Ethnic inequities in use of breast conserving surgery and radiation therapy in Aotearoa/New Zealand: which factors contribute?

PURPOSE: Aotearoa/New Zealand (NZ) faces ethnic inequities with respect to breast cancer survival and treatment. This study establishes if there are ethnic differences in (i) type of surgery and (ii) receipt of radiotherapy (RT) following breast conserving surgery (BCS), among women with early-stage breast cancer in NZ. METHODS: This analysis used Te Rehita Mata Utaetae (Breast Cancer Foundation National Register), a prospectively maintained database of breast cancers from 2000 to 2020. Logistic regression models evaluated ethnic differences in type of surgery (mastectomy or BCS) and receipt of RT with sequential adjustment for potential contributing factors. Subgroup analyses by treatment facility type were undertaken. RESULTS: Of the 16,228 women included, 74% were NZ European (NZE), 10.3% were Maori, 9.4% were Asian and 6.2% were Pacific. Over one-third of women with BCS-eligible tumours received mastectomy. Asian women were more likely to receive mastectomy than NZE (OR 1.62; 95% CI 1.39, 1.90) as were wahine Maori in the public system (OR 1.21; 95% CI 1.02, 1.44) but not in the private system (OR 0.78; 95% CI 0.51, 1.21). In women undergoing BCS, compared to NZE, Pacific women overall and wahine Maori in the private system were, respectively, 36 and 38% less likely to receive RT (respective OR 0.64; 95% CI 0.50, 0.83 and 0.62; 95% CI 0.39, 0.98). CONCLUSION: A significant proportion of women with early-stage breast cancer underwent mastectomy and significant ethnic inequities exist. Recently developed NZ Quality Performance Indicators strongly encourage breast conservation and should facilitate more standardized and equitable surgical management of early-stage breast cancer.

A study of Samoan, Tongan, Cook Island Maori, and Niuean infant care practices in the Growing Up in New Zealand study.

BACKGROUND: Despite a low rate of infant mortality, Aotearoa New Zealand has a high rate of Sudden Unexpected Death in Infants (SUDI), with disproportionate impact for Pacific infants. This study explored the infant care practices, factors and relationships associated with increased risk of SUDI amongst Tongan, Samoan, Cook Islands Maori, and Niuean mothers in New Zealand, to inform evidence-based interventions for reducing the incidence of SUDI for Pacific families and their children. METHODS: Analysis comprised of data collected in 2009-2010 from 1089 Samoan, Tongan, Cook Islands Maori and Niuean mothers enrolled in the Growing Up in New Zealand longitudinal cohort study. The sleeping environment (bed-sharing and sleep position) of the infants was assessed at 6 weeks. Multivariable logistic regression analysis were conducted, controlling for sociodemographic factors to explore the association between selected maternal and pregnancy support and environment factors and the sleeping environment for infants. RESULTS: Mothers who converse in languages other than English at home, and mothers who consulted alternative practitioners were less likely to follow guidelines for infant sleeping position. Similarly language, smoking, alcohol, household dwelling, crowding and access to a family doctor or GP were associated with mothers following guidelines for bed-sharing. CONCLUSION: The impact of SUDI on Pacific infants may be lessened or prevented if communication about risk factors is more inclusive of diverse ethnic, cultural worldviews, and languages. Societal structural issues such as access to affordable housing is also important. This research suggests a need for more targeted or tailored interventions which promote safe sleeping and reduce rates of SUDI in a culturally respectful and meaningful way for Pasifika communities in Aotearoa, New Zealand.

A qualitative study of patient perspectives of diabetes and diabetic retinopathy services in Vanuatu.

ISSUE ADDRESSED: Diabetes mellitus is an increasing global health problem, particularly in Vanuatu, where it poses a major health burden. There is paucity of information on how patients in Vanuatu perceive diabetes, diabetic retinopathy, access to services and management, health promotion and intervention services to alleviate the issues. This study aimed to explore the perceptions of diabetic patients in Vanuatu on these issues, to help inform the design of health promotion materials and community activities to empower people to self-manage and shape diabetic services that are integrated and people-centred. METHODS: Qualitative Talanga and Kakala Pacific research methodologies were applied. Participants were diabetic patients from both urban locations and rural villages in Vanuatu. Data were collected from four (two male, two female) focus group interviews and thematically analysed. RESULTS: There were 26 participants. System failures became apparent, including the inability of the health care services to meet the complex needs of patients with diabetes. The protective factors to reduce the risk and increasing incidence of diabetes and diabetic retinopathy included comprehensive village-based health promotion and community development programmes at the primary prevention level. CONCLUSION: This study described patients' experiences of their diabetic care and identified key barriers and facilitators of service delivery pathways. SO WHAT?: Vanuatu needs to expand nationwide health promotion and education programmes on nutrition and exercise, food insecurity and access through trade agreements and provide well-trained nursing and medical specialists for early diagnosis and adequate management of diabetes that all people can access and afford.

