National | Diabetes

Study shows positive outcomes in prioritising Māori and Pasifika diabetes treatments

A University of Waikato study of the impact of greater prioritisation of Māori and Pacific in accessing medications has increased the prescribing of new medications for Māori and Pacific people with type 2 diabetes.

Te Whatu Ora endocrinologist and University of Waikato senior lecturer Dr Ryan Paul (Ngāti Maru, Hauraki) says it shows more Māori and Pasifika patients are receiving medication than before.

“This is a significant turnaround, as many Māori and Pacific patients were not getting the glucose-lowering therapies they needed despite multiple contacts with the health system,” Dr Paul says.

“These medications are hugely important in helping support greater health and wellbeing for these high-needs patients as they also have the effect of reducing the incidence of other co-morbid and deadly diseases, like heart and kidney failure.”

Previous research in Aotearoa showed the number of New Zealanders with type-2 diabetes was expected to grow by 90%. Māori and Pasifika were the most overrepresented in both case numbers and health outcomes, however, were less likely to be prescribed medications and in some cases were not prescribed any at all.

Dr Paul says two new diabetes medications available, empagliflozin and dulaglutide, are potent agents in reducing the progression of cardiovascular and renal disease. Two-thirds to three-quarters of people with diabetes in New Zealand die early from these diseases.

However, due to their cost, Pharmac made a decision in 2021 to dispense the medications under a ‘special authority criteria’ (SAC). Māori and Pasifika health experts and health professionals lobbied for ethnicity criteria to be added to provide easier access for Māori and Pasifika patients.

“It was granted in 2021 and, although the decision was viewed as controversial at the time, it does not alter funded access for high-risk Pākehā and other ethnicities."

Dr Paul says the latest Waikato study investigated the results of the Pharmac decision to add the ethnicity criteria.

“The results are a step in the right direction and have led us to believe Pharmac should strongly consider adding ethnicity criteria in all medications accessed through a special authority. In reality the decision has led to better access to quality medications and is a start in reducing the massive inequities that type 2 diabetes creates,” he says.

Type 2 diabetes costs the country more than $2 billion annually and the incidence of type 2 diabetes in the population is predicted to increase, with one in four Pacific people predicted to have the disease within 20 years. It also leads to about 600 amputations each year.

Māori with diabetes are twice as likely to die from cardiovascular disease and four times more likely to need dialysis than Pākehā.

The figures are even higher for Pacific people. Mortality rates for Māori with type 2 diabetes are still two to three times higher than for non-Māori and this gap has not closed in the 20 years prior to the introduction of empagliflozin and dulaglutide, the research shows.

The next step in the study will be to assess if there has been a reduction in mortality, hospitalisations and GP and clinic visits.

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