Culturally Safe Diabetes Care for Indigenous Australians

NURSING PRACTICE | CULTURAL SAFETY

Diabetes Mellitus in Aboriginal & Torres Strait Islander Peoples

Pathophysiology, Treatment & Culturally Safe Care

Evidence-Based Nursing Practice | Australia

SLIDE 01 — INTRODUCTION

Introduction

GLOBAL HEALTH BURDEN

T2DM is a major global health concern, with Aboriginal & Torres Strait Islander peoples experiencing disproportionately high prevalence compared to non-Indigenous Australians (AIHW, 2024; Frier et al., 2021).

SOCIAL DETERMINANTS

Geographical isolation, socioeconomic disadvantage, limited healthcare access, and the ongoing impacts of colonisation shape health disparities in Indigenous communities (Bourke et al., 2023).

CULTURAL SAFETY IN CARE

Cultural incongruence between Western health systems and Aboriginal ways of knowing, being, and doing reduces engagement and trust. Holistic, culturally safe nursing practice is essential.

3x

higher prevalence of T2DM in Aboriginal & Torres Strait Islander peoples

(AIHW, 2024)

SLIDE 02 — PATHOPHYSIOLOGY

Pathophysiology of T2DM

Disease Mechanism

Insulin resistance in peripheral tissues

Progressive β-cell dysfunction in pancreas

Chronic hyperglycaemia & blood glucose dysregulation

Complications

Nephropathy, retinopathy & neuropathy

Cardiovascular & chronic kidney disease

Disproportionate impact on Aboriginal peoples (AIHW, 2024)

Systemic inequities — food insecurity, reduced health literacy, and limited preventive care — compound physiological disease progression (Rasmussen et al., 2021; Liddell et al., 2025).

Insulin Resistance

β-cell Failure

Hyperglycaemia → Organ Damage

Pathological cascade of T2DM

SLIDE 03 — TREATMENT & NURSING

Treatment & Nursing Considerations

PHARMACOLOGICAL MANAGEMENT

Metformin is first-line therapy, improving insulin sensitivity and reducing hepatic glucose output (Pink et al., 2023). Advanced cases may require insulin or combination pharmacotherapy.

SIDE EFFECTS & ADHERENCE

GI discomfort, nausea and diarrhoea may reduce adherence, particularly in remote communities with limited clinical follow-up (Bourke et al., 2023).

CULTURALLY SAFE NURSING

Nurses support adherence through education and culturally safe communication. ACCHS-based care improves outcomes and trust (Stoneman et al., 2014; Tan et al., 2024).

Non-pharmacological: dietary modification, physical activity & weight management — contextualised within structural barriers (Rasmussen et al., 2021).

Metformin

Insulin Therapy

Lifestyle Modification

Cultural Safety

Core pillars of T2DM management

SLIDE 04 — CARE PLANNING & RESOURCES

Care Planning & Support Resources

Multidisciplinary team: Aboriginal Health Workers, GPs, dietitians & ACCHS (Stoneman et al., 2014)

Regular HbA1c monitoring, comorbidity review & complication screening

Motivational interviewing & strengths-based communication (Spry et al., 2025)

NDSS: subsidised diabetes supplies & education (Diabetes Australia, 2022)

Telehealth & outreach programs improve specialist access in remote areas

CONCLUSION

Addressing diabetes among Aboriginal & Torres Strait Islander peoples requires evidence-based clinical management combined with culturally safe, community-informed nursing practice. Nurses play a pivotal role in reducing health disparities through holistic, person-centred care and collaboration with ACCHS (Tan et al., 2024).

NDSS

National Diabetes Services Scheme — subsidised supplies & education

ACCHS

Aboriginal Community Controlled Health Services — culturally safe primary care

Telehealth

Remote specialist access & outreach programs

Spry et al. (2025); Tan et al. (2024)

APA 7TH EDITION

Reference

List

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Diabetes Australia. (2022, October 25). Diabetes resources – Aboriginal and Torres Strait Islander Unit. https://www.diabetesaustralia.com.au/aboriginal-torres-strait-islander-people/resources/

Liddell, A., Pink, N., Baldim Jardim Nobre, F., Bernardo, C., Williams, S., Stocks, N., & Gonzalez-Chica, D. (2025). Trends in diabetes monitoring and control among Aboriginal and Torres Strait Islander Peoples attending general practice in urban and rural locations in Australia.

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