Falling into a deep dark hole: Tongan people's perceptions of being at risk of developing type 2 diabetes.

BACKGROUND: Prediabetes is a precursor for type 2 diabetes. Compared to the New Zealand/European and other population groups (24.6%), the prevalence of prediabetes is higher within Pacific groups (29.8%). The diagnosis of prediabetes presents a potential opportunity to intervene to prevent progression to type 2 diabetes. OBJECTIVE: To develop an understanding of how being 'at risk' of developing type 2 diabetes is perceived by Tongan people with prediabetes living in Auckland, New Zealand. METHODS: The Kakala and Talanga Tongan methodologies underpinned this study. Twelve one-on-one, semi-structured interviews with Tongan patients who had prediabetes from a primary health-care clinic in Auckland, New Zealand, were conducted. Thematic analysis was used to identify recurrent themes from the data. RESULTS: Participants were not aware of their prediabetes diagnosis, emotions associated with the diagnosis reflected fear and disbelief and a perception of imminent danger. Family history informed perceptions of the risk of developing type 2 diabetes. Participants could not differentiate prediabetes from type 2 diabetes, and recollections of being 'back in the Islands' of Tonga were consistent with healthy lifestyles. CONCLUSIONS: Prediabetes appeared to be poorly understood and was believed to be irreversible, which could discourage behaviour change, social and physical improvements in health. Appropriate culturally tailored messages to accompany a prediabetes diagnosis, including cause and management, would be beneficial for Pacific peoples.

Manaaki - a cognitive behavioral therapy mobile health app to support people experiencing gambling problems: a randomized control trial protocol.

BACKGROUND: The low utilisation of current treatment services by people with gambling problems highlights the need to explore new modalities of delivering treatment interventions. This protocol presents the design of a pragmatic randomized control trial aimed at assessing the effectiveness and acceptability of cognitive behavioral therapy (CBT) delivered via a mobile app for people with self-reported gambling problems. METHODS: An innovative CBT mobile app, based on Deakin University's GAMBLINGLESS online program, has been adapted with end-users (Manaaki). Six intervention modules have been created. These are interwoven with visual themes to represent a journey of recovery and include attributes such as avatars, videos, and animations to support end-user engagement. An audio facility is used throughout the app to cater for different learning styles. Personalizing the app has been accomplished by using greetings in the participant's language and their name (e.g. Kia ora Tane) and by creating personalized feedback. A pragmatic, randomized control two-arm single-blind trial, will be conducted in New Zealand. We aim to recruit 284 individuals. Eligible participants are ≥18 years old, seeking help for their gambling, have access to a smartphone capable of downloading an app, able to understand the English language and are willing to provide follow-up information at scheduled time points. Allocation is 1:1, stratified by ethnicity, gender, and gambling symptom severity based on the Gambling Symptom Assessment Scale (G-SAS). The intervention group will receive the full mobile cognitive behavioural programme and the waitlist group will receive a simple app that counts down the time left before they have access to the full app and the links to the data collection tools. Data collection for both groups are: baseline, 4-, 8-, and 12-weeks post-randomisation. The primary outcome is a change in G-SAS scores. Secondary measures include changes in gambling urges, frequency, expenditure, and readiness to change. Indices of app engagement, utilisation and acceptability will be collected throughout the delivery of the intervention. DISCUSSION: If effective, this study will contribute to the improvement of health outcomes for people experiencing gambling problems and have great potential to reach population groups who do not readily engage with current treatment services. ETHICS APPROVAL: NZ Health and Disability Ethics Committee (Ref: 19/STH/204) TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry (ANZCTRN 12619001605189) Registered 1 November 2019.

Betel Nut Use in Vanuatu: Investigating Opportunities to Reduce Harms to Health.

