Transforming diabetes care in Indigenous communities through innovation, partnership and support
The challenge
For Aboriginal and Torres Strait Islander people living in regional and remote Australia, type 2 diabetes is far more than a health statistic. It's a daily reality that affects families, communities and futures.
Diabetes occurs at nearly four times the rate in Indigenous Australians compared to non-Indigenous Australians. It's a leading cause of kidney disease, heart disease, vision loss and early death. These challenges are compounded by distance from healthcare services, limited access to specialist support, and care models that weren't designed with community needs at the centre.
Because the problem still exists, we're working to change it.
A new model of care
IMPROVE sugar is reimagining what diabetes care can look like when it's built around people and communities, not systems.
Instead of expecting people to navigate complex treatment alone, this study tests a more intensive, supportive approach. Participants attend their local Aboriginal Community Controlled Health Organisation weekly for monitoring, lifestyle support, and access to tirzepatide — an innovative medication that helps improve blood sugar control, supports weight management, and reduces cardiovascular risk.
This isn't just about better medicine. It's about better care. Regular check-ins. Clinical support. A model designed to fit into community life, not disrupt it.
We're comparing this approach with standard diabetes care across 10 communities in Queensland, Victoria, New South Wales and Central Australia, working with around 260 participants.
Research led by community
This research is guided at every step by an Indigenous Advisory Board, ensuring cultural safety, community priorities and lived experience shape the work.
We're partnering with Aboriginal Community Controlled Health Organisations because they understand their communities best. They're not just research sites — they're co-designers, leaders and trusted voices ensuring this work delivers real value.
What success looks like
By the end of the study, we'll know whether this intensive model leads to better health outcomes, is cost-effective for health systems, and is sustainable for clinics and communities.
If successful, IMPROVE sugar could reshape how diabetes care is delivered across regional and remote Australia — putting people at the centre, improving lives, and reducing the devastating impact of this disease.
Project details
Led by: Associate Professor Neale Cohen
Partners: 10 Aboriginal Community Controlled Health Organisations across Qld, Vic, NSW and Central Australia.
Participants: Approximately 260 Aboriginal and Torres Strait Islander adults living with type 2 diabetes.
Status: Active
Associate Professor Neale Cohen visiting the Bidgerdii Community Health Service in Queensland