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The prevalence of glucose metabolism disorders in the community intervention area (the rural area north of Gisborne) is high.  About half of the community was identified as having insulin resistance, impaired fasting glycaemia, impaired glucose tolerance or type 2 diabetes in our pre-intervention survey in 2003. [1]  This group is at high risk of cardiovascular disease, one of the most common causes of premature mortality.  Diabetes and cardiovascular disease are a significant health burden in New Zealand, particularly in Maori communities and this burden is likely to worsen dramatically if the prevalence of obesity continues to increase, unless effective prevention programmes are implemented.

Ngati and Healthy, the 2006 Whanau Ora Award supreme winner (Read the media release here) and a 2006 Health Innovation Award finalist, is a collaborative community intervention between Ngati Porou Hauora and the Edgar National Centre for Diabetes Research, aimed at reducing the incidence of insulin resistance in the short term and type 2 diabetes in the long term.  Implementation of the diabetes prevention community intervention began in 2004.  Key risk factors identified in the pre-intervention survey 2 informed the intervention objectives, which are:

1. to increase the consumption of fruit and vegetables
2. to increase the consumption of wholegrain foods
3. to reduce the consumption of fat
4. to increase exercise levels
5. to reduce level of smoking
6. to reduce alcohol intake

The first 2 years of the community intervention raised awareness of diabetes and that it is a preventable condition, and importantly, the community has been mobilised and members have begun to take an active part in the design, set up and running of community initiatives (eg walking groups, water only schools), a critical feature of sustainable community interventions.

The next 3-year phase of the intervention aims to consolidate work already initiated and to embed the intervention into all parts of the community including workplaces and schools.

Evaluation is a critical part of our community intervention research. To assess the effectiveness of our diabetes prevention community intervention we are using interrupted time series prevalence surveys of glucose metabolism disorders and health behaviours, and formative and process evaluation methods. The surveys include the assessment of the prevalence of insulin resistance, impaired fasting glycaemic, impaired glucose tolerance, T2DM, cardiovascular risk factors and health behaviours. The results of the 2003 and 2006 surveys will be compared.

A 3-year formative and process evaluation of stage 2 of the intervention began at the end of 2007. The aims of this research are:

1. to undertake a formative evaluation, as a critical and integral part of the next 3-year phase of the intervention.
2. to continue and build on a process evaluation, which will be utilised to assist with interpreting the results of the planned 2010 prevalence survey in the context of intervention activities.

Funding:

2003 Prevalence Survey
Professor Mann's Bristol-Myers Squibb/Mead Johnston Unrestricted Research Grant
Service and personnel resources from Tairawhiti District Health (laboratory services)

Process Evaluation Stage 1
Lottery Grants Board
Hawkes Bay Medical Research Foundation

2006 Prevalence Survey
Health Research Council of New Zealand

Process Evaluation Stage 2
Health Research Council of New Zealand

Publications:

Coppell KJ, Tipene-Leach DC, Pahau HL, Williams SM, Abel S, Iles M, Hindmarsh JH, Mann JI. Two-year results from a community-wide diabetes prevention intervention in a high risk indigenous community: The Ngati and Healthy project. Diabetes Res Clin Pract 85 (2): 220-7.
View abstract

Tipene-Leach D, Pahau H, Joseph N, Coppell K, McAuley K, Booker C, Williams S, Mann J. (2004). "Insulin resistance in a rural Maori community." N Z Med J 117: U1208.
View PDF

Mann JI, Tipene-Leach DC, Pahau HL, Joseph NR, Abel S, McAuley KA, Coppell KJ, Booker CS and Williams SM. (2006). "Insulin resistance and impaired glucose metabolism in a predominantly Maori community." Diabetes Res Clin Pract 72(1): 68-74.
View abstract

Media coverage: