Type 2 diabetes is a condition in which the body gradually loses the ability to produce enough insulin in the pancreas to manage blood glucose levels [46617].

The exact cause of type 2 diabetes is unknown, however, it has strong genetic, family-related and age risk factors [46617]. Factors that can increase the risk of developing type 2 diabetes include an unhealthy diet, a lack of exercise and being overweight. The condition can develop over years and many people will not have symptoms, which can delay diagnosis. For some people, complications may already be present.

Common symptoms of type 2 diabetes can include, but are not limited to:

• increased thirst
• passing more urine
• feeling tired and lethargic
• always feeling hungry
• gradual weight gain/loss
• blurred vision
• wounds that heal slowly [46617][47945].

Type 2 diabetes is increasingly being diagnosed in Aboriginal and Torres Strait Islander children, adolescents and young adults [44185][49259]. Initiatives such as the ‘Doing it Together’ program, works with young people with type 2 diabetes in the Big Rivers region of the NT. The program aims to develop innovative, strengths based, culturally appropriate peer-support and peer-led education to address key issues including isolation, stigma and shame associated with having diabetes.

Reducing the impact of diabetes among Aboriginal and Torres Strait Islander people is one of the key goals of the Australian national diabetes strategy 2021-2030 [44185]. Areas for action include:

• increasing awareness of type 2 diabetes with culturally appropriate services and programs, with an emphasis on youth type 2 diabetes
• designing and delivering diabetes prevention and management programs via partnerships with communities and Aboriginal and Torres Strait Islander community controlled health services.

The risk factors that contribute to cardiovascular disease (CVD) among Aboriginal and Torres Strait Islander people are complex. They reflect a combination of broad historical, social, cultural, and economic factors, as well as the more commonly described behavioural and biomedical risk factors [24669].

Behavioural or ‘lifestyle’ risk factors common to many types of CVD include:

• smoking tobacco
• being inactive
• an unhealthy diet [34579].

Biomedical risk factors shared by many types of CVD include:

• high cholesterol
• high blood pressure
• diabetes
• being overweight.

A high proportion of Aboriginal and Torres Strait Islander people report having one or more of these risk factors [32052][27711][28321].

A number of tools have been developed to identify people at risk of CVD who may benefit from the early introduction of preventive therapies [33621]. The current Australian Guidelines for the management of absolute CVD risk recommend that a prediction algorithm called the Framingham Risk Equation be used to identify Aboriginal and Torres Strait Islander adults who are at high risk of developing CVD over a five-year period [23381]. The Framingham tool takes into account a number of traditional risk factors: age, sex, high blood total cholesterol, low high-density lipoprotein (HDL) cholesterol level, high systolic blood pressure, the presence of diabetes, and smoking. Australian researchers are interested in improving the accuracy with which this tool predicts CVD for Aboriginal and Torres Strait Islander patients [33463], and identifying additional risk factors that increase the currently unmeasured risk of CVD in Aboriginal and Torres Strait Islander peoples [33621].

While different types of cancer have unique risk factors, there are several risk and protective factors that are common to most cancers [44125]. These factors can be genetic, lifestyle and environmental. Factors relating to behaviour and lifestyle can be adjusted to reduce the risk of getting cancer.

To help protect against getting cancer, people should be supported to:

• not smoke tobacco
• drink alcohol in moderation
• have a healthy diet that is high in fibre (including fruits, vegetables, legumes and cereals) and low in red and processed meats
• limit sun exposure
• be physically active
• maintain a healthy body weight [44125][44126][44127].

Cancer can be associated with chronic infections such as human papillomavirus (HPV), hepatitis B and C viruses and human immunodeficiency virus (HIV) [49032] . Human T-cell lymphotropic virus type 1 (HTLV-1) is another viral risk factor for cancer [49031], with some of the highest rates reported among Aboriginal and Torres Strait Islander people in Central Australia [44396]. There are also environmental risk factors for cancer, including exposure to carcinogens (cancer-causing agents) such as radiation, chemicals and pollution [36771][44128].

For Aboriginal and Torres Strait Islander people, the prevalence of risk factors can be driven by social determinants, including racism and discrimination [47115][49154], while cultural factors such as connection to Country, knowledge and beliefs, language, self-determination, family and kinship and cultural expression can be protective factors for health [45520].

Importantly, being exposed to a risk factor does not mean that a person will definitely develop cancer; some people exposed to one or more risk factors may never develop a cancer, and other people who do develop cancer have no apparent risk factors [44125].

A poor diet contributes to diet-related chronic disorders such as overweight and obesity, malnutrition, cardiovascular disease, type 2 diabetes and chronic renal disease, tooth decay and their complications [5920][5304]. Aboriginal and Torres Strait Islander people are more likely to die from cardiovascular disease and type 2 diabetes than other Australians, yet these diseases are largely preventable [29647][31982][30742]. Five of the seven leading risk factors that contribute to the health gap between Aboriginal and Torres Strait Islander and non-Indigenous Australians – obesity, high blood cholesterol, alcohol, high blood pressure and low fruit and vegetable intake – relate to poor diet [33841].

Good maternal nutrition and healthy infant and childhood growth are fundamental to the achievement and maintenance of health throughout life [33754][33756]. Key factors that impact on the maternal and perinatal outcomes of Aboriginal and Torres Strait Islander mothers and their babies include young maternal age, remoteness and socioeconomic disadvantage [32383].

