Diabetes and cardiovascular disease are a significant health burden in New Zealand, particularly in Māori communities and this burden is likely to worsen dramatically if the prevalence of obesity continues to increase, unless effective prevention programmes are implemented.
Award winning programme
Ngati and Healthy, the 2006 Whanau Ora Award supreme winner and a 2006 Health Innovation Award finalist, was a collaborative community intervention between Ngati Porou Hauora and the Edgar National Centre for Diabetes and Obesity Research (now EDOR). The project aimed to reduce 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.
High diabetes risk identified
The prevalence of glucose metabolism disorders in the rural area north of Gisborne, New Zealand, is high. About half of the community was identified as having insulin resistance, impaired fasting glycaemia, impaired glucose tolerance or type 2 diabetes (pre-intervention survey 1, 2003). This group is at high risk of cardiovascular disease, one of the most common causes of premature mortality.
Key risk factors identified in pre-intervention survey 2 informed the objectives:
- To increase the consumption of fruit and vegetables
- To increase the consumption of wholegrain foods
- To reduce the consumption of fat
- To increase exercise levels
- To reduce level of smoking
- To reduce alcohol intake
Community embraces initiatives
The first 2 years of the community intervention raised awareness of diabetes and that it is a preventable condition. Importantly, the community were mobilised and members began 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 aimed to consolidate work already initiated, and to embed the intervention into all parts of the community (including workplaces and schools).
Evaluating the programme
Evaluation is a critical part of our community intervention research. To assess the effectiveness of our diabetes prevention community intervention we used interrupted time series prevalence surveys of glucose metabolism disorders and health behaviours, and formative and process evaluation methods.
The surveys included the assessment of:
- The prevalence of insulin resistance
- Impaired fasting glycaemia
- Impaired glucose tolerance
- Type 2 diabetes mellitus
- Cardiovascular risk factors
- Healthy behaviours
Participation in a community diabetes prevention intervention appeared to reduce insulin resistance prevalence after 2 years in those with the highest level of participation and most marked lifestyle changes.
Tipene-Leach, D.C., Coppell, K.J., Abel, S., Pāhau, H.L., Ehau, T., Mann, J.I. (2013). Ngāti and healthy: translating diabetes prevention evidence into community action. Ethn Health, 18(4), 402-14. doi: 10.1080/13557858.2012.754406. Epub 2013 Jan 29.
PMID: 23360172 [PubMed - in process]
Coppell, K.J., Tipene-Leach, D.C., Pahau, H.L., Williams, S.M., Abel, S., Iles, M., Hindmarsh, J.H., Mann, J.I. (2009). Two-year results from a community-wide diabetes prevention intervention in a high risk indigenous community: The Ngati and Healthy project. Diabetes Research and Clinical Practice, 85 (2): 220-7.
Mann, J.I., Tipene-Leach, D.C., Pahau, H.L., Joseph, N.R., Abel, S., McAuley, K.A., Coppell, K.J., Booker, C.S. and Williams, S.M. (2006). Insulin resistance and impaired glucose metabolism in a predominantly Maori community. Diabetes Research and Clinical Practice, 72(1): 68-74.
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. New Zealand Medical Journal, 117: U1208.