Te Wai o Rona: Diabetes Prevention Strategy
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Te Wai o Rona: Diabetes Prevention Strategy was a randomised trial of lifestyle change among Māori in whole communities. It intended to serve as a model for the rest of New Zealand under the National Diabetes Research Strategy.
New Zealand has identified diabetes and/or heart disease a major public health problems and health priority areas in the New Zealand Health Strategy.
The Health Research Council and Ministry of Health funded a competitive grant to prevent diabetes within the Waikato/Southern Lakes District Health Board regions. Funding was also provided by the respective District Health Boards, the local Ministry of Health Public Health Directorate, Sport and Recreation New Zealand and others. The recipients of this funding were a partnership of iwi, researchers, Māori health providers and other health services. The grants funded Te Wai o Rona.Browse
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- ItemSupplementary Materials to Development and Piloting of a Community Health Worker-based Intervention for the Prevention of Diabetes Among New Zealand Māori in Te Wai O Rona: Diabetes Prevention Strategy(Cambridge University Press, 2008) Simmons, D; Rush, E; Crook, NThe supplementary files in this record point to Table 1 (pg. 4) of the article; Development and Piloting of a Community Health Worker-based Intervention for the Prevention of Diabetes Among New Zealand Māori in Te Wai O Rona: Diabetes Prevention Strategy.
- ItemLow Prevalence of Retinopathy, but High Prevalence of Nephropathy Among Māori With Newly Diagnosed Diabetes - Te Wai o Rona: Diabetes Prevention Strategy(Elsevier, 2008) Lim, S; Chellumuthi, C; Crook, N; Rush, E; Simmons, DAims/hypothesis To describe the prevalence of retinopathy and microalbuminuria at diagnosis of diabetes in a predominantly Maori study population. Methods Biomedical assessment including photographic retinal examination was undertaken among 157 (68.9% of eligible) members of Maori families (3.3% non-Maori) diagnosed with diabetes during a community screening programme (n = 5240) as part of a diabetes prevention strategy. Results Mean HbA1c of those with newly diagnosed diabetes was 7.8 ± 1.5% with 34.4% having an HbA1c ≥8.0%. Retinopathy was present in 3 (1.7%) subjects, cataracts in 3.2%, microalbuminuria in 29.6% and albuminuria in 7.7%. After adjusting for covariates, only smoking was a risk factor for microalbuminuria/proteinuria (current and former smokers: increased 3.81(1.32–11.0) and 3.67(1.30–10.4) fold, respectively). Conclusions The prevalence of retinopathy at diagnosis was lower than in previous studies, yet that of microalbuminuria/proteinuria remained high. The retinopathy data suggest that case detection for diabetes in the community may be improving, but that other strategies among those at risk of diabetes, including those promoting smoking cessation, will be needed to reduce the risk of renal disease among Maori with diabetes.
- ItemDevelopment and Piloting of a Community Health Worker-based Intervention for the Prevention of Diabetes Among New Zealand Māori in Te Wai O Rona: Diabetes Prevention Strategy(Cambridge University Press, 2008) Simmons, D; Rush, E; Crook, NObjective The progression from impaired glucose tolerance (IGT)/impaired fasting glucose (IFG) to type 2 diabetes can be prevented or delayed through intensive lifestyle changes. How to translate this to implementation across whole communities remains unclear. We now describe the results to a pilot of a personal trainer (Maori Community Health Worker, MCHW) approach among Maori in New Zealand. Design, setting and subjects A randomised cluster-controlled trial of intensive lifestyle change was commenced among 5240 non-pregnant Maori family members without diabetes from 106 rural and 106 urban geographical clusters. Baseline assessments included lifestyle questionnaires, anthropometric measurements and venesection. A pilot study (Vanguard Study) cohort of 160 participants were weighed before and during MCHW intervention, and compared with fifty-two participants weighed immediately before intervention and with 1143 participants from the same geographical area. Interactions between participants and the MCHW were reported using personal digital assistants with a programmed detailed structured approach to each interview. Results During the Vanguard Study, participants and MCHW found the messages, toolkit and delivery approach acceptable. Those with IGT/IFG diagnosed (n 27) experienced significant weight loss after screening and during the Vanguard Study (5·2 (sd 6·6) kg, paired t test P < 0·01). Significant weight loss occurred during the Vanguard Study among all participants (−1·3 (sd 3·6) kg, P < 0·001). Conclusions Comparable initial weight loss was shown among those with IGT/IFG and those from existing trials. Community-wide prevention programmes are feasible among Maori and are likely to result in significant reductions in the incidence of diabetes.
