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Yu D, Cai Y, Levi Osuagwu U, Pickering K, Baker J, Cutfield R, McKree Jansen R, Orr-Walker BJ, Sundborn G, Zhao Z, Simmons D. Ethnic differences in metabolic achievement between Māori, Pacific, and European New Zealanders with type 2 diabetes. Diabetes Res Clin Pract 2022; 189:109910. [PMID: 35537520 DOI: 10.1016/j.diabres.2022.109910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/07/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
AIMS To compare variations in metabolic target achievement by ethnicity (Europeans, Māori and Pasifika) among patients with type 2 diabetes (T2DM) in Auckland, New Zealand (NZ) between 1994 and 2013. METHODS 32,237 patients were enrolled. Adjusted marginal difference (European as reference) of systolic blood pressure (SBP), body mass index (BMI), HbA1c and total cholesterol, alongside the proportion achieving metabolic targets were estimated using multivariable mixed effect models at baseline, 1-, 2-, 3-, 4-, and 5-years, adjusted for covariates. RESULTS Compared with Europeans, Māori and Pasifika had continuously, significantly higher HbA1c (by 0.3% (+3.5 mmol/mol) and 0.6% (+6.8 mmol/mol) respectively and BMI (+1.5 and +0.3 kg/m2 respectively) but lower SBP (-1.8 and -3.4 mmHg respectively) and TG (-0.03 and -0.34 mmol/L respectively), and insignificantly TC (+0.004 and +0.01 respectively), by 5-years of follow-up. While 49% Europeans were within target HbA1c, this was achieved by only 30% Māori and 27% Pasifika. Conversely, 41% Europeans, 46% Māori and 59% Pasifika achieved the SBP target (all P < 0.0001). CONCLUSIONS Managing hyperglycemia appears to be more challenging than treating hypertension and dyslipidemia among Māori and Pasifika. New anti-hyperglycemia treatments, addressing health literacy, socioeconomic and any cultural barriers to management and self-management are urgently needed to reduce these disparities.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China; Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele ST5 5BG, UK
| | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - Uchechukwu Levi Osuagwu
- Macarthur Clinical School, Western Sydney University, Campbelltown, Sydney NSW 2751, Australia
| | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand; Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand; Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | | | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand; Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Epidemiology and Biostatistics, the University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - David Simmons
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China; Macarthur Clinical School, Western Sydney University, Campbelltown, Sydney NSW 2751, Australia.
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Daly BM, Arroll B, Scragg RKR. Nurse's contribution to the diabetes annual review and funded programmes in Auckland, New Zealand. Prim Care Diabetes 2022; 16:318-324. [PMID: 35065898 DOI: 10.1016/j.pcd.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 11/15/2021] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
Abstract
AIMS Examine trends in nurse's contribution to diabetes funded programmes,estimate total nurse consultations, and document the division of diabetes care between doctors and nurses in general practice. METHODS All primary health care nurses in Auckland were identified in 2006-8 and 2016 and 26% and 24% were randomly surveyed, achieving response rates of 86%and 73%, respectively. Participants completed a self-administered and telephone questionnaire detailing their contribution to diabetes funded programmes. RESULTS In response to more people with diabetes, significantly more nurses in 2016 consulted patients, provided follow-up care, completed Diabetes Annual Reviews independently of doctors (48%), accessed more educational resources (including theinternet) and 63% felt supported, compared with 27% and 55% of nurses respectively,in 2006-8. The main reason nurses surveyed did not participate in diabetes reviews was because designated nurses conducted them, with more reporting this in 2016 (55%) compared to 32% in 2006-8. Most nurses in the 2016 survey addressed cardiovascular risk such as blood pressure, smoking cessation, physical activity and nutrition during the review. CONCLUSIONS Nurses conducted more diabetes consultations and reviews, addressed cardiovascular risk in 2016 and reported increased support for participating in diabetes reviews within general practice, compared with nurses in 2006-8.
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Affiliation(s)
- Barbara M Daly
- Senior Lecturer, School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Road, Grafton, Auckland 1142, New Zealand.
| | - Bruce Arroll
- Professor of General Practice & Primary Health Care, School of Population Health, University of Auckland, New Zealand
| | - Robert Keith Rhodes Scragg
- Professor & Head of School of Population Health, School of Population Health, University of Auckland, New Zealand
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Yu D, Cai Y, Osuagwu UL, Pickering K, Baker J, Cutfield R, Jansen RM, Orr-Walker BJ, Sundborn G, Zhao Z, Simmons D. Metabolic Profiles of Maori, Pacific, and European New Zealanders With Type 2 Diabetes Over 25 Years. Diabetes Care 2021; 44:dc211255. [PMID: 34362817 DOI: 10.2337/dc21-1255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/14/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Dahai Yu
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, U.K
| | - Yamei Cai
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | | | | | - John Baker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Richard Cutfield
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Waitemata District Health Board, Auckland, New Zealand
| | | | - Brandon J Orr-Walker
- Diabetes Foundation Aotearoa, Otara, New Zealand
- Department of Diabetes and Endocrinology, Counties Manukau Health, South Auckland, New Zealand
| | - Gerhard Sundborn
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Zhanzheng Zhao
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - David Simmons
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Macarthur Clinical School, Western Sydney University, Campbelltown, Sydney, Australia
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McNamara BJ, Sanson-Fisher R, D'Este C, Eades S. Type 2 diabetes in Indigenous populations: quality of intervention research over 20 years. Prev Med 2011; 52:3-9. [PMID: 21070804 DOI: 10.1016/j.ypmed.2010.11.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 11/01/2010] [Accepted: 11/02/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND A robust evidence base is needed to reduce the disproportionately high rates of diabetes-related mortality and complications among Indigenous peoples. OBJECTIVE This study aimed to evaluate the quantity and methodological quality of published intervention research on Type 2 and gestational diabetes in the Indigenous populations of Australia, Canada, New Zealand, and the United States from 1989 to 2008. A robust evidence base is needed to reduce the disproportionately high rates of diabetes-related mortality and complications among Indigenous peoples. METHODS Systematic searches of Medline, Embase, and EBM Reviews identified publications focused on Type 2 or gestational diabetes in Indigenous peoples published between 1 January 1989 and 31 December 2008. Total publication number and proportion of research involving interventions over time were examined. The quality of intervention studies was evaluated using Cochrane's Effective Practice and Organisation of Care (EPOC) criteria. RESULTS Total publication number increased significantly over the 20 years (p<0.004). Research was predominantly descriptive (87%), with the proportion of research involving interventions increasing from 3% in 1989-1993 to 12% in 2003-2008 (χ(2)=12.42, df=3, p=0.006). However, only 25% (95%CI: 9-41%) of intervention studies met the EPOC methodological quality criteria; other studies lacked sufficient controls or measurements over time. CONCLUSIONS Increases in the amount of high-quality intervention research for prevention and treatment of Type 2 and gestational diabetes among Indigenous populations of these countries are needed.
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Affiliation(s)
- Bridgette J McNamara
- Preventative Health, Baker IDI Heart and Diabetes Institute, PO Box 6492 St Kilda Road Central, Melbourne, Vic 8008, Australia.
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