title: Continuing disparities in cardiovascular risk factors and complications between aboriginal and Anglo-Celt Australians with type 2 diabetes: the Fremantle Diabetes Study.
abstract: OBJECTIVE
  To determine whether disparities in the nature and management of type 2 diabetes persist between Aboriginal and the majority Anglo-Celt patients in an urban Australian community.
  
  
  METHODS
  Baseline data from the observational Fremantle Diabetes Study collected from 1993 to 1996 (phase I) and from 2008 to 2011 (phase II) were analyzed. Patients characterized as Aboriginal or Anglo-Celt by self-report and supporting data underwent comprehensive assessment, including questionnaires, examination, and biochemical testing in a single laboratory. Generalized linear modeling with age/sex adjustment was used to examine differences in changes in variables in the two groups between phases I and II.
  
  
  RESULTS
  The indigenous participants were younger at entry and at diabetes diagnosis than the Anglo-Celt participants in both phases. They were also less likely to be educated beyond primary level and were more likely to be smokers. HbA(1c) decreased in both groups over time (Aboriginal median 9.6% [interquartile range 7.8-10.7%] to 8.4% [6.6-10.6%] vs. Anglo-Celt median 7.1% [6.2-8.4%] to 6.7% [6.2-7.5%]), but the gap persisted (P = 0.65 for difference between phases I and II by ethnic group). Aboriginal patients were more likely to have microvascular disease in both phases. The prevalence of peripheral arterial disease (ankle-brachial index ≤0.90 or lower-extremity amputation) increased in Aboriginal but decreased in Anglo-Celt participants (15.8-29.7 vs. 30.7-21.5%; P = 0.055).
  
  
  CONCLUSIONS
  Diabetes management has improved for Aboriginal and Anglo-Celt Australian patients, but disparities in cardiovascular risk factors and complications persist.
authors: School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia. tim.davis@uwa.edu.au
authors: Timothy M E
authors: TM
authors: Davis
authors: Kerry
authors: K
authors: Hunt
authors: Daniel
authors: D
authors: McAullay
authors: Stephen A P
authors: SA
authors: Chubb
authors: Brett A
authors: BA
authors: Sillars
authors: David G
authors: DG
authors: Bruce
authors: Wendy A
authors: WA
authors: Davis
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D044465:White People
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human