- ItemPoint-of-care Testing As a Tool for Screening for Diabetes and Pre-diabetes(John Wiley & Sons, 2008) Rush, E; Crook, N; Simmons, DAim To determine the utility of finger-prick point-of-care testing (POCT) of blood glucose for the detection of dysglycaemia. Methods A fasting POCT and an oral glucose tolerance test (OGTT) with laboratory assays were performed as part of the baseline screening for 5309 participants enrolled in the Te Wai o Rona Diabetes Prevention Strategy. Participants were aged 46 ± 19 years with no self-reported diabetes. Dysglycaemia, including diabetes, was defined using World Health Organization criteria. Agreement between the two fasting plasma glucose measurements and their screening properties (with sensitivity and specificity for cut points) were compared using receiver operator characteristic analysis. Results A total of 3225 participants had both capillary and venous fasting blood sampled within 30 min and then underwent OGTT. New diabetes was found in 161 participants (5.0%) and pre-diabetes in 414 [impaired glucose tolerance 299 (9.3%), impaired fasting glucose 115 (3.6%)]. The mean difference in capillary and venous measures was 0.02 mmol/l (95% confidence interval −0.04 to +0.01; limits of agreement –1.37 to 1.33 mmol/l). Capillary POCT was a poorer predictor of dysglycaemia and impaired glucose tolerance and new diabetes (area under curve 0.76 and 0.71) than venous laboratory analysis (area under curve 0.87 and 0.81 respectively). Optimal screening criteria were best at a venous glucose of 5.4 mmol/l; 77% sensitivity/specificity. Conclusions POCT significantly underestimated the true blood glucose at diagnostic levels for diabetes. POCT cannot be recommended as a means of screening for or diagnosing diabetes or pre-diabetes.
- ItemThe New Zealand Experience in Peer Support Interventions Among People With Diabetes(Oxford Academic, 2009) Simmons, D; Voyle, J; Rush, E; Dear, MBackground. Peer-to-peer support has the potential to assist people with diabetes, or at risk of diabetes. Objective. To review the development of diabetes peer support initiatives in New Zealand. Methods. A systematic review of diabetes peer support publications from New Zealand, supplemented by unpublished records from Diabetes New Zealand (DNZ, the national diabetes patient organization) and the two major regional initiatives in South Auckland and Waikato. Results. DNZ, which has 40 societies and 71 diabetes support groups, delivers a range of services to members and non-members. The membership is mainly older European New Zealanders with diabetes, with some Maori and associated societies for Pacific and Youth. While demand exists, no quantitative evaluation of health impact by these organizations has been undertaken. Other peer support groups have developed in South Auckland and Northland. Common themes that emerge relate to leadership, organization and balancing the different needs of people with diabetes at different stages (e.g. newly diagnosed versus others) and with different personal needs. In South Auckland and the Waikato, lay educators have been trained to provide 1:1 and group sessions for people with, or at high risk of, diabetes. A range of training, management, funding and organizational barriers existed in the implementation of these lay educator programmes. Conclusions. Peer-to-peer support and education programmes in diabetes have been considered useful in New Zealand. Knowledge regarding training, management and organization is nearing a level, which would allow formal evaluation of a strategy for both the prevention of diabetes and in supporting people with diabetes.
- ItemOptimal Waist Cutpoint for Screening for Dysglycaemia and Metabolic Risk: Evidence From a Māori Cohort(Cambridge University Press, 2009) Rush, EC; Crook, N; Simmons, DWe sought to identify the sex-specific cut-off in waist circumference which best identifies those with metabolic abnormalities consistent with the metabolic syndrome (MS) among Maori, the indigenous people of New Zealand of Polynesian origin. In 3816 self-identified Maori (2742 women, 1344 men) a 75 g oral glucose tolerance test, fasting lipid, anthropometric and blood pressure measurements were made. MS components were defined by Adult Treatment Panel (ATP) III criteria. Waist cut-off was defined using receiver operating characteristic (ROC) curve analysis to define the presence of at least two of the other MS components ( ≥ 2MS). Prevalence of ≥ 2MS was high (42·1 %). In males and females, waist was as good, or better, a predictor of ≥ 2MS (area under ROC 0·73 women, 0·68 men) as waist:hip ratio (0·66, 0·67), BMI (0·72, 0·68) or percentage body fat (0·70, 0·68). The prediction of dysglycaemia using anthropometric variables followed a similar pattern to ≥ 2MS. Waist circumference to predict ≥ 2MS or dysglycaemia in Maori women and men was 98 cm and 103 cm. Applying this cut-off to the International Diabetes Federation (IDF) criteria would identify 27·8 % (34·0 % males, 25·5 % females) with the MS with an OR for ≥ 2MS (adjusted for sex, smoking and age) of 3·5 (95 % CI 3·1, 4·0). Age >48 years, smoking and being male increased the odds of the MS. These waist cut-offs should be considered in both clinical practice and to optimise the definition of the MS for Maori. The validity of these criteria in other Polynesian groups should be confirmed.