Background: Betel nut chewing is a public health concern in the Asia-Pacific region and is an emerging issue in Vanuatu. Despite the significant health risks associated with betel nut chewing, few interventions have been undertaken to reduce its harm. Objectives: To investigate betel nut use in Vanuatu and to identify opportunities to reduce its harm and possible interventions, framing the responses using the World Health Organization's MPOWER tobacco control model. Method: Qualitative research design, in the form of semi-structured interviews with ten participants with expertise in health, agriculture, education or non-communicable disease in Port Vila, Vanuatu during June 2017. Recorded interviews were transcribed verbatim, and a general inductive approach was used to identify key themes. Results: Participants reported a recent increase in betel nut use in Vanuatu due to the influence from Papua New Guinea and the Solomon Islands. To reduce the harm of betel nut use in Vanuatu, participants suggested policies and strategies that aligned with the MPOWER framework that could be adopted for betel nut control, including restricting cultivation and sale of betel nut in Vanuatu and using radio and existing community networks to reach people with messages about the dangers of betel nut use. Conclusion: Betel nut use may be growing in popularity in Vanuatu, where there are potential policy options to minimize harm. The MPOWER model for tobacco control may be a useful framework to help the Vanuatu government to deliver a comprehensive approach to reducing harm from betel nut use.

E-learning: A Tool to Upgrade the Skills of Health Workers to Address Betel Quid and Areca Nut Chewing.

Background: In the Asia-Pacific region, betel quid and areca nut chewing is a public health concern that requires immediate attention. There is a need to improve knowledge about the harmful effects of betel quid and areca nut chewing and train health care professionals to provide preventive interventions. Objectives: To introduce and evaluate the Pacific Open Learning Health Net (POLHN) online courses about the dangers of betel quid and areca nut. Methods: Two self-paced courses about betel quid and areca nut chewing were developed and offered via the POLHN which predominantly engages health professional working in the Pacific islands. Students completing each of the courses were asked to complete a survey measuring course organization, content, length and comprehension level, evaluation methods, adaption to the Pacific island context, relevance to work and level of interaction. Conclusions: The POLHN courses about the dangers of betel quid and areca nut were well accepted by participants for quality and relevancy to their work. POLHN is the first platform that offers a course in betel quid and areca nut in the Pacific and has the potential to be adopted elsewhere.

Investigating Betel Nut Use, Antecedents and Consequences: A Review of Literature.

Background: Betel nut use is a public health issue in the Asia-Pacific region that is often neglected. To control betel nut use, understanding of the adverse effects of betel nut use and evidence-based policies and strategies is necessary. Objectives: This narrative review aims to characterize the current situation on betel nut use at a global level regarding the epidemiology, pharmacology and toxicology, health effects, treatment options, policies and strategies. Methods: We found 139 existing literature published between 1970-2019 on the Web of Science database and other technical documents to collate the most relevant information on betel nut use. Data were categorized into appropriate themes. Results: The literature demonstrates that there is a lack of up to date statistics on betel nut use. There is limited research on the effect of policies and strategies to control betel nut use. Conclusion: Betel nut-chewing countries should focus on understanding which populations chew betel nut and implement appropriate policies, educational and cessation programs to help control betel nut use.

The use of home brew in Pacific Islands countries and territories.

This review examines what is known about the production and use of home brew in the Pacific Islands countries and territories. Data collection involved interviews of 78 men and women from the Marshall Islands, Papua New Guinea, Toga, and Tuvalu. The interviews were conducted in 2013 by local interviewers. The questions fell into four key areas: people's history of home-brew consumption, the reasons for home-brew use, the effects of home brew, and people's perceptions about home brew. An open ethnographic approach revealed that males are the main consumers of home brew, that home brew is consumed in private venues by those with low socioeconomic status, and that there are positive and negative outcomes associated with the use of home brew. Finally, policy implications of the findings are included in this article.

Cytisine versus nicotine for smoking cessation.

