Doing the work to address Type 2 Diabetes

20 Oct 2021

Type 2 Diabetes is a significant issue in Aboriginal communities. Ray Kelly shares his experience and what work is being done to support our community health.

Do we need to rethink a lot of what we have previously been taught about type 2 diabetes? Over the past 10 years there has been a major paradigm shift occurring in the research world and it is now reaching the broader health profession. I say the broader health profession because Indigenous communities in New South Wales have been successfully utilising this research for a number of years. But more about that later.

It’s common knowledge that rates of type 2 diabetes are higher in Indigenous communities. Lazy researchers will put this down to some ancient gene or some issue with adapting to western foods. But let’s be honest, the rates of obesity and diabetes are rapidly increasing in the non-Indigenous community, so I think it’s obvious that EVERYONE is having a major issue with adapting to western foods. The cause of increased rates of type 2 diabetes in the Indigenous community within Australia is much simpler: We carry more fat around our organs (primarily liver and pancreas) at a lower body weight. It’s the same for the Asian community as well as other groups throughout the world. Lose the fat from that area, and you will be able to improve your blood sugars!

In a new 3-part documentary series, I team up with world renowned medical journalist Dr Michael Mosley to explain this research and show how rapidly the progression of type 2 diabetes can be turned around. Eight Australians were selected to participate in an 8-week lifestyle program. I designed this by combining mine and Michael’s programs, and then coached them over the 8 weeks. This included taking them shopping, guiding them with meal selections, designing an exercise program, providing motivation and support, and working with their doctors as medications were reduced.

This is an area I have a great deal of experience in. ‘Too Deadly for Diabetes’ is the program I developed to turn around the progression of type 2 diabetes within the Indigenous community. It has been provided through Aboriginal medical services in Bourke, Brewarrina, Walgett, Coonamble and other locations throughout the state. The results have shown that if community are provided with a program they understand and good support, they will achieve great results. In just 11 months the community in Coonamble have lost a combined total of 1,316kg, with many having medications reduced or totally removed. In other towns people have been taken off insulin within weeks, after 15-20 years of giving themselves daily injections.

The programs are led by their local team of GPs, nurses and Aboriginal health workers. Almost all of whom have never provided an intensive lifestyle program like this before. Each location can bring its own unique challenges, so as we increase our learning at each location the program is always improving. This is a great example of what local communities can achieve when provided with clear information and support. It’s a program all Indigenous people in Australia can be proud of, developed by and within our own communities.

So, why haven’t we been seeing these results in the mainstream medical centres in major cities? I mean, this is where we should be seeing the best outcomes in the country isn’t it?

The obstacles to success begin when a patient is first diagnosed. Very few people are ever told that remission of type 2 diabetes is even possible. In fact, it’s only recently that remission has been added to the Diabetes Australia website. Lifestyle change is accepted as the first line of treatment but few people are successful. This leaves doctors with the last line of defence: medications. The problem is medications reduce the symptoms (rising blood sugars) but not the cause (accumulation of fat around the organs) so the disease progresses, along with more medications and additional health issues.

We can turn this around but programs must be led by the local community. An honest assessment needs to be made of our current management strategies and the focus needs to be on what is working. It can no longer be a matter of whether remission of type 2 diabetes is possible, but more a focus on what assistance do our patients need to achieve it. Programs must be provided through primary care where possible and funding bodies need to provide long term support. Aboriginal health workers play a crucial role, but they must be from the local community as this can improve communication between the medical service and local families. Clear leadership needs to be provided by our health organisations too. NACCHO and Diabetes Australia can lead the way with a clear and simple message: Type 2 diabetes does not have to be a lifelong disease, and this is how you can turn it around!

Australia’s Health Revolution can be seen on SBS on October 13 at 7:30pm.

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