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Diabetes
-49
Diabetes is a common condition in Western societies and has some important and
unusual features. Involving 2-4% of adults, it has been shown that the condition accelerates
arteriosclerosis and its consequences and that diabetic women have a rate of CHD (coronary
heant disease) that is similar to men. In non-diabetics, the sex ratio of CHD is around 4 males
to I female. Diabetes is also associated wilh hypertension. The pattern in Pacific countries is
an important parL of the perspective we are considering.
Within the Pacif ic there is a remarkable range in the extent of diabetes - from
population samples where the prevalence and incidence is low (e.g; New Guinea, Pukupuka) to
ihose where it is common and increasing (Table 2). This is seen particularly where groups are
undergoing urbenization or migration as in Western Samoa, Tokelau, Fiji and finally Nauru
which ranks with the Pima lrdians of Arizona as having ihe highest rates in the world
(Zimmett, 1977; Prior and Brauer, L979; Zimmett, 1982).
Geo-ethnic Aroup
Micronesians
Polynesians
Melanesians
Indians
T
**
Table 2 : Diabetes in the Pacific Region L975-I987
Age-standardized prevalence rates*
Nauru
Kiribatit* (rural)
(urban)
Tuvalu
Western Samoa (rural)
(urban)
Cook Islands**
Rarotonga
Manihiki
Wallis Islandti*
Niue#
Loyalty Islands
New Caledonia
Fiji (rural)
(urban)
Papua New Guinea (rural)
(urban)
Fiji (rural)
(urban)
No. studied
(20 years and over)
456
t08)
1917
t97
745
744
LT77
B'
579
TL92
5t5
t72
477
861
r05
I84
452
848
Diabetes
Prcvalence (%)
n.t
2.7
7.5
t.9
2.7
7.O
6.0
6.6
2.7
7.t
2.O
1.5
1.8
6.9
0.8
L5.4
Lt.t
14.8
Age standardized to Western Samoa Census (I976)
Recent survey - data not yet age standardized
Diabetes prevalence according to WHO criteria
Table provided by P. Zimmett, Epidemiology Unit, Royal Southern Memoriel Hcpital,
Melbourne, Auslralia (includes some resulls published in Zimmett, 1982)
The Nauruans stand out as suffering from the most severe epidemic of 20th century
affluence and this is playing an important role in contributing to the high rate of diebetes. A,
mean per capita income of around $l9rm0 for each Nauru man, woman and child has given
them extraordinary qportuniLies for indulgence in rnany aneas including food, alcohol and
decreased physical activity.
The genetic predisposition, or genotype, for diabetes is thought to be common in nnst
communities and obesity is the factor which is the most important risk faetor for the type
now classified by WHO as Non Irsulin Dependant Diabetes Mellitus (NIDDM) (WHO, f980).
Obesity is not a new phenomenon in the Pacific and many Pacific people have experienced
traditional affluence even though their material resources are limiLed. Adequate or more lhan