1629-P: Changes in the Prevalence of Diabetes, Its Management, and Complications over 15 Years in a Rural Australian Population

Objective: Diabetes screening and management guidelines have changed over the last 15 years. We compared diabetes prevalence, management, metabolic control and complications in 2 surveys, conducted 15 years apart.

Methods: Repeat cross-sectional studies 2001-2003 (XRDS1) and 2016-2018 (XRDS2) across 4 rural Australian towns with previously low access to primary care, involving a household survey followed by biomedical assessments (including OGTTs) among randomly selected individuals.

Results: Overall, household survey/clinic responses were >60% involving 4464/1042 and 2315/748 residents in XRDS1 and 2 respectively. The prevalence of known diabetes increased overall (5.4% to 10.4% p<0.001), in those <50, 50-59, 70+ years; but not 60-69 years (2.5% vs. 4.8% p<0.001, 6.5% vs. 9.7% p<0.05, 9.9% vs. 18.4% p<0.001; 12.8% vs.13.4%). Proportions with undiagnosed diabetes and IFG/IGT were not significantly different (2.3% vs. 1.5%; 11.7% vs. 10.0%). Diabetes screening increased from 48.9% to 59.5% (p<0.001). Among those with known diabetes age (59±16 vs. 63±16 p<0.01), lipid testing (84.8% vs. 92.8% p<0.05), hypertension (52.2% vs. 65.8% p<0.01) and dyslipidaemia (21.9% vs. 55.8% p<0.001) diagnoses, increased. Age at diagnosis (53±15 vs. 52±16 years), BMI (30.4±6.9 vs. 30.8±7.1 kg/m2), glycaemia testing (97.1 vs. 95.3%) and BP testing (98.4% vs. 98.2%) were similar. Mean HbA1c and diastolic BP were similar but systolic BP (143±24 vs. 136±19 mm Hg p<0.05) and total cholesterol (4.8±0.9 vs. 4.4±1.1 mmol/l p<0.05) were lower. Complication rates were similar (nephropathy 27.8% vs. 22.4%, non-fatal stroke 6.2% vs. 5.0%) or increased (depression 14.1% vs. 33.5% p<0.01; cardiac condition 24.1% vs. 32.4% p<0.05).

Conclusions: Over 15 years, diabetes prevalence increased, CVD risk management improved but complications were unchanged or increased. Further work is required to understand the extent to which changing survival, migration, access to care and ageing have contributed to these patterns.