Breakthrough in battle against diabetes

By Martin Johnston

Doctors have made a breakthrough in dealing with one of New Zealand's fastest-growing diseases, spawned in part by the obesity epidemic.

New techniques at the Starship children's hospital will help manage Type 2 diabetes, reducing the risk of child sufferers developing kidney failure and blindness as young adults.

A two-year trial programme to manage the disease has been permanently adopted after proving a success.

The Auckland-wide trial included running a clinic in South Auckland; phone consultations after patients sent in blood test results by computer; a 24-hour telephone helpline to avoid medical emergencies; insulin pumps replacing injections for many Type 1 patients; diabetes screening in some schools; and camps to encourage Type 2 patients to eat well and exercise.

In the trial, the least compliant patients made a contract with their diabetes nurse and were closely monitored. Within 39 weeks, blood tests showed a 2 percentage point improvement in their diabetes control, equivalent to a 60 per cent reduction in their risk of complications.

Reremoana Darlington said her 16-year-old daughter Yvonne, a Type 2 patient on the trial, had lost weight, her blood-sugar levels had improved dramatically and she no longer needed insulin injections.

"She's eating better, she's exercising, she's sleeping better - and taking her pills consistently. It took ages to get her there."

More than 100,000 New Zealanders have diabetes, mostly the obesity-linked Type 2. The number is expected to soar, pushing the annual cost of treatment - including kidney transplants and dialysis - past $1 billion by 2021, unless the country controls its obesity epidemic.

Before 1995, the Starship had no cases of Type 2 diabetes, which had been considered solely an adult disease.

The average weight of the Starship's adolescent patients with Type 2 diabetes was 100kg to 130kg, the heaviest yet being 180kg, said Dr Wayne Cutfield, an architect of the $1.7 million trial. Normal weight for adolescents was 50kg to 80kg.

More than 80 per cent of the Starship's Type 2 patients are Maori or Pacific Islanders.

Dr Cutfield said the biggest gains in the trial were for those who were least compliant with their diet, drug and exercise regimes.

The programme required an extra fulltime specialist and nurse and a part-time dietitian, but was considered a long-term net saving for the health system.

Diabetes NZ president Murray Dear praised the Starship's work.

"There is very good evidence that intensive interventions are much more successful than just expecting people to self-manage themselves, especially with young people, who do need quite a bit of guidance and support."

Health Ministry chief clinical adviser Sandy Dawson said many hospitals were already using some of the Starship ideas, but it was the first to test their effectiveness.

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