BACKGROUND: Placebo-controlled trials indicate that cytisine, a partial agonist that binds the nicotinic acetylcholine receptor and is used for smoking cessation, almost doubles the chances of quitting at 6 months. We investigated whether cytisine was at least as effective as nicotine-replacement therapy in helping smokers to quit. METHODS: We conducted a pragmatic, open-label, noninferiority trial in New Zealand in which 1310 adult daily smokers who were motivated to quit and called the national quitline were randomly assigned in a 1:1 ratio to receive cytisine for 25 days or nicotine-replacement therapy for 8 weeks. Cytisine was provided by mail, free of charge, and nicotine-replacement therapy was provided through vouchers for low-cost patches along with gum or lozenges. Low-intensity, telephone-delivered behavioral support was provided to both groups through the quitline. The primary outcome was self-reported continuous abstinence at 1 month. RESULTS: At 1 month, continuous abstinence from smoking was reported for 40% of participants receiving cytisine (264 of 655) and 31% of participants receiving nicotine-replacement therapy (203 of 655), for a difference of 9.3 percentage points (95% confidence interval, 4.2 to 14.5). The effectiveness of cytisine for continuous abstinence was superior to that of nicotine-replacement therapy at 1 week, 2 months, and 6 months. In a prespecified subgroup analysis of the primary outcome, cytisine was superior to nicotine-replacement therapy among women and noninferior among men. Self-reported adverse events over 6 months occurred more frequently in the cytisine group (288 events among 204 participants) than in the group receiving nicotine-replacement therapy (174 events among 134 participants); adverse events were primarily nausea and vomiting and sleep disorders. CONCLUSIONS: When combined with brief behavioral support, cytisine was found to be superior to nicotine-replacement therapy in helping smokers quit smoking, but it was associated with a higher frequency of self-reported adverse events. (Funded by the Health Research Council of New Zealand; Australian New Zealand Clinical Trials Registry number, ACTRN12610000590066.).

Development of a text message intervention aimed at reducing alcohol-related harm in patients admitted to hospital as a result of injury.

BACKGROUND: Screening for alcohol misuse and brief interventions (BIs) for harm in trauma care settings are known to reduce alcohol intake and injury recidivism, but are rarely implemented. We created the content for a mobile phone text message BI service to reduce harmful drinking among patients admitted to hospital following an injury who screen positive for hazardous alcohol use. The aim of this study was to pre-test and refine the text message content using a robust contextualisation process ahead of its formal evaluation in a randomised controlled trial. METHODS: Pre-testing was conducted in two phases. First, in-depth interviews were conducted with 14 trauma inpatients (16-60 years) at Auckland City Hospital and five key informants. Participants were interviewed face-to-face using a semi-structured interview guide. Topics explored included: opinions on text message ideas and wording, which messages did or did not work well and why, interactivity of the intervention, cultural relevance of messages, and tone of the content. In a second phase, consultation was undertaken with Maori (New Zealand's indigenous population) and Pacific groups to explore the relevance and appropriateness of the text message content for Maori and Pacific audiences. RESULTS: Factors identified as important for ensuring the text message content was engaging, relevant, and useful for recipients were: reducing the complexity of message content and structure; increasing the interactive functionality of the text message programme; ensuring an empowering tone to text messages; and optimising the appropriateness and relevance of text messages for Maori and Pacific people. The final version of the intervention (named 'YourCall(™)') had three pathways for people to choose between: 1) text messages in English with Te Reo (Maori language) words of welcome and encouragement, 2) text messages in Te Reo Maori, and 3) text messages in English (with an option to receive a greeting in Samoan, Tongan, Cook Island Maori, Niuean, Tokelauan, Tuvaluan, or Fijian). CONCLUSIONS: We have developed a text message intervention underpinned by established BI evidence and behaviour change theory and refined based on feedback and consultation. The next step is evaluation of the intervention in a randomised-controlled trial.

A response for substance and harm reduction in Pacific Island countries and territories.

The Pacific is characterised as a region for the purposes of many international interventions and assistance programmes. Representatives of Pacific States participate in regional fora to build a strategic and unified approach to development. Regionally, bilateral trade agreements impact upon strategies to regulate alcohol imports. Policing and customs initiatives are increasingly supporting prevention of illicit drug production and trafficking, and model laws have been proposed to achieve consistency in enforcement. The aim of this commentary is to provide a response for policies using the case of alcohol and other drug research in the Pacific Islands Countries Territories. This commentary undertook a review of the current literature for regional developments for alcohol and other drug use in the Pacific Island Countries Territories region. A total of 14 articles were used in this article. The publication date for the articles used in this review ranged from 1997 to 2011. The findings of the review found that there should be a co-ordinated approach for adopting alcohol and other drug approaches. Furthermore, there should be a co-ordinated regional response with the inclusion of targeted domestic programming that will meet the needs for the Pacific Island countries and territories. Countries in the Pacific Island territories are characterised by varying degrees of political stability. Without stable government and democratic process, it is likely to remain difficult to develop consistent and effective legislation and policy for implementation of successful alcohol and other drug programmes. We found that there is a lack of robust and current data for alcohol and other drugs in Pacific Island countries and territories. Further research funding is needed to build the limited knowledge of alcohol and other drug substance use.

