with age. There is also the inclusion of
profound or severe limitations of core activities prevalent due to diabetes in 5.2% of the
population with diabetes. The Baker IDI Heart and Diabetes Institute assembled policymakers,
researchers and clinicians to address the issue of type 2 diabetes mellitus or T2DM. They
identified that the rate of the disease in the male population of the mentioned region is
disproportionately higher due to excessive risks related to onset age that is premature and remote
settings. Obesity becomes a family-related issue for these people and they show signs related to
hyperinsulinism like acanthosis nigricans (Azzopardi et al., 2012). They develop macro-vascular
and micro-vascular complications due to genetic predisposition and physical inactivity as well.
Figure 6: Additional diagnosis of T2DM
(Source: Australian National Diabetes Strategy 2016–2020. 2016)
Logical assessment
While perceiving the health-related aspects of the male population of North Queensland in
Australia concerning type II diabetes it has been analyzed that rural self-management can help
prevent the disease. Suggestions can be made concerning the disease that leads to serious
cardiovascular risk in the high population of people affected by it. The prevalence of the disease
increases with age and affects the young Indigenous population too (Sane, 2018). People living
in remote areas are twice as increasingly affected and the adult males show signs related to

PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW 10
chronic kidney disease. A 2011 report states that the disease is frequent among 60% of the male
population with 12.9% more men dying because of it than the non-Indigenous male population
(Page-Carruth, Windsor & Clark, 2014).
Conclusion
In conclusion, it can be said that the understanding of type II diabetes-related complications in
the male population of North Queensland have helped in developing the idea that not only their
lifestyle choices or their educational standards result in them being diabetic. The remote areas
they reside in and their genetic history amounts to the chronic aspect of the disease. Therefore,
improving health literacy along with developing the socio-economic sectors can help them
survive better and have better care concerning diabetes.

PROPOSAL PART 1: QUESTION AND LITERATURE REVIEW 11
Reference list
Australian National Diabetes Strategy 2016–2020. Health.gov.au. (2016). Retrieved 3 April
2020, from https://www.health.gov.au/sites/default/files/documents/2019/09/australian-
national-diabetes-strategy-2016-2020_1.pdf.
Azzopardi, P., Brown, A., Zimmet, P., Fahy, R., Dent, G., & Kelly, M. et al. (2012). Type 2
diabetes in young Indigenous Australians in rural and remote areas: diagnosis, screening,
management and prevention. Medical Journal Of Australia, 197(1), 32-36.
https://doi.org/10.5694/mja12.10036
Burrow, S., & Ride, K. (2016). Review of diabetes among Aboriginal and Torres Strait Islander
people. Australian Indigenous HealthInfoNet. Healthinfonet.ecu.edu.au. Retrieved 3 April
2020, from https://healthinfonet.ecu.edu.au/healthinfonet/getContent.php?
linkid=590810&title=Review+of+diabetes+among+Aboriginal+and+Torres+Strait+Islan
der+people.
Crowshoe, L., Dannenbaum, D., Green, M., Henderson, R., Hayward, M., & Toth, E. (2018).
Type 2 Diabetes and Indigenous Peoples. Canadian Journal Of Diabetes, 42, S296-S306.
https://doi.org/10.1016/j.jcjd.2017.10.022
Davis, T., Chubb, S., Bruce, D., & Davis, W. (2016). Metabolic memory and all-cause death in
community-based patients with type 2 diabetes: the Fremantle Diabetes Study. Diabetes,
Obesity And Metabolism, 18(6), 598-606. https://doi.org/10.1111/dom.12655
Diabetes and disability Impairments, activity limitations, participation restrictions and
comorbidities. Aihw.gov.au. (2013). Retrieved 4 April 2020, from

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https://www.aihw.gov.au/getmedia/c839baba-3180-4a0e-bbbf-1b68986ac26e/
14593.pdf.aspx?inline=true.
Johnson, D., McDermott, R., Clifton, P., D’Onise, K., Taylor, S., Preece, C., & Schmidt, B.
(2015). Characteristics of Indigenous adults with poorly controlled diabetes in north
Queensland: implications for services. BMC Public Health, 15(1).
https://doi.org/10.1186/s12889-015-1660-2
Libianto, R., Davis, T., & Ekinci, E. (2020). Advances in type 2 diabetes therapy: a focus on
cardiovascular and renal outcomes. Medical Journal Of Australia, 212(3), 133-139.
https://doi.org/10.5694/mja2.50472
McCulloch, B., McDermott, R., Miller, G., Leonard, D., Elwell, M., & Muller, R. (2003). Self-
Reported Diabetes and Health Behaviors in Remote Indigenous Communities in Northern
Queensland, Australia. Diabetes Care, 26(2), 397-403.
https://doi.org/10.2337/diacare.26.2.397
Page-Carruth, A., Windsor, C., & Clark, M. (2014). Rural self-reliance: the impact on health
experiences of people living with type II diabetes in rural Queensland,
Australia. International Journal Of Qualitative Studies On Health And Well-Being, 9(1),
24182. https://doi.org/10.3402/qhw.v9.24182
Perrin, B., Allen, P., Gardner, M., Chappell, A., Phillips, B., & Massey, C. et al. (2019). The
foot-health of people with diabetes in regional and rural Australia: baseline results from
an observational cohort study. Journal Of Foot And Ankle Research, 12(1).
https://doi.org/10.1186/s13047-019-0366-6

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Perrin, B., Allen, P., Skinner, I., Gardner, M., Chappell, A., & Phillips, B. et al. (2015). The foot-
health of adult diabetics in regional Australia: baseline findings from an epidemiological
study. Journal Of Foot And Ankle Research, 8(S2). https://doi.org/10.1186/1757-1146-8-
s2-o32
Sane, R. (2018). Efficacy of Comprehensive Diabetes Care (CDC) Management Program in
Elderly Male Patients of Type II Diabetes Mellitus: A Retrospective Study. International
Journal Of Diabetes And Endocrinology, 3(2), 29.
https://doi.org/10.11648/j.ijde.20180302.12