DIABETES MELLITUS

Definition

This topic refers primarily to those ever told by a doctor or nurse they have diabetes mellitus or high sugar levels in their blood or urine.

All types reported were recorded for the item 'whether ever told by a doctor or nurse:

• diabetes - type 1
• diabetes - type 2
• diabetes - gestational
• diabetes - insipidus
• diabetes - type unknown
• high sugar levels.

More than one response was allowed.

For respondents who reported they currently had any type of diabetes, their condition was assumed to be of six months or more duration i.e. long-term, with the exception of gestational diabetes which is assumed to be short-term. Due to the collection methodology for high sugar levels used in NATSIHS (which did not include a question regarding whether it was expected to last for 6 months or more), current high sugar levels is classified as current and long-term for AATSIHS.

Those respondents reporting only diabetes insipidus were recorded as a current, long-term condition and coded under other endocrine, nutritional and metabolic diseases. In this chapter, diabetes refers to diabetes mellitus (type 1, type 2 and type unknown) and gestational diabetes unless otherwise indicated.

Estimates in all ABS publications exclude gestational diabetes and diabetes insipidus. In addition, published diabetes mellitus data from the AATSIHS are primarily based on diagnosis, regardless of whether the respondent considered it to be current.

In addition to self report data for diabetes, information on diabetes was also collected from the NATSIHMS. For more details on this biomedical component, see the Biomedical Measures chapter of this Users' Guide.

Population

Information was obtained for all persons in the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) and persons aged 2 years and over in the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (NATSINPAS).

Methodology

Information about diabetes and high sugar levels was collected in both the NATSIHS and the NATSINPAS surveys. Information on diabetes and high sugar levels was first published in the First Results publication based on the NATSIHS only sample of 9,300 people of all ages. Updated results on diabetes and high sugar levels for the larger, combined NATSIHS and NATSINPAS sample (known as the Core sample), of 12,900 people aged two years and over was published in the Updated Results publication. For comparison of diabetes or high sugar levels with NATSIHS only items or the 0-1 year old population, the NATSIHS file should be used and similarly, for comparison with NATSINPAS only items, the NATSINPAS file should be used. However, for the most accurate information on diabetes or high sugar levels alone or comparison with other items collected in the Core, the Core file should be used. For more information on the structure of the AATSIHS, see the Structure of the Australian Aboriginal and Torres Strait Islander Health Survey page of this Users' Guide.

Respondents were asked if they had ever been told by a doctor or nurse that they had diabetes and/or high sugar levels in blood or urine.

All NATSINPAS respondents, regardless of whether they reported having diabetes, were then asked whether their parents and/or siblings had been told by a doctor or nurse that they had diabetes. This new question has been included in the NATSINPAS to assist with the calculations of diabetes risk using the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK).

Those respondents who reported they had been told they had diabetes or high sugar levels were asked the age at which they were told, and the type of diabetes they were told they had. Persons were then asked whether the diabetes or high sugar level was still current. Those reporting not currently having diabetes/high sugar levels or only having diabetes insipidus earlier were sequenced out of further diabetes questions at this point.

Respondents reporting current diabetes are assumed to have long-term diabetes, with the exception of gestational diabetes which is considered to be short-term. For NATSINPAS, if the respondent reported they currently had high sugar levels they were asked if their condition had lasted, or was expected to last, for six months or more. Note that for output, to be consistent with NATSIHS and due to a low number of NATSINPAS respondents identifying their high sugar levels would not last for 6 months or more, current high sugar levels is only located in the diagnosed, current and long-term condition status category for NATSIHS, NATSINPAS and the Core. However it should be treated as presenting diagnosed and current high sugar levels.

NATSIHS respondents in non-remote areas who had current diabetes or high sugar levels were then asked:

• how often in the last 12 months did they or someone else test their blood glucose levels
• how often in the last 12 months did they or someone else check their feet
• whether they had an HbA1c test in the last 12 months.

NATSIHS respondents in both remote and non-remote areas that had current diabetes or high sugar levels were asked:

• whether they were currently taking insulin every day and, if so, the age at which they began taking insulin and the brand of insulin (in non-remote areas) that they take
• whether they had changed their eating pattern or diet because of diabetes/high sugar levels, and whether they were still following a change of diet
• whether they had taken or used any form of medication in the two weeks previous, other than vitamins or herbal medicines
• whether they had taken any other actions, including:
  • losing weight
  • exercising most days
  • taking vitamins or minerals
  • taking any natural, herbal or bush medicines.

With the exception of insulin, specific medications were not collected in the NATSIHS, however, NATSIHS respondents who had a diabetes or high sugar levels were asked whether they took medication for it in the two weeks prior to the interview.

In addition to self report data for diabetes, information on diabetes was also collected from the NATSIHMS. For more details on this biomedical component, see the Biomedical Measures chapter of this Users' Guide.

Data items

The data items and related output categories for this topic are available in Excel spreadsheet format from the Downloads page of this product.

Interpretation

Points to be considered in interpreting data for this topic include the following:

• Because this is a household based survey, those people with diabetes resident in hospitals, nursing or convalescent homes, or similar accommodation are outside the scope of this survey. As a result, the survey will under-represent those with more severe complications of the condition.
• Due to a collection issue in the NATSIHS, which did not ask whether high sugar levels was expected to last for 6 months or more, data in the NATSIHS, NATSINPAS and Core files categorise diagnosed current high sugar levels as being diagnosed, current and long term. When presenting high sugar levels data it should be reported as diagnosed current high sugar levels.
• Gestational diabetes (ICD-10 detailed codes 754 and 949) is not considered a long-term condition and therefore is not counted in the estimates for diabetes. However, it does contribute towards NATSIHS Diabetes module-specific data.

Comparability with 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS)

The data collected regarding diabetes and high sugar levels in the 2012-13 NATSIHS is considered comparable to that of the 2004-05 survey. However, the following points should be considered when producing time-series data:

• High sugar levels in the 2004-05 NATSIHS was collected in combination with diabetes in remote areas. Therefore data related specifically to diabetes cannot be produced. High sugar levels and diabetes should be combined for 2012-13 NATSIHS when making comparisons.
• Diagnosed and current high sugar levels in 2012-13 NATSIHS is presented in only the diagnosed, current and long-term category. In 2004-05 non-remote respondents were asked whether it would last for 6 months or more to determine whether it was long-term. When making comparisons, the 2004-05 NATSIHS current and long-term and current but not long-term categories should be combined.

Comparability with 2008 National Aboriginal and Torres Strait Islander Social Survey (NATSISS)

Diabetes information was not collected in the 2008 NATSISS, therefore no comparisons can be made.

Comparability with 2011-12 Australian Health Survey (AHS)

Where common, the 2011-12 AHS data is considered comparable to that collected in the 2012-13 AATSIHS regarding diabetes.

However, data regarding high sugar levels should be used with care. The AATSIHS only presents respondents with diagnosed current high sugar levels in the 'diagnosed, current and long-term' condition status category. The AHS separates respondents with diagnosed current high sugar levels into long-term or not long-term. For comparisons with AATSIHS, the AHS 'diagnosed, current and long-term' and 'diagnosed, current but not long-term' condition status categories should be combined.

Care should also be taken when comparing data for items such as the NATSIHS and NHS 'All types of action taken to manage diabetes/HSL', that only common categories are compared and any requirement for output categories such as 'takes actions' or 'does not take actions' are appropriately calculated using only the comparable categories.

Family history of diabetes collected in NATSINPAS is considered comparable to the data collected in the AHS.

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