Ethnic differences in time to surgery for women with early stage breast cancer in Aotearoa/New Zealand: a population-based study.

Background: This study evaluates whether there are ethnic differences in time to surgery in women with early-stage (1-3a) breast cancer in four NZ urban regions between 2000 and 2020 pre- and post- Faster Cancer Treatment (FCT) implementation, which was introduced to address inequities in cancer outcomes. Methods: This retrospective analysis used Te Rehita Mate Utaetae (Breast Cancer Foundation National Register), a prospectively maintained database of breast cancers from 2000 to 2020. Women with stage 3b, 3c, metastatic or bilateral cancers were excluded. Logistic regression models evaluated ethnic differences in time to surgery (≤31/>31 days as per FCT plan) with sequential adjustment for potential contributing factors (demographic, mode of diagnosis, tumour, treatment facility type and treatment). Subgroup analyses by pre- and post-FCT implementation date were undertaken. Findings: Of the 16,365 women included, 74.1% were NZ European (NZE), 10.2% were Maori, 6.1% were Pacific, and 9.2% were Asian. Wahine Maori (Maori women) and Pacific women were more likely to experience delays in surgery >31 days, compared to NZE (maximally adjusted OR: 1.18; 95% CI:1.05, 1.33 and OR:1.42; 95% CI:1.22, 1.65, respectively)-deprivation and treatment facility type contributed most to this. Wahine Maori experienced delay in the public system only. The associations did not differ between the pre- and post- FCT periods. Interpretation: Ethnic inequities exist with respect to time to surgery for women with early-stage breast cancer and these differences persist after FCT implementation. Funding: LB is supported by the Richard Stewart scholarship, the Royal Australasian College of Surgeons and Oxford Population Health.

Predictors of cigarette use amongst Pacific youth in New Zealand.

BACKGROUND: Despite progressive population health policies to reduce tobacco harm, smoking prevalence continues to be inequitable amongst key ethnic groups in New Zealand. The purpose of this study is to describe the predictors of cigarette use amongst Pacific youth in New Zealand. METHODS: Data were collected as part of Youth'07, a nationally representative survey of the health and well-being of New Zealand adolescents. The study sample comprised 5471 students and this includes 1,178 were Pacific youth. RESULTS: The smoking prevalence rate for Pacific youth was twice that of New Zealand European youth. Pacific girls and older age groups, ages 16-17, smoked more than Pacific boys and younger adolescents. Pacific youth from higher and mid-deprivation neighbourhoods smoked at twice the rate of youth from low deprivation areas. Local neighbourhood stores (dairies) were the most used location for purchasing cigarettes, and only 12.7% of under-aged adolescents were asked "most of the time" for age identification. Pacific adolescent smoking was associated with parental smoking, peer-group smoking and binge drinking. Parents not knowing the whereabouts of adolescents during after-school hours and night-times were also associated with adolescent smoking. A majority of Pacific adolescent smokers (70.2%) had tried to quit smoking. CONCLUSION: The strategies for addressing ethically the issue of equal health for all is to allocate increased public health investments towards targeted quit-smoking treatment programmes for Pacific youth in New Zealand. Further qualitative studies with Pacific youth to inform the development of culturally-appropriate youth-focused quit-substance interventions is recommended.

Looks like smoking, is it smoking?: children's perceptions of cigarette-like nicotine delivery systems, smoking and cessation.

BACKGROUND: Alternative cigarette-like nicotine delivery systems have been met with diverse opinions. One concern has been for the effect on children. We investigate whether children can differentiate tobacco cigarette smoking from use of a nicotine inhaler and electronic cigarette. Their opinions on these devices was also of interest. METHODS: Two structured focus groups and twelve individual interviews were conducted with twenty Maori and Pacific children (6-10 years old) in low socioeconomic areas in Auckland, New Zealand. Children viewed short video clips on an iPad that demonstrated an actor smoking a tobacco cigarette, sucking a lollipop or using an electronic cigarette or a nicotine inhaler. RESULTS: Children did not recognise the inhaler or electronic cigarette. Some children did however notice anomalies in the 'smoking' behaviour. Once told about the products the children were mostly positive about the potential of the inhaler and electronic cigarette to assist smokers to quit. Negative perceptions were expressed, including views about the ill health effects associated with continued nicotine intake and the smoker's inability to quit. CONCLUSIONS: In a context unfamiliar with electronic cigarettes or nicotine inhalers, such as New Zealand, children may misperceive use of these products as smoking. Once these products are more common and the purpose of them is known, seeing people use them should normalise quitting behaviour, something the children were very supportive of.

