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Despite Australia being a wealthy nation with a highly developed healthcare system, diabetes continues to disproportionately impact Aboriginal and Torres Strait Islander peoples and other vulnerable communities.
Geography, language, cultural factors and socio-economic disadvantage contribute to unequal access to healthcare services.
This in turn affects the prevention, diagnosis and ongoing management of diabetes, particularly for people living in rural and remote areas.
Healthcare Impact on Australia’s Indigenous Communities
Key Challenges
- Around one in six Aboriginal and Torres Strait Islander adults are living with diabetes, most commonly type 2 diabetes. (Australian Bureau of Statistics, 2024)
- Hospitalisation rates for diabetes-related conditions are four times higher for Aboriginal and Torres Strait Islander peoples than for non-Indigenous Australians. (Australian Institute of Health and Welfare, 2024)
- Cultural safety, language diversity and socio-economic disadvantage are recognised barriers to accessing effective healthcare services, specialist support and diabetes technologies.
- For many people living in rural and remote Australia, the tyranny of distance remains a significant barrier in accessing basic medical care.
Our Commitment to Health Equity
ACADI is committed to closing the gap in diabetes-related health equity by transforming models of care and improving access to the latest innovations in prevention, treatment and technology.
To help address these challenges, ACADI supports and delivers research projects dedicated to improving access to diabetes care and advancing health equity for Australia’s Indigenous population.
As a trusted partner, ACADI works with Aboriginal and Torres Strait Islander communities to co-design culturally safe, sustainable and community-led approaches to care.
Together, we are helping to close gaps in health outcomes, prevent avoidable complications and create a future where every person has the opportunity to benefit from advances in diabetes care, regardless of where they live.
Diabetes in Northern Australia
30% of the population in the Northern Territory identify as Aboriginal and Torres Strait Islander people, 77% of whom live in remote areas. Access to these locations is difficult, particularly during the wet season when roads are cut off and many communities become accessible only by boat or air.
The Northern Territory is linguistically diverse, with more than 100 Indigenous languages and dialects spoken across the region. English is often the second, third, fourth, fifth or sixth language, so public health campaigns need to be flexible when communicating about diabetes with individuals and their families.
Connection to Country, cultural knowledge and practice are vital to the wellbeing of Aboriginal and Torres Strait Islander people.
Culturally appropriate communication is essential to overcoming the stigma and shame about diabetes, and to supporting those living with, or at risk of, the condition to seek support from local healthcare providers.
Supporting Indigenous Health-Focused Research
A growing portfolio of Indigenous-focused research projects demonstrates ACADI’s commitment to reducing diabetes-related health inequities.
Through co-design, our researchers are translating new knowledge into practical, culturally safe and community-led solutions.
These new approaches can help overcome barriers to care and deliver meaningful benefits for Indigenous Australians living with, or at risk of, diabetes.
The FlashGM Study investigated whether continuous glucose monitoring could improve diabetes management for Aboriginal and Torres Strait Islander people living with type 2 diabetes. Conducted across multiple sites throughout Australia, the study compared flash glucose monitoring with traditional finger-prick blood glucose testing over a six-month period.
With 350 participants recruited nationally, the findings are expected to inform more effective and equitable access to diabetes technologies, improve health service delivery and support better diabetes outcomes for Aboriginal and Torres Strait Islander peoples and other high-risk populations.
Project lead: Prof Elif Ekinci (University of Melbourne)
Collaborator: Coralie Cross (University of Melbourne, ADEA)
Indigenous Australians experience significantly higher rates of type 2 diabetes and diabetes-related complications than non-Indigenous Australians. While continuous glucose monitoring technology can help people better understand and manage their glucose levels, access remains limited and cost is a significant barrier for many who could benefit from the technology.
Building on the national FlashGM Study and its established partnerships with Aboriginal and Torres Strait Islander communities, healthcare providers and health services, this project evaluates the use of continuous glucose monitoring alongside routine diabetes care. The findings will help identify barriers and opportunities for implementation, guide the integration of diabetes technology into Indigenous health settings, and inform future funding and policy decisions across Australia.
Project lead: Prof Elif Ekinci (University of Melbourne)
Collaborators: Mariam Hachem (University of Melbourne), Prof Leonid Churilov (University of Melbourne), Prof Jill Francis (University of Melbourne), Prof Sandra Eades (University of Melbourne), Tracey Hearn (Rumbalara Aboriginal Health Service, University of Melbourne), Belinda Moore (Rumbalara Aboriginal Health Service, University of Melbourne), Ray Kelly (University of Melbourne), Hannah Morris (Maari Ma Health Aboriginal Corporation), Dr Zoe Williams (Austin Health), Prof David O’Neal (University of Melbourne), Diabetes Australia.
