Prevention and control of diabetes in Pacific people

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Abstract
Diabetes is a major problem worldwide. Among Pacific people, prevention and control of diabetes lies in counteracting rapid changes in lifestyle and must take account of political and economic factors and social structure Early studies clearly showed that while diabetes was virtually non-existent in populations indigenous to the Pacific maintaining a traditional lifestyle, the reverse was true for the urbanised Pacific populations.1 In recent decades diabetes prevalence has increased rapidly over time in the indigenous people in the Pacific region (Polynesian, Melanesian, Micronesian), both in the Pacific islands and in countries such as New Zealand.2 Epidemiological evidence indicates that prevalence is generally lowest in traditional Pacific environments, and is higher in both urban Pacific and adopted metropolitan environments; in the latter environments, prevalence is markedly higher in Pacific people than in white people. Prevalence has been increasing rapidly in all three environments, and Pacific people experience greater morbidity and more complications than white people with diabetes. Genetic factors alone cannot explain these patterns, which are due to rapid changes in lifestyle and risk factors such as obesity, unhealthy diets, and physical inactivity that have become widespread throughout the region.2 Although the risk factors associated with diabetes are now reasonably well understood, the prevention and control of the condition in the Pacific, and in Pacific people in Western countries, is not straightforward. We here consider the individual level and population level approaches to diabetes prevention and control in Pacific people. Vigorous pharmacological interventions have a clear role in the management of existing diabetes. Nevertheless, in some Pacific countries a large proportion of resources is spent on identifying people with diabetes and on a variety of non-standardised drug treatment regimens. Modification of individual behaviour is undertaken in less than 5% of the population.3 Given the high cost of …