One in four Indigenous Australians with a diagnosis of diabetes are not prescribed antidiabetic medications irrespective of whether they live in a major city or rural location, a study suggests.

The cross-sectional study drew from de-identified electronic medical records of 29,429 Aboriginal and/or Torres Strait Islander adults (mean age 45, 60% females) regularly attending 528 mainstream Australian general practices in 2018.

Prevalence of diabetes was 16% among the cohort and more frequent among those living in rural areas (22%) than inner regional (18%) or major cities (16%).

The highest prevalence of diabetes was for males living in rural settings (25%).

Findings published in the Australian Journal of Rural Health [link here] showed that of the patients with diabetes, 72% were prescribed antidiabetics in 2018, with only small differences in frequency between major cities, inner regional or rural areas.

The researchers said insulin was less frequently prescribed in rural areas (18%) than in major cities or inner regional (~21%). In contrast, sulfonylurea prescriptions were more often prescribed in rural settings (20% vs. ~15%).

The less frequent insulin prescriptions might have been due to access constraints for those living in rural or remote areas, such as lack of access to appropriate storage, GP reluctance to prescribe insulin or higher stigma within the rural or remote communities associated with injecting insulin, the authors said.

Of the 2776 patients prescribed metformin, 66% received another antidiabetic medication in 2018, which was lower than the co-prescription of insulin (77%).

After adjustment for sociodemographics, the only persisting difference in diabetes management was the higher frequency of sulfonylureas prescriptions in rural areas than in major cities (odd ratio 1.39), which was also more often co-prescribed.

The clinical significance of this finding remained unclear and questionable, said the University of Adelaide researchers, which included two Aboriginal authors.

The combination of insulin with DPP-4 inhibitors was also more frequent in rural or inner regional areas than in major cities.

“Although this study provided insights into general practice antidiabetic prescribing patterns across geographical regions and suggest there are no geographical gaps, it does not inform on relevant aspects of diabetes management such as education adherence, diabetes monitoring and diabetes control,” the authors concluded.

“Further studies are warranted to explore these and other aspects related to diabetes management among Aboriginal and Torres Strait Islander populations within rural and remote areas to hopefully address the current gap of diabetes burden.”

An Indigenous advisory group enlisted by the researchers when designing the study preferred not to compare Indigenous to non-Indigenous people as they felt there was too much literature describing poor health statistics in comparison to the non-Indigenous population.