Boosting Diabetes Prevention

A community intervention program has improved the health of people of Samoan heritage in south-western Sydney.

A doctor approached a Western Sydney University diabetes expert, Distinguished Professor David Simmons from the School of Medicine, at a conference, and explained how she was struggling to treat patients of Samoan heritage. She described how many of her patients in south-western Sydney were being treated in hospital, or dying from avoidable complications of diabetes.

Simmons relayed the conversation to his colleague at Western, Dr Freya MacMillan, an associate professor in the School of Health Sciences, and this became the impetus for Simmons and MacMillan to establish a pilot study. With three Samoan churches in south-western Sydney, they set up a reference group of community leaders to advise them in the project. Churches are the central meeting point for the Samoan community both in their home country, and in Australia.

Australia has a significant number of immigrants from the Pacific Islands. According to the 2016 census, 75,755 people are of Samoan heritage and more than 40% of them live in New South Wales. Samoans have an inherited predisposition to diabetes, but prior to the Western study, there was little research on the effectiveness of public health interventions to reduce the health risks of diabetes in this immigrant group.

In 2017 MacMillan and Simmons’ team developed a program called Le Taeao Afua (the new dawn) derived from evidence-based research on community interventions and tailored by participants themselves to fit the Australian-Samoan lifestyle. The University trained a Samoan community activator, who in turn trained 20 church volunteers to become peer support facilitators.

Of the 187 participants first enrolled, 96% were overweight or obese and 32% had Type 2 diabetes. “The really worrying thing was that 13% didn’t even know they had diabetes until we tested their blood,” says MacMillan.

Volunteers developed workshops and more than 100 activities covering 12 public health messages dealing with diet and exercise. These included cooking classes that introduced people to new vegetables, and also revived other vegies used in Samoan culture, or promoted steaming and grilling instead of deep frying.

Need to know

  • Many people of Samoan heritage in south-western Sydney are at risk of diabetes.
  • Western’s Simmons and MacMillan developed a community intervention program called Le Taeao Afua.
  • Program participants had significant reductions in average blood glucose levels

“We looked at affordable and seasonal options to take away the stigma that healthy eating is expensive,” says Ronda Thompson, the community activator. Zumba classes, resistance band exercises and family power-walking were some of the physical activity favourites. Feedback suggested that competitive activities were motivating, says MacMillan.

After 3-8 months, the participants had statistically significant reductions in HbA1c levels, average blood sugar for the past two to three months, showing that the project had improved people’s health. MacMillan says the average blood glucose reduction was the equivalent to a reduction from a dose of diabetes medication.

Following the pilot’s success, the University secured $4.5 million to roll their program out to 48 churches encompassing other Pacific communities across Sydney over the next five years. The team will train more community activators to reach more than 3,600 adults and 1,000 children.

After the arrival of COVID-19, MacMillan says the group quickly pivoted resources towards providing vaccination information to Pacific communities. This process taught them valuable lessons about how to organise baseline data collection for their diabetes project. “We found that getting multiple churches to come to what had been our ‘Covid hubs’ was resource-effective,” says MacMillan.

“We’re thinking about affordable translation,” she explains. “And by empowering communities, our goal is to embed this program into the health care system.”

Meet the Academic | Distinguished Professor David Simmons

David is a Distinguished Professor of Medicine at the Western Sydney University Macarthur Clinical School, Head of the Campbelltown Hospital Endocrinology Department, Chair of the Campbelltown Hospital Clinical Council, Director of the Diabetes Obesity and Metabolism Translation Unit (DOMTRU) and Co-Director of the Diabetes Obesity and Metabolism Clinical Academic Group of the Sydney Partnership for Health, Education, Research and Enterprise.

From 2007 to 2014, he was the lead diabetes consultant at Cambridge University Hospitals NHS Foundation Trust, overseeing major changes in the local model of care.  Between 2003-2007 he was the inaugural Professor of Medicine at the University of Auckland Waikato Clinical School, New Zealand and 1998-2002 he was the Foundation Chair in Rural Health at the University of Melbourne, Australia.  During this time he established a full department, a clinical school (where he was acting Dean) and a range of undergraduate, postgraduate and research activities relating to rural and indigenous health.

With over 280 refereed publications, he has won several national and international awards for his work in diabetes epidemiology, diabetes in pregnancy and diabetes service development.  He is a past president of the Australasian Diabetes in Pregnancy Society (ADIPS) and was a member of the World Health Organisation technical working group on the criteria for hyperglycaemia in pregnancy.  He was previously the chair of the Diabetes UK Health Professional Education Steering Group.  He is a Visiting Professor for the University of Örebro, Sweden and Professorial Fellow at the University of Melbourne.

Meet the Academic | Associate Professor Freya MacMillan

Freya MacMillan has a background in physical activity for health (University of Strathclyde) and came to Western Sydney University initially as a post-doctoral fellow in physical activity for health across the lifespan in 2013, prior to being appointed a lecturer in interprofessional health sciences in 2015. Her research career has focused on understanding lifestyle behaviours and developing, implementing, evaluating and translating lifestyle behaviour interventions into practice. She engages with communities, healthcare workers and other professionals to ensure that the interventions that she develops are sustainable.

Freya is also a Health and Wellbeing Research Theme Champion at Western Sydney University, deputy director of the Diabetes, Obesity and Metabolism Translational Research Unit, an executive member and lead of the prevention working group in the Maridulu Budyari Gumal Sydney Partnership for Health, Enterprise Research & Education (SPHERE) Diabetes, Obesity and Metabolism Clinical Academic Group, a member of the Translational Health Research Institute and an International Union for Health Promotion and Education Registered Health Promotion Practitioner.


© Ronda Thompson © Kate/Unsplash © Mareko Tamaleaa

Future-Makers is published for Western Sydney University by Nature Research Custom Media, part of Springer Nature.