Type 2 diabetes has a significant impact on Aboriginal and Torres Strait Islander communities, yet there are limited evidence-based lifestyle programs specifically designed for, and in consultation with, Indigenous Australians.
Dhirrabuu Maaruma-li (meaning “Excellent Healing” in Gamilaraary) investigates whether an Aboriginal-led 10-week lifestyle program, combined with flash glucose monitoring technology, can improve diabetes management for Aboriginal and Torres Strait Islander people living with type 2 diabetes. Delivered through Aboriginal Medical Services across Australia, the study will assess whether this culturally tailored program can improve diabetes outcomes and quality of life, while providing evidence to support broader implementation in Indigenous communities.
Project lead: Ray Kelly (University of Melbourne)
Collaborators: Prof Elif Ekinci (University of Melbourne), Mariam Hachem (University of Melbourne), Prof Leonid Churilov (University of Melbourne), Dr Tamara Power (University of Sydney), A/Prof Jaquelyne Hughes (Flinders University), Tracey Hearn (University of Melbourne), Belinda Moore (University of Melbourne), Hannah Morris (Maari Ma Health Aboriginal Corporation), Dr Zoe Williams (Austin Health), Barbara Flick (University of Melbourne), Dr An Tran-Duy (University of Melbourne), A/Prof Michelle Kennedy (University of Newcastle), University of Melbourne, Indigenous Allied Health Australia, Diabetes Australia.
Diabetes management can be demanding for Aboriginal and Torres Strait Islander peoples, who often develop type 2 diabetes at a younger age. A once-weekly insulin may offer a more practical option for some people while reducing the burden of daily treatment.
Building on the FlashGM Study and its established network, this study will assess whether once-weekly insulin, called insulin icodec, combined with a continuous glucose sensor worn on the arm, can make diabetes management easier for Indigenous Australians living with type 2 diabetes while keeping glucose levels in a safe range. If successful, this approach could reshape type 2 diabetes care for Aboriginal and Torres Strait Islander peoples by making treatment simpler and more accessible.
Project lead: Mariam Hachem (University of Melbourne)
Collaborators: Prof Elif Ekinci (University of Melbourne), Tracey Hearn (University of Melbourne), Bernard Kelly-Edwards (University of Melbourne), Prof Leonid Churilov (University of Melbourne), Dr Marlena Klaic (University of Melbourne), Prof David O’Neal (University of Melbourne), Ray Kelly (University of Melbourne), Coralie Cross (University of Melbourne), Prof Chris Schilling (University of Melbourne), Dr Elizabeth Holmes-Truscott (Deakin University), Prof Stephen Twigg (University of Sydney), Laura Zimmerman, Dr Jas-mine Seah (University of Melbourne), Prof Sean Taylor (University of Melbourne).
Effective, evidence-based diabetes care exists, yet Aboriginal and Torres Strait Islander people do not always have consistent access to it in ways that reflect their priorities, traditional knowledge and practices, and cultural context. Achieving equitable access requires diabetes care that is designed with Aboriginal and Torres Strait Islander peoples and grounded in their ways of knowing, being and doing.
This project aims to transform diabetes prevention and management through the co-design of culturally safe, evidence-based care packages for Indigenous Australians, by working in partnership with individuals and their families, communities and healthcare providers. The findings will help identify practical ways to deliver effective diabetes care that is culturally safe and locally relevant, supporting self-determination and strengthening diabetes care across Australia.
Project lead: Prof Elif Ekinci (University of Melbourne)
Collaborators: Dr Marlena Klaic (University of Melbourne), Prof Sean Taylor (University of Melbourne), Mariam Hachem (University of Melbourne), Prof Sandra Eades (University of Melbourne), Prof Leonid Churilov (University of Melbourne), Bernard Kelly-Edwards (University of Melbourne), Tracey Hearn (University of Melbourne), Coralie Cross (University of Melbourne), Dr Elizabeth Holmes-Truscott (Deakin University), Prof Chris Schilling (University of Melbourne), Dr Gaurav Puri, Dr Tripti Joshi, Prof David O’Neal (University of Melbourne).
Bernard and the FlashGM study
Bernard, a proud member of the Gumbaynggirr, Bundjalung and Dhunghutti Nations, has turned his life around after a decade of health struggles and neglecting his type 2 diabetes. The turning point came when an Indigenous doctor took the time to listen, connect and meet his needs. “I can be my authentic self with a doctor who knows how to listen,” Bernard says.
A need to retain his driver’s licence was the ultimate motivator to take control of his diabetes. Bernard has lost more than 20 kilograms by walking 4.5 kilometres each day, learned to cook healthy food, and now enjoys being an active and energetic father to his daughter.
His hard work has paid off. Bernard has retained his driver’s licence for another two years, proving he is safe to be behind the wheel.
Bernard had worked with members of the ACADI research team for some time before being invited in 2024 to contribute to diabetes community engagement activities for Indigenous and non-Indigenous communities.
