Pharmaceutical management of type 2 diabetes among Indigenous Australians living in urban or rural locations: a comparative study using a national general practice database.

INTRODUCTION: Type 2 diabetes is more prevalent among Aboriginal and Torres Strait Islander Peoples, especially those living in rural than urban areas. However, little is known about how diabetes is managed in different settings. OBJECTIVE: To investigate differences in the prevalence of diabetes and the prescription of antidiabetic medications for Aboriginal and/or Torres Strait Islander Peoples living in urban or rural Australia. DESIGN: Cross-sectional study using de-identified electronic medical records of 29,429 Aboriginal and/or Torres Strait Islander adults (60.4% females; mean age 45.2 ± 17.3 years) regularly attending 528 'mainstream' Australian general practices (MedicineInsight) in 2018. FINDINGS: The prevalence of diabetes was 16.0%, and it was more frequent among those living in rural areas (22.0; 95% CI 19.3-24.4) than inner regional (17.6%; 95% CI 16.0-19.2) or major cities (15.8%; 95% CI 14.7-17.0; p < 0.001). The highest prevalence of diabetes was for males living in rural settings (25.0%). Of those with diabetes, 71.6% (95% CI 69.0-74.0) were prescribed antidiabetics, with a similar frequency in urban and rural areas (p = 0.291). After adjustment for sociodemographics, the only difference in diabetes management was a higher prescription of sulfonylureas in rural areas than in major cities (OR 1.39; 1.07-1.80). DISCUSSION: The prevalence of diabetes was similar to other national data, although we found it was more frequent amongst Aboriginal and/or Torres Strait Islander males, especially those from rural areas. CONCLUSION: Despite current recommendations, one-in-four Indigenous Australians with diabetes were not prescribed antidiabetics. The clinical significance of more frequent prescriptions of sulfonylureas in rural locations remains unclear.

General practitioner assessment of lifestyle risk factors for chronic disease: a cross-sectional study in urban, rural and remote South Australia.

BACKGROUND: The assessment and management of the SNAP lifestyle risk factors (smoking, nutrition, alcohol intake and physical activity) is fundamental to primary prevention of chronic disease. This study investigates the prevalence of SNAP assessments conducted in South Australian general practice, according to patient risk profiles, and across urban, rural and remote locations. METHODS: A cross-sectional population-based survey was conducted in South Australia in 2017. Survey data included information on health characteristics, lifestyle risks and general practitioner (GP) assessments for 2775 participants, aged ≥18years, who visited a GP in the past 12months. The main outcome measure was assessment for two or more (≥2) SNAP risks in this time. Logistic regression models were used to estimate the prevalence of ≥2 SNAP assessments by remoteness area, using the Modified Monash Model (MMM) classifications for urban (MMM), rural (MMM3-4) and remote (MMM5-6), and adjusting for sociodemographic, SNAP lifestyle risks and clinical variables. RESULTS: Of the 2775 participants (mean age 49.1±18.7years; 52.7% women), 32% were assessed for ≥2 SNAP in the past 12months. The adjusted prevalence of assessments was higher in rural (43.8%; 95% CI 36.4-51.2%) than urban (29.7%; 95% CI 27.2-32.2%) or remote (34.7%; 95% CI 28.4-41.0%) areas. Depending on rurality, ≥2 SNAP assessments were 2.5-3.4times more likely among participants with existing cardiovascular disease, and two to seven times more likely among participants with three or four SNAP risk factors (P <0.05 in all cases). CONCLUSION: Greater attention to GP SNAP assessments is warranted to match the prevalence of SNAP risks across South Australia.