Te Wai o Rona: Diabetes Prevention Strategy

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https://hdl.handle.net/10292/14236

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.

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    Supplementary 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, N
    The 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.
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    Mapping 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, D
    Objective 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.
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    Low 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, D
    Aims/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.
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    Relationships Between a Walk Test, Body Size and Metabolic Risk Among a New Zealand Māori Community
    (Taylor and Francis, 2010) Rush, E; Crook, N; Simmons, D
    Aims: 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.
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    Point-of-care Testing As a Tool for Screening for Diabetes and Pre-diabetes
    (John Wiley & Sons, 2008) Rush, E; Crook, N; Simmons, D
    Aim  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.
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