Background

Far North Queensland and Torres Strait region encompasses the land from Cairns city north to the Torres Strait and has one of the highest indigenous populations in Australia with 14% (vs 17.8%) being of Aboriginal or Torres Strait Islander (ATSI) origin. [1]. The ATSI population in Australia live in more geographically remote areas compared to Australia’s non-indigenous population with two-thirds living outside major cities and over 20% living in remote or very remote communities. [2] 

ATSI Australians have the highest prevalence of diabetes in Australia as well as higher premature death and hospitalisations from complications. [3] The prevalence of diabetes in these communities increases with geographic remoteness. [4] 

Management of diabetes in remote areas is challenged by limited resources at the individual, community and health-care levels. Glyacemic control has been identified as the least well managed diabetes complication in remote ATSI communities. Despite being indicated, insulin therapy and self-monitoring of blood glucose is much less common in these communities. 

Exenatide extended-release is a once-weekly GLP-1 receptor agonist approved for use in adults with type 2 diabetes in Australia in 2016 as an adjunct to lifestyle medication and/or in combination with metformin or sulfonylurea. Treatment adherence is higher with weekly compared to daily administration of GLP-1 agonist. 

Aim

The impact of once weekly exenatide on T2DM management is essentially unknown in ATSI population. This prospective audit will examine the impact of directly observed extended-release exenatide therapy on management of T2DM amongst this extremely unique ATSI population with type 2 diabetes in Far North Queensland.  

Methods

Indigenous type 2 diabetic adults aged over 16 years living in rural and remote Australia that were reviewed by the Cairns Hospital Endocrinology Outreach Service in 2016-2017 were included. Locations involved in the study included Thursday Island, Wujal Wujal, Cooktown, Hopevale, Weipa, Cairns. 


References

1.	Regional Development Australia. Cairns and Far North Queensland Regional Profile. 2012. [cited 2017 Apr 9]. Available at: http://rdafnqts.org.au/  
2.	Australian Bureau of Statistics. Estimates of Aboriginal and Torres Strait Islander Australians, June 2011. Canberra (AU). 2011. ABS Cat. No. 3238.0.55.001 Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/3238.0.55.001
3.	Australian Institute of Health and Welfare. The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples. Canberra (AU). 2015. Cat. No. IHW 147
4.	Australian Bureau of Statistics. Australian Aboriginal and Torres Strait Islander Health Survey. Canberra (AU). 2013. ABS Cat. No. 4727.0.55.001

Directly observed Rx use of exenatide LAR in a unique Aboriginal and Torres Strait Islanders population in Australia