New Zealander makes diabetes breakthrough

Press, 2 June 1988, Page 37

New Zealander makes diabetes breakthrough

By TOM BRIDGMAN NZPA Washington A New Zealander’s research into diabetes in a tribe of south-west American Indians has provided important information to help with early treatment of the condition which particularly affects Polynesians. Dr Stephen Lillioja, aged 36, a graduate of the Otago Medical School, has for the last six years been in the United States working on a Federal funded National Institutes of Health special diabetes research programme in Phoenix, Arizona. The study is centred on the Pima tribe at the Gila' Indian River reservation, a group where about 50 per cent of those over 35 years of age have diabetes, the highest rate in the world. In a paper published in the prestige “New England Journal of Medicine,” Dr Lillioja writes about his research into what is called impaired glucose tolerance, a mildly abnormal rise in blood sugar levels. About 25 per cent of adults who suffer this condition go on to develop severe glucose intolerance in the form of non-insulin dependent diabetes. Overweight adults, es-

pecially those with a family history of diabetes, are at high risk from this. Dr Lillioja, whose father emigrated to New Zealand from Estonia just before World War 11, has been studying a question that has puzzled doctors — whether impaired glucose tolerance is, like diabetes, marked by a failure of the pancreas to produce enough insulin, the hormone that regulates glucose metabolism. The research by Dr Lillioja and other N.I.H. workers at Phoenix has showed that overweight adults with I.G.T. have a normal, functioning, pancreas and so if they lose weight the insulin they produce can become more effective and so may help prevent the onset of diabetes. The findings mean that doctors should be more active in counselling their overweight patients with I.G.T. to lose weight and lower the amount of fat in their diet, said Dr Lillioja. “The paper covers one of the central issues that we think is causing diabetes in the population," he said.

“We think that the underlying problem in the Indians is that insulin is unable to work properly. When that is prolonged

for long enough the pancreas gives up.

"So diabetes is due to the insulin not working and the presence of a bad pancreas, but what happens to the pancreas is something that happens later.” People with mildly abnormal glucose tolerance did not yet have diabetes, “but obviously they are in trouble,” he said. The cause of the insulin not working properly was partly genetic and also partly due to obesity. “Those people have to start losing weight What we are saying is that you shouldn’t be telling people to lose weight and correct their diet once the horse has bolted.” Doctors should be alerted when someone was in the earliest stages of 1.G.T., he said, and treatment begun then. -"Dietary habits are the only really good measure we have at the moment of regulating the problem. People have to reduce the total amount of food they’re eating, they have to increase the. amount of activity and probably specifically reduce the amount of fat in their diets because fat may have an independent effect on worsening insulin’s ability to work.”

He felt that the diabetes problem amongst the Pima Indians was in part because of Westernisation and their changed lifestyle and dietary habits. “Food is much more readily available and in different sorts. Now they can eat large amounts of fat where before that was much more difficult. You had basically an unrefined carbohydrate diet”

The same diabetes problem was occurring in Samoans who had about twice the rate of diabetes as white New Zealanders. “It is very likely Samoans have exactly the same metabolic condition that Pima Indians have,” said Dr Lillioja. “I’ve heard they are worried in South Auckland at all the diabetes that is developing. I don’t have any recent numbers on that, but I know it is higher than the whites.” He said if overweight white New Zealanders and Polynesians, most of whom were overweight when they got diabetes, had abnormal glucose intolerance "then that is an indication that they are at high risk of going on and getting the full diabetes.” “They are the sort that should be treated now,” he said, not when diabetes had fully developed.

Dr Lillioja said that apart from specialists who were aware of the connection, doctors generally tended to overlook impaired glucose tolerance. “There is a need l for more emphasis at an early stage on health and diet,” he said. Dr Lillioja is continuing his work at Phoenix and while there has encouraged other New Zealand doctors to come to work on the research. Mr Boyd Swinburne, from Auckland, is with him at present, while previously Mr William Abott and Mr Andrew Young, son of a former Cabinet Minister, Mr Venn Young, have also been involved.

After study at Otago University and the Christchurch Clinical School of Medicine, Dr Lillioja, whose speciality is endocrinology, had gone on to post-graduate work at hospitals in Auckland and then later at Royal Melbourne Hospital and the University of Michigan.

Such has been the Importance of his work on diabetes research, the United States Indian Health service successfully gained from the Federal Government permission for him to stay in the United States as a per--manent resident. »