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Background: Aboriginal and Torres Strait Islander people have higher rates of diabetes and its complications than non‐Aboriginal people. Rumbalara Aboriginal Co‐operative is the major primary healthcare provider for Aboriginal people in the Greater Shepparton region. Aims: To evaluate the baseline metabolic parameters and presence of diabetes complications in people with type 2 diabetes attending Rumbalara Aboriginal Co‐operative in 2017 and compare it with other Aboriginal and Torres Strait Islander studies and Australian specialist diabetes services. Methods: Clinical and biochemical characteristics, including diabetes type, age, weight, body mass index (BMI), blood pressure, micro‐ and macrovascular complications, glycosylated haemoglobin (HbA1c), haemoglobin, renal function, lipid profile, urine albumin:creatinine ratio, diabetes medications, renin angiotensin system inhibition therapies, HMG‐CoA reductase inhibitors and antiplatelet agents, were determined. Results: One hundred and twenty‐six individuals had diabetes, 121 had type 2 diabetes. One hundred and thirteen identified as Aboriginal and/or Torres Strait Islander. Median age was 57.5 (48–68) years, median HbA1c was 7.8% (6.8–9.6) and median BMI was 33.4 kg/m2 (29–42.3). Compared with other Australian Aboriginal and Torres Strait Islander populations, this population was older and had more obesity, but with better glycaemia management. Compared with specialist diabetes services, this population was of similar age, with greater BMI but comparable HbA1c. Conclusions: Aboriginal people living with type 2 diabetes attending this regional Aboriginal health service have comparable glycaemic management to specialist diabetes services in Australia, managed largely by primary care physicians with limited access to specialist care for the past 5 years. [ABSTRACT FROM AUTHOR]

Aim: The aim was to describe vascular risk factors in Australian adults with diabetes attending an Indigenous primary care nurse‐led diabetes clinic. Design: This was a cross‐sectional descriptive single‐site study. Methods: Vascular risk factor data were extracted from the electronic health records of participants in the nurse‐led integrated Diabetes Education and Eye disease Screening (iDEES) study at a regional Victorian Indigenous primary health‐care clinic between January 2018 and March 2020. Results: Of 172 eligible adults, 135 (79%) provided data. Median (IQR) age was 56 (46–67) years; 89% were Indigenous; 95% had Type 2 diabetes of median (IQR) duration of 6 (2–12) years and 48 (36%) were male. Median HbA1c, blood pressure, cholesterol (total; LDL and HDL), triglycerides, eGFR, CRP and BMI were 8.0% (64 mmol/mol), 127/78 mm Hg, 4.2; 1.9; 1.1 mmol/L, 2.3 mmol/L, 89 ml/min/1.73 m2, 7.0 mg/L and 32.4 kg/m2. Of nine clinical risk factors, the median (IQR) number of risk factors at target was 4 (3–5) for women and 3 (2–5) for men, pχ2 = 0.563. Clinical targets for BMI, HbA1c, blood pressure, triglycerides, total cholesterol, LDL cholesterol, urine albumin: creatinine ratio, HDL cholesterol and smoking were met by 14%, 34%, 38%, 39%, 44%, 52%, 54%, 62% and 64%, respectively. Conclusion: A nurse‐led model of integrated clinical risk factor assessment and diabetes education identified suboptimal levels of clinical risk factor control for avoiding diabetes chronic complications amongst Australian adults with diabetes in an Indigenous primary care setting. Impact A nurse‐led model of diabetes care integrating clinical risk factor assessment into a diabetes education service is achievable. Understanding by stakeholders, including people with diabetes, their clinicians and health services, of the importance of regular monitoring of risk factors impacting diabetes complications is important. The novel nurse‐managed iDEES primary‐care model of care can assist. Trial registration: This study was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618001204235). [ABSTRACT FROM AUTHOR]

