“Medical yarn ups”试验帮助原住民妇女应对 2 型糖尿病

Lisa Wellington 记得七年前她被诊断出患有 2 型糖尿病时所感受到的评判和无助。

“医生只想谈论体重、体重、体重，”她说。

“这是你的剧本，你走吧，走出去。”

微笑的女人
丽莎·惠灵顿 （Lisa Wellington） 在七年前被诊断出患有 2 型糖尿病后处于缓解期。 （提供：Waminda）

但是，在她的家乡 Yuin Country 的 Nowra 领导的为期八周的审判，让 Jerrinja Cullunghutti Wandi Wandandian 妇女的精神和健康状况有所不同。

“我的糖尿病正在缓解，”她说。

"我现在能够做出这些决定，我的健康掌握在我手中。"
惠灵顿女士说，她已经将药物从高剂量转变为“非常低剂量”，并计划在未来几周内完全停止服药。

不同的药物治疗
澳大利亚原住民患 2 型糖尿病的可能性是非原住民的四倍。

根据澳大利亚健康与福祉研究所 2021 年的数据，在 120 万患有 2 型糖尿病的澳大利亚人中，估计有 51,900 人（10.7%）是原住民。

五年前，南海岸原住民妇女健康组织 Waminda 开始着手改变统计数据。

它与南十字星大学 （SCU） 合作，为一组 25 名患有 2 型糖尿病至少 10 年的女性开发了一项使用共享医疗预约的试验。

A variety of cabbages, capsicums, zucchinis, tomatoes and beans for sale inside a green grocer.
Waminda participants shopped and cooked together weekly as part of the program. (ABC news: Kate Ainsworth)

The study, which was recently published in the peer-reviewed American Journal of Lifestyle Medicine, also explored the continuous monitoring of glucose levels.

SCU associate professor John Stevens said the approach to First Nations health needed to change.

"The process we've used in the past has been very much from a colonised perspective … the 'smart non-Indigenous clinician telling the Aboriginal person what to do' — and that's just not working,"  he said.
'Medical yarn-ups'
The eight-week trial allowed participants themselves to decide what would work for them during "medical yarn-ups".

They chose to use modern technology.

"We used a continuous glucose monitor (CGM), and you get to read out in real time on your phone what your blood sugar levels are doing," Dr Stevens said.

"If you eat a packet of chips or lollies up it goes, and if you eat food that doesn't react with it, like some porridge, you can see it coming down.

"So very quickly you get a good response with your food."

Associate Professor John Stevens smiling at camera in lush green environment
John Stevens says the culturally responsive shared medical appointment model is a game-changer  (Supplied: Southern Cross University)

Dr Stevens said by the end of the trial, 18 of the 25 participants had lowered their blood-sugar levels significantly, and kept those results for 12 months.

He said seven women went into remission, and four participants who needed insulin had stopped taking it by the end of the program and were insulin-free 12 months later.

"It was an amazing response, the way they felt about themselves was amazing, and the way they re-engaged with the health service," Dr Stevens said.

"Because they were heard and listened to, it worked."
Push for type 2 CGM subsidies
A CGM is wearable device that tracks glucose (sugar) levels over time, but currently subsidies are only available to those with type 1 diabetes.

"They're a very powerful behaviour change tool, and this study proves that," Waminda's diabetes educator and study co-author Willow Firth said.

"They are not subsidised by the government at all [for type 2 diabetes]."

Ms Wellington said the CGM motivated her to keep pushing towards her goals.

"I love my sweets, I love my chocolate, but alternatives like dark chocolate didn't spike so much," she said.

Glucose monitor on arm
Women in the NSW trial used continuous glucose monitors to track their sugar levels. (ABC Illawarra supplied: Waminda)

"Seeing in real time with the CGM, I was able to see things that I could and couldn't eat."
In a statement to the ABC, Diabetes Australia chief executive Justine Cain said the study results showed "the life-changing impact of accessible, culturally attuned healthcare".

She said they were also a reminder that technology like CGMs should not be a luxury.

"It's essential," Ms Cain said.

"There is an urgent need in communities … we must find a way to meet it."
Diabetes Australia is calling on both side of politics to address the issue ahead of the federal election.

It wants a commitment of $200 million over four years to fund access to CGMs and insulin-pump technology for First Nations peoples living with type 2 diabetes.

Trial moves west
史蒂文斯博士说，共享医疗预约试验的下一阶段——不是糖尿病治疗所必需的——现在正在东阿纳姆地区、达尔文和中央沙漠进行，它对远程诊所的就诊率产生了巨大影响。

10 Aboriginal men sit on picnic blankets beneath trees, smiling, four are are waving and on gestures 'thumbs up'
雍古人在东阿纳姆地谈论健康。 （提供：SCU）

“你会有 10 个人预约去远程诊所看全科医生，但只有两个人会来，因为他们太害怕了，”他说。

"我们让 100% 的人参加了这些共享医疗预约。"
缩小差距
惠灵顿女士说，她从试验的其他参与者那里得到的社会支持令人振奋。

“真的互相鼓励，你知道，当你过得好日子和不那么好的时候，”她说。

Aboriginal women sitting and standing on verandah, looking at camera
Gapu 妇女在共享医疗预约中谈论健康。 （提供：SCU）

史蒂文斯博士说，这种方法有可能在原住民社区取得重大成果。

“与我们交谈的每个人都非常客观地看着这一切，'哇，这改变了游戏规则，'”他说。

"这就是政府应该用来缩小这一差距的一部分。"
Waminda 和 SCU 即将在第一次试验五年后审查参与者的进展。

“这段旅程是终生的——生活中发生的事情可能会让我们倒退一点，”Firth 女士说。

“但重点是回到正轨并获得这种支持。”