Boosting Diabetes Prevention

A community intervention program has improved the health of Australian Samoans with diabetes 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 from diabetes.

Professor Simmons relayed the conversation to his colleague at Western, Dr Freya MacMillan, a senior lecturer in the School of Health Sciences, and the chance meeting became the impetus for Simmons and MacMillan to establish a pilot study. They liaised with three Samoan churches in south-western Sydney and 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.

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 187 participants enrolled at the start of the program, 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 others used in Samoan culture that may have been forgotten, 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.

After 3-8 months, the participants had statistically significant reductions in average blood glucose levels (HbA1c), showing that the project had improved people’s health.
Following the pilot’s success, the University secured $4.5 million in funding to roll their program out to 48 churches encompassing other Pacific communities across greater western and south eastern Sydney. The team will train more community activators to reach more than 3,600 adults, and their children.

“We’re thinking about affordable translation,” MacMillan says. “By empowering communities, our goal is to embed this program into the health care system and sustain it. We hope it can then be translated across New South Wales and Australia.”

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 | Doctor Freya MacMillan

Dr Freya MacMillan is a Senior Lecturer in Interprofessional Health Sciences, based in the School of Science and Health, a CI in the Diabetes, Obesity and Metabolism Translational Research Unit (DOMTRU), an Executive member and lead of the prevention working group in the Sydney Partnership for Health, Enterprise, Research & Education (SPHERE) Diabetes, Obesity and Metabolism Clinical Academic Group and co-investigator of the Diabetes, Obesity and Metabolic Health white paper group at Western.

Freya is a diabetes prevention expert. She uses her research skills to inform the development, evaluation and translation of lifestyle programs for people at risk and living with diabetes. She has expertise in lifestyle and health outcome measurements, including physical activity monitoring (such as use of accelerometers) and questionnaire administration to capture physiological, psychological and social outcomes. She also has skills in using theory to guide interventions (such as social cognitive theory, and the Readiness to Change Model) and has applied qualitative interviews and focus groups to guide intervention development and evaluation.

Freya has a particular focus on working with communities and partners to identify sustainable approaches. This involves close engagement with the end-users and deliverers of the interventions she develops throughout all phases of her research. Current industry partners include Local Health Districts, Primary Health Networks, Diabetes NSW & ACT, SPHERE and NSW Health. Her links within these networks and across DOMTRU, SPHERE and Western, provide multi-disciplinary collaborative opportunities to tackle diabetes.


© Ronda Thompson © Kate/Unsplash © Mareko Tamaleaa

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