Screening, diagnosing and management of Pacific peoples with prediabetes in New Zealand primary healthcare clinics with high concentrations of Pacific peoples: an online survey.

Introduction Prediabetes is a condition of elevated blood sugar levels which can increase the risk of type 2 diabetes (T2D) if not managed effectively. Prediabetes is likely to affect about 24.6% of New Zealand (NZ) adults, with estimates of 29% of the Pacific population currently living with the condition. A prediabetes diagnosis is an opportunity for intervention from trusted primary care providers. The study aim was to describe primary healthcare clinician's knowledge and practice regarding screening, diagnosing and management of prediabetes in Pacific patients. Methods An online survey was conducted with current practicing primary healthcare clinicians between February and April 2021. Eligible participants included clinicians employed in a primary healthcare clinic with over 50% of enrolled patients identified as Pacific. Results Primary healthcare clinicians (n = 30) reported that their prediabetes screening, diagnosis and management were aligned with the NZ Ministry of Health clinical guidelines. The most common factors that prompted screening was a family history of T2D (25/30, 83%), ethnicity (24/30, 80%) weight and BMI (24/30, 80%). The initial management practices involved providing recommendations for dietary changes and physical activity (28/30, 93%) and referring patients to a diabetes prevention lifestyle change programme (16/30, 53%). Discussion Primary healthcare clinicians are the foremost point of engagement with patients and their famili (family) in their health journey. Culturally appropriate tools could be useful to assist healthcare providers to communicate to a higher risk population and most clinicians rely on up to date guidelines for screening and management.

Pacific patients' reasons for attending the emergency department of Counties Manukau for non-urgent conditions.

AIM: To determine Pacific patients' reasons for Emergency Department (ED) use for non-urgent conditions by Pacific people at Counties Manukau Health. METHODS: Patients who self-presented to Counties Manukau ED with a non-urgent condition in June 2019 were surveyed. Responses to open-ended questions were analysed using a general inductive approach, in discussion with key stakeholders. RESULTS: Of 353 participants with ethnicity reported, 139 (39%) were Pacific, 66 (19%) Maori and 148 (42%) were non-Maori non-Pacific, nMnP. A total of 58 (42%) of Pacific participants had been to their general practitioner prior to presenting to the ED; this proportion was similar for Maori (19 [30%]) and nMnP (59 [40%]) (p=0.215). The most common reasons for ED attendance among Pacific (as well as other) participants were 1) advice by a health professional (41%, 95% CI 33-50%), 2) usual care unavailable (28%, 20-36%), 3) symptoms not improving (21%, 14-28%), and 4) symptoms too severe to be managed elsewhere (19%, 12-26%). CONCLUSIONS: Multiple reasons underlie non-urgent use of EDs by Pacific and other ethnic groups. These reasons need to be considered simultaneously in the design, implementation, and evaluation of multi-dimensional initiatives that discourage non-urgent use of EDs to ensure that such initiatives are effective, equitable, and unintended consequences are avoided.

Diabetes in the Cook Islands: a clinical audit.

Introduction The global burden of diabetes mellitus (diabetes) is significant and of increasing concern with more pregnant women being diagnosed with gestational diabetes mellitus (GDM). The Cook Islands face mounting pressures to address diabetes alongside competing population health needs and priorities. Cook Islands residents frequently travel to New Zealand to access health services. Inadequate information systems also make it difficult for countries to prioritise preventative measures for investment. In the absence of good data to inform effective diabetes preventative and treatment measures, people with diabetes are likely to progress to complications which will burden society and health systems in the Cook Islands and New Zealand. Aim To determine the prevalence of diabetes and prediabetes, and incidence of GDM, in the Cook Islands. Methods We analysed two Te Marae Ora Cook Islands Ministry of Health datasets, the Non-Communicable Diseases (NCD) register examining demographic data for the period 1967 to December 2018 and same for the GDM register from January 2009 to December 2018. Results Of the 1270 diabetes cases, 53% were female and half were aged 45-64 years. There were 54 pre-diabetes cases and 146 GDM. Of the 20 GDM cases who developed type 2 diabetes, 80% were diagnosed before the age of 40 years. Data quality was poor. Discussion The Cook Islands diabetes registers provide important data to inform priorities for diabetes-related preventative and treatment measures. A data analyst has been employed to ensure quality, regularly audited data and information systems.