Aim: To assess the prevalence of modifiable health‐risk behaviours among Indigenous Australian adults with diabetes attending a regional Victorian Indigenous primary‐care clinic. Design: A cross‐sectional observational single‐site study. Methods: As part of a multi‐study project we administered the Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional wellbeing (SNAPE) survey tool during the study baseline visit to methodically capture health‐related behavioural data in the nurse‐led integrated Diabetes Education and Eye Screening (iDEES) project in a regional Indigenous primary healthcare setting between January 2018 and March 2020. This descriptive SNAPE study helps address the lack of health behaviour data for Indigenous people with diabetes. Results: Of 172 eligible adults, 135 (79%) were recruited to the iDEES study, 50 (37%) male. All participated in at least one survey. Median (range) age was 56 (46–67) years; 130 (96%) had Type 2 diabetes of median [IQR] duration 6 (2–12) years. All 135 provided smoking data; 88 (65%) completed all surveys. Forty‐nine (36%) and 29 (22%) were current or former smokers, respectively; 5 (6%) met vegetable intake guidelines, 22 (25%) met fruit intake guidelines; 38 [43%] drank alcohol in the past year. On average, participants walked for ≥10 min at a time 4 days/week and sat for an average of 8 h on weekdays; 35 (40%) had minimal‐mild, and 30 (34%) had moderate‐severe depressive symptoms. Conclusion: Suboptimal modifiable health‐risk behaviours and depressive symptoms are common in Indigenous Australian adults with diabetes. Impact: Orderly assessment and reporting of health‐risk behaviours using a single multi‐component survey instrument (SNAPE tool) during a nurse‐led diabetes education clinical visit is feasible and efficient. Such data may facilitate personalised interventions and improve diabetes management at both individual and health service levels. [ABSTRACT FROM AUTHOR]

Aims: To improve diabetes management in Indigenous Australians using an integrated nurse-led model of diabetes education and eye screening in indigenous primary care and specialist diabetes clinics., Design: A pre-post study., Methods: This study will be implemented in indigenous primary care and specialist diabetes clinics in Victoria, Australia. Participants recruited to the study will be existing adult patient with diagnosed diabetes attending study sites. A nurse-credentialled diabetes educator and certified retinal imager will deliver three study components: (a) retinal photography as a diabetic retinopathy screening and patient engagement tool; (b) lifestyle and behaviour surveys, administered at baseline and at the final visit, in 12 months. Findings from the surveys and participants' retinal images will be used to guide; and (c) personalized diabetes education. The primary outcomes are participant adherence to diabetic eye screening recommendations and health service diabetic retinopathy screening coverage. Secondary outcomes are baseline DR prevalence and changes in clinical and lifestyle risk factor levels, diabetes knowledge and satisfaction with diabetes care., Discussion: Compared with non-indigenous Australians, Indigenous Australians have a high prevalence of diabetic retinopathy and blindness, low adherence to eye screening recommendations and suboptimal health literacy. Nurse-credentialled diabetes educators can be trained to incorporate retinal imaging and eye screening into their clinical practice to give image-based diabetes education to facilitate diabetic retinopathy management., Impact: Credentialled nurse diabetes educators who integrate eye screening and diabetes education can facilitate timelier diabetic retinopathy screening, referral pathways and treatment of sight-threatening retinopathy. We believe that this model of integrated diabetes education and eye screening will also improve adherence to eye screening recommendations, population screening coverage, health literacy, risk factor levels and diabetes self-care., Clinical Trial Registration: ANZCTRN1261800120435., (© 2021 John Wiley & Sons Ltd.)

Background: Aboriginal Community Controlled Organisations (ACCOs) provide community-focussed and culturally safe services for First Peoples in Australia, including crisis intervention and health promotion activities, in a holistic manner. The ecological model of health promotion goes some way towards describing the complexity of such health programs. The aims of this project were to: 1) identify the aims and purpose of existing health promotion programs conducted by an alliance of ACCOs in northern Victoria, Australia; and 2) evaluate the extent to which these programs are consistent with an ecological model of health promotion, addressing both individual and environmental determinants of health., Methods: The project arose from a long history of collaborative research. Three ACCOs and a university formed the Health Promotion Alliance to evaluate their health promotion programs. Local community members were trained in, and contributed to developing culturally sensitive methods for, data collection. Information on the aims and design of 88 health promotion activities making up 12 different programs across the ACCOs was systematically and prospectively collected., Results: There was a wide range of activities addressing environmental and social determinants of health, as well as physical activity, nutrition and weight loss. The design of the great majority of activities had a minimal Western influence and were designed within a local Aboriginal cultural framework. The most common focus of the activities was social connectedness (76 %). Physical activity was represented in two thirds of the activities, and nutrition, weight loss and culture were each a focus of about half of the activities. A modified coding procedure designed to assess the ecological nature of these programs showed that they recruited from multiple settings; targeted a range of individual, social and environmental determinants; and used numerous and innovative strategies to achieve change., Conclusion: First Peoples' health promotion in the Goulburn-Murray Rivers region encompasses a broad range of social, cultural, lifestyle and community development activities, including reclaiming and strengthening cultural identity and social connectedness as a response to colonisation.