Getting handle on diabetes

By ANGELA GREGORY

Iolesina Tagoilelagi could barely raise her hands above her head or lift her legs a year ago.

Overweight and diabetic, the 57-year-old Mangere grandmother felt her body was giving up and her life was faltering.

Mrs Tagoilelagi, who emigrated from Samoa 19 years ago, found her busy life as a minister's wife and early childhood teacher contributed to a loss in control of her eating habits.

She had a mild stroke four years ago and her husband, also diabetic, died aged just 69 from a stroke in January.

"I felt if I did not do something it would be the end for me."

Mrs Tagoilelagi joined a ground-breaking Counties Manukau District Health Board programme that is improving the management of Pacific Islanders with diabetes.

With support from community health workers, she scrutinised her diet, cut back on sugar and fats, and rediscovered some old pleasures such as smoking her own fish.

Mrs Tagoilelagi started going to the gym every morning for an hour, and in six weeks she lost 12kg.

Her daughter and then granddaughters also joined the gym in an effort to break the family pattern of poor health and diabetes.

Six months on Mrs Tagoilelagi feels like a new woman.

"The strength is coming back to my body and I am more happy, more positive ... I feel there is hope."

She believes many Islanders are simply unaware of the dangers of their lifestyle.

"They do not understand how much they put their health at risk by not getting exercise and relying on takeaway foods."

Mrs Tagoilelagi is one of 330 Islanders selected for the programme.

The aim is to manage the disease at community level, lessening the strain on hospitals. The Government pays for one doctor's visit each year for diabetics, and the Health Board funds a further three visits annually.

It contracted Health Pacifica, a group of Mangere general practitioners, to run a diabetes clinic in the town centre.

Health workers of Pacific ethnicity work directly with diabetics who have other risk factors such as smoking, high blood pressure and obesity.

The nurses and educators take shopping trips to the supermarket, pointing out good and bad foods, run cooking demonstrations, quit-smoking clinics, and twice-weekly aerobic classes.

They try to involve the whole family, explain the importance of keeping appointments, and identify other issues hampering treatment, such as financial or social problems.

Blood-sugar tests are offered at community events and after church services and radio broadcasts highlight the disease.

Patient information is collected on computers and fed to a central database, which specialists can easily access.

A year on, the results have been startling, with a significant drop in patient blood-sugar levels.

When the diabetics enrolled, their blood-sugar averaged 9.5 points, but was now down to 8.5 points - each point increasing life expectancy between five to 10 years.

Eighty-two per cent of the participants were returning for doctor visits.

Health Pacifica clinical director Dr Siro Fuata'i said 17 per cent of the Counties-Manukau population was Pacific, and the growing number of type 2 diabetics was a concern.

Diabetes was five times more prevalent for Pacific Island people than for Europeans. Up to half the cases were undiagnosed, and the disease was striking people younger.

Dr Fuata'i said Pacific Island people were also more likely to develop related problems such as eye and renal disease, leading to costly complications such as kidney failure.

The medical director of the health board's Integrated Care Unit, Dr John Wellingham, said the programme would be extended.

"We will start looking at other long-term illnesses like chronic heart failure and chronic lung disease."

He said the diabetes scheme had probably already reduced heart attacks in that group by one in five.

Further reading
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