- ItemPrevalence of Undiagnosed Diabetes, Impaired Glucose Tolerance, and Impaired Fasting Glucose Among Māori in Te Wai o Rona: Diabetes Prevention Strategy(New Zealand Medical Association, 2009) Simmons, D; Rush, E; Crook, NAims To describe the prevalence of undiagnosed diabetes, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) (“dysglycaemia”) among Māori. Methods Te Wai o Rona: Diabetes Prevention Strategy was a trial of lifestyle change among Māori families in the Waikato/Lakes areas of New Zealand. All Māori family household members aged ≥28 years, without known diabetes, were invited to participate through primary care, community, and media approaches. Participants were invited to have an oral glucose tolerance test (OGTT). Results Of the 3817 eligible Māori, mean BMI was 32.9±7.8 kg/m2 (women) and 33.1±6.7 kg/m2 (men). The age standardised prevalence of undiagnosed diabetes was higher among men than women (6.5[5.8–7.4]% vs 4.2[3.6–4.8]%), as was that for IFG (5.4[4.7–6.1]% vs 3.0[2.3–3.5]%), but not IGT (8.5[7.6–9.4]% vs 9.7[8.7–10.6]%) with no rural-urban differences. The prevalence of dysglycaemia increased with increasing BMI with no clear inflection point and was 1.33(1.11–1.60) greater among those with a community services card after adjusting for age, sex and BMI. Conclusions Undiagnosed diabetes, IGT, and IFG remain common among Māori, particularly men, the very obese, and those with greater socioeconomic disadvantage. There remains significant opportunity to reduce Māori morbidity and premature mortality through diabetes case-finding and intervention.
- ItemMapping the Availability and Accessibility of Healthy Food in Rural and Urban New Zealand: Te Wai o Rona: Diabetes Prevention Strategy(Cambridge University Press, 2010) Wang, J; Williams, M; Rush, E; Crook, N; Forouhi, N; Simmons, DObjective Uptake of advice for lifestyle change for obesity and diabetes prevention requires access to affordable ‘healthy’ foods (high in fibre/low in sugar and fat). The present study aimed to examine the availability and accessibility of ‘healthy’ foods in rural and urban New Zealand. Design We identified and visited (‘mapped’) 1230 food outlets (473 urban, 757 rural) across the Waikato/Lakes areas (162 census areas within twelve regions) in New Zealand, where the Te Wai O Rona: Diabetes Prevention Strategy was underway. At each site, we assessed the availability of ‘healthy’ foods (e.g. wholemeal bread) and compared their cost with those of comparable ‘regular’ foods (e.g. white bread). Results Healthy foods were generally more available in urban than rural areas. In both urban and rural areas, ‘healthy’ foods were more expensive than ‘regular’ foods after adjusting for the population and income level of each area. For instance, there was an increasing price difference across bread, meat, poultry, with the highest difference for sugar substitutes. The weekly family cost of a ‘healthy’ food basket (without sugar) was 29·1 % more expensive than the ‘regular’ basket ($NZ 176·72 v. $NZ 136·84). The difference between the ‘healthy’ and ‘regular’ basket was greater in urban ($NZ 49·18) than rural areas ($NZ 36·27) in adjusted analysis. Conclusions ‘Healthy’ foods were more expensive than ‘regular’ choices in both urban and rural areas. Although urban areas had higher availability of ‘healthy’ foods, the cost of changing to a healthy diet in urban areas was also greater. Improvement in the food environment is needed to support people in adopting healthy food choices.
- ItemRelationships Between a Walk Test, Body Size and Metabolic Risk Among a New Zealand Māori Community(Taylor and Francis, 2010) Rush, E; Crook, N; Simmons, DAims: Programmes to prevent or delay chronic disease incorporate promotion of physical activity, particularly walking. The objective of this study was to test the associations of the ability to walk quickly with measures of adiposity and metabolic risk including dysglycaemia. Subjects and methods: Participants (3209), without known diabetes, in a lifestyle trial undertook a 4-minute walk test (4MWT) following measurements of fasting lipids, 75 g oral glucose tolerance test, anthropometry and blood pressure. Lower socio-economic status was defined by possession of a ‘community services card’ (CSC). Dysglycaemia (diabetes, impaired glucose tolerance and impaired fasting glucose) and metabolic syndrome (MS) were defined by WHO and ATPIII criteria, respectively. Results: Controlling for age, length of the walk-course and height, distance walked during the 4MWT decreased linearly (p < 0.001) with increasing waist, body mass index, %fat mass and MS risk. On average those with dysglycaemia walked 15.2 (95% CI 9.3, 20.8) m less than ‘normal’ participants independent of gender. In the best-fit regression model, distance walked was associated with reduced distances walked 1.3 (1.2, 1.5) m/year of age, 0.9 (0.8, 1.1) m/kg fat, 15.7 (11.2, 19.5) m with a CSC and 8.0 (5.8,10.2) m if currently smoking. Each additional MS factor was associated with a reduction of the distance walked by 6.6 (4.6, 8.6) m. Conclusion: Increasing numbers of MS components are associated with slower walking. The 4MWT is an easy assessment of functional limitation, which may have use in guiding intervention.