“My journey with type 2 diabetes had been pretty impacting until I was asked to work on this project. It was a real kick up the backside. This diabetes isn’t just about me. It’s about helping my mob, nationally.”
Bernard is the multimedia artist behind ACADI’s FlashGM video, used by doctors to support informed discussions with Aboriginal and Torres Strait Islander people considering participation in the study.
The program aimed to replace finger-prick blood glucose testing with continuous glucose monitoring. By wearing a monitor that measures glucose levels continuously, participants could better understand how food and other factors affected their blood glucose levels in real time. In total, 350 Aboriginal and Torres Strait Islander people were recruited across multiple trial sites throughout Australia. With the study now complete, the research team is analysing the data.
Bernard continues to support ACADI and the FlashGM study team as a cultural advisor, ensuring communications acknowledge culturally sensitive approaches to community and Country.
He is passionate about helping younger generations understand the importance of caring for their health before they are diagnosed with diabetes, “We need to encourage oral storytelling through the FlashGM study; we need to listen to our Elders and ask them how they have found life with diabetes.”
Tony, diabetes educator with FlashGM
Tony, a diabetes educator, is managing the FlashGM study at a Carins-based, community-run Wuchopperen Health Service. Most of his clients identify as Torres Strait Islander and many others are Aboriginal. Since the FlashGM study arrived in mid-2021, his capacity to assist his clients has improved significantly.
The ACADI study is a national multi-centre clinical trial for 350 Indigenous Australians with type 2 diabetes. The trial investigates if a continuous glucose monitoring device that sits under the skin on the arm, providing immediate blood glucose monitoring, improves diabetes management compared to finger prick testing.
“I’ve been a nurse and diabetes educator for decades and it’s the first time I’ve been involved in running a study,” Tony says. “It’s been really interesting and pretty straightforward. I guess the most demanding aspect is keeping my files up-to-date in REDCap (trial database) and ensuring clients come in for their three-monthly checks and blood tests.”
When communicating with patients, Tony says the quality of graphs displayed on his computer screen – generated by the device’s sensor software – take diabetes self-management to a new level. “The clients can see their insulin levels over a 24-hour, and a two-week period so it helps them understand and manage.”
Tony estimates 80 per cent of his clients are highly motivated from seeing the data and are keen to learn more when he explains the need for insulin adjustment. All of Tony’s clients much prefer wearing the sensor to finger-pricking.
He says there is a lot of curiosity when community members see a client wearing the sensor on their arm. “The clients become educators. I have community members coming in to see me after hearing the client’s enthusiastic description of their improved diabetes management. Everyone wants one but cost is a big factor.”
According to ACADI Director and the study’s lead investigator, Professor Elif Ekinci, the research aims to achieve major, cost-effective health gains for Indigenous Australians, and significantly improved health-service delivery for Indigenous and other high-risk Australians.
Coralie and the FlashGM study
ACADI doctoral candidate Coralie is a proud Wiradjuri woman, born in Dubbo, and a clinical nurse practitioner working in diabetes care in South Australia.
Her path to nursing and research has been one of resilience and determination. Leaving school at 16, pregnant and single, Coralie knew she needed a career that would allow her to support her son.
“I wanted to keep my son and I knew that I would need a career. Nursing would always get me a job so I’d be able to support him,” she says.
Today, Coralie combines her role as a credentialled diabetes educator with the York and Northern Local Health Network in regional South Australia with doctoral studies supported by ACADI’s FlashGM Study and the University of Melbourne’s Poche Centre for Indigenous Health.
Her PhD investigates how Aboriginal and Torres Strait Islander people living with diabetes are asked questions about their health-related quality of life during health appointments and whether there may be more culturally appropriate ways for healthcare professionals to gather meaningful patient information.
Looking back on her own upbringing, Coralie recognises that traditional oral storytelling techniques were often used by her grandmother, with lessons and values woven into gentle yarns. These experiences are helping to shape her thinking about how researchers engage with Aboriginal and Torres Strait Islander peoples and understand their experiences of living with diabetes.
“People wonder why they are asked the same simple questions over and over again,” Coralie says. “I’m looking at how we can ask more revealing questions like, ‘Tell me about your pain. Is it physical, spiritual, cultural or maybe psychological?'”
Her objective is to help ensure that health-related quality of life tools better reflect Indigenous perspectives and experiences, recognising that wellbeing extends beyond physical health to include social, emotional, cultural and spiritual dimensions.
Coralie’s research complements ACADI’s commitment to culturally safe, community-led approaches to diabetes care and has the potential to improve the way healthcare providers engage with Aboriginal and Torres Strait Islander peoples.
Reflecting on her journey to a PhD at the age of 68, Coralie is quietly proud to be the only person from her generation in her family to attain a university qualification.
“I was never meant to be anything.”