Good nutrition prior to conception and during pregnancy influences both the mother’s health and that of her baby. It can influence intra-uterine growth, birthweight, and the risk of complications during pregnancy and birth [33754][32383].

Poor nutrition in early childhood can affect growth, which is associated with both short and long term health effects including increased risk of infection and development of chronic diseases later in life [33756][33920][33921]. Poor nutrition can result in both over-nutrition (obesity) and under-nutrition, with increasing rates of overweight and obesity being observed in Aboriginal and Torres Strait Islander children, particularly Torres Strait Islander children [5304].

Food security exists “when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life” [33763].

The underlying cause of food insecurity in Aboriginal and Torres Strait Islander communities include socioeconomic factors such as income and employment, housing, overcrowding, transport, food costs, cultural food values, education, food and nutrition literacy, knowledge and skills [29431].

Lack of food security causes hunger and anxiety related to food shortage in the short term, and serious health consequences related to malnutrition in the medium to long term [32878]. Young children and pregnant and breastfeeding women tend to be particularly vulnerable to the short and longer term effects of food insecurity, which can impact on children’s growth, physical and social and emotional development and learning potential.

Aboriginal and Torres Strait Islander people in remote areas are more likely to experience food insecurity than those in non-remote areas, however food insecurity is experienced in urban areas mostly due to lack of transport and quality of public transport [33769].

Some behaviour and health factors can protect against developing diabetes (protective factors), while others can increase a person’s risk of developing the condition (risk factors) [44997].

Currently, there are no known protective factors for type 1 diabetes. However, changes in lifestyle such as losing weight, increasing physical activity and eating healthy foods are protective factors for type 2 diabetes [44997]. There is also evidence that breastfeeding can reduce the risk of maternal type 2 diabetes later in life [44621].

For Aboriginal and Torres Strait Islander people, cultural factors can also be protective. These can include cultural identity, family and kinship, access to Country and participation in cultural activities [47098][44397].

The risk factors for diabetes can be divided into two categories: modifiable (can be changed) and non-modifiable (cannot be changed) [44997]. Non-modifiable factors include a person’s family history and age. Modifiable factors include:

• high blood pressure
• high blood cholesterol
• tobacco smoking
• low levels of physical activity
• inadequate diet
• overweight or obesity [44185].

Another modifiable risk factor is pre-diabetes. Pre-diabetes is a condition when sugar (glucose) levels in the blood are high, but not high enough to be diabetes [34460].

Having more than one risk factor increases the risk of developing diabetes [44997].

Reducing the impact of diabetes among Aboriginal and Torres Strait Islander people is one of the key goals of the Australian national diabetes strategy 2021-2030. The strategy advocates for communities to have food security, and be supported to make healthy choices and lifestyle changes [44185].

Type 1 diabetes is an autoimmune disease that cannot be prevented. However, type 2 and gestational diabetes can be prevented or delayed by understanding risk factors and making lifestyle changes [45543][27354]. Access to health services, diabetes-related education programs, healthy and affordable food, and places to exercise are important factors in preventing diabetes [44997].

The management of diabetes once diagnosed includes, but is not limited to, healthy eating, being active, taking medications and monitoring blood glucose levels [47945][45667]. Targeted programs, such as Diabetes Yarning – All About Diabetes, provide information about diabetes and how to manage it, presented from a cultural perspective and reflecting the experiences that are specific to Aboriginal and Torres Strait Islander people.

Culturally competent diabetes support, education and services play a significant role in the prevention and management of diabetes among Aboriginal and Torres Strait Islander people [44997][44185].

Reducing the impact of diabetes among Aboriginal and Torres Strait Islander people is one of the key goals of the Australian national diabetes strategy 2021-2030 [44185]. Partnerships with communities and Aboriginal and Torres Strait Islander community controlled health services are an important part of designing and delivering diabetes prevention and management programs.

Type 1 diabetes is a chronic condition where the immune system destroys the cells of the pancreas, the part of the body that produces insulin which regulates the amount of glucose in the blood [45543][47945]. While type 1 diabetes is often diagnosed in childhood or early adulthood, it can occur at any age.

The cause of type 1 diabetes is unknown and it cannot be prevented, however, maintaining a healthy lifestyle, monitoring blood glucose levels and having daily insulin injections or using an insulin pump can help manage the condition after it has been diagnosed [47945][29749].

Symptoms of type 1 diabetes can include, but are not limited to:

• increased thirst
• frequent urination
• unexplained weight loss
• extreme fatigue
• blurred vision
• slow-healing wounds
• increased hunger [47945].

Reducing the impact of diabetes among Aboriginal and Torres Strait Islander people is one of the key goals of the Australian national diabetes strategy 2021-2030 [44185]. Areas identified for action include:

• increase awareness, education and recognition of the symptoms of type 1 diabetes in all communities, including adults, parents, teachers and carers
• ensure education and awareness for timely detection among health care providers, particularly GPs and primary care settings
• develop and implement population screening approaches
• maintain population-wide awareness and early detection of type 1 diabetes during periods of health system challenges [44185].

Targeted health initiatives, such as the Diabetes Yarning – All About Diabetes program, presents information from a cultural perspective reflecting the experiences that are specific to Aboriginal and Torres Strait Islander people. Participants are encouraged to share and continue the yarn with family, friends, community or their health team.