Epidemiology of diabetes in New Zealand: Revisit to a changing landscape

Aim: The aim of this review is to describe the evolution of the burden of diabetes, its risk factors and complications in New Zealand, and the current national strategies underway to tackle a condition likely to impact on the national ability to afford other health services. Methods: The MEDLINE database from 1990 was searched for New Zealand-specific diabetes studies. The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) Reports from 1990-2004 and Ministry of Health (MoH) publications and reports were also reviewed. Key contact people working in the field of diabetes care in every district health board (DHB) were contacted, and information on current initiatives for diabetes control and prevention were collected. Results: The prevalence of diabetes (known and undiagnosed), impaired glucose tolerance (IGT)/impaired fasting glucose (IFG) and gestational diabetes are tabulated by ethnic group. The latest New Zealand Health Survey (NZHS) result of known diabetes: European 2.9%, Maāori 8%, Pacific 10.1%, Asian 8.4%. Diabetes risk factors have been examined and the reported rates have been compiled. Māori and Pacific people have a particularly high prevalence of diabetes risk factors (e.g. obesity, physical inactivity, insulin resistance, metabolic syndrome) compared with Europeans. The profile of diabetic patients in New Zealand has been summarised using publications on their clinical characteristics. The latest available data on ethnic specific clinical characteristics are a decade old. With the suboptimal participation in the Get Checked program: 63% Europeans/Others, 27% Māori, 92% Pacific (possibly overestimated) people in 2004, the results may not be representative. The burden of diabetes complications and diabetes related mortality has been reviewed. A high proportion of Māori and Pacific dialysis patients and new renal disease patients from the ANZDATA registry have diabetes comorbidity. The inadequacy of official statistics in New Zealand and the scarcity of indepth studies across the country, including ethnic perspectives, has been clearly demonstrated. Conclusions: While the diabetes epidemic has continued to impact increasingly on New Zealanders and its health services over the past 5 years, a growing number of Government and DHB-funded initiatives are in place to prevent diabetes and its complications. A nationally agreed strategic plan is now urgently needed on how best to monitor and control the increasing incidence and prevalence of diabetes in the New Zealand population as well as the proportion with undiagnosed diabetes, impaired glucose tolerance, and impaired fasting glucose.