It was a stroke of genius to hold this year’s annual scientific conference and AGM here at St David Theatre.

This theatre has won prestigious architectural awards for its use of space; the quality of the light it lets in; and its comfortable relationship with other buildings adjacent to this complex.

It is, indeed, a perfect metaphor for the challenges we must confront in the pursuit of diabetes management.

We must create the space that welcomes academic insights alongside anecdotal evidence; where the views and perspectives of family are as valued as the advice of dietitians and specialists.

This conference has been a vital opportunity to let the light in, to expose research gaps and policy needs; to explore new areas of discovery.

And perhaps the greatest test of all, is to examine the relationship that diabetes treatment and management has with other areas across the discipline of health, and indeed within the context of the wider social services.

I am delighted to be here, at this premier meeting of people passionate about priority and pending issues for diabetes management in New Zealand.

I have always held a view that the diabetes epidemic is the silent killer, an epidemic which is evidenced by the fact some 180,000-190,000 adults are known to have diagnosed diabetes, and who knows how many more are yet to find out.

In fact, in a paper on Te Wai o Rona: diabetes prevention strategy, published earlier this year, their study of Maori families living in the Waikato/Lakes area concluded that undiagnosed diabetes, impaired glucose tolerance and impaired glucose remain common among Maori.

I use the word silent deliberately, because it conveys to me one of the major challenges we still face in confronting such a significant health threat.

Recently, I reluctantly became the covergirl for the Diabetes New Zealand magazine.  I note that they didn’t ask me to also be their page 3 pinup – my story didn’t appear till ten pages in.

What has amazed me over the last few weeks is just how many people have come out, and disclosed their story to me.  It has made me utterly aware of just how widespread the impact of diabetes is, particularly amongst Maori and Pasifika peoples.

Of course, as Associate Minister of Health, I had received all the briefings.

I knew that one in three New Zealanders are overweight, and one in four are categorized as obese.

I knew that children and adults living in the highest quintile of neighbourhood deprivation were more likely to be obese than those living in less deprived areas.

I knew that Maori are more likely to be diagnosed with diabetes at a younger age than non-Maori and to develop complications such as eye disease, kidney failure, heart disease and strokes.

But it is one thing to read all the paperwork; it is quite another to be confronted with real-life stories.

One woman talked to me of the secret trauma she remembered from her childhood days.   Her mother, a type one diabetic, occasionally experienced hypoglycemic episodes, when her blood sugar levels fell to dangerously low levels.

For the children, the impact was often terrifying, as their mother would one minute be laughing hysterically; the next climbing the chairs and pretending to fly; and then just as suddenly dissolving into uncontrollable crying.

After the episodes, Mum would be mortified, Dad would attempt to quickly change the focus, and all the time, the children were left wondering, why.

In their home, forbidden foods were eaten secretly behind closed doors; periods of hospital were endured without explanation; and all along the one thing that they wanted to talk about was left unsaid.

I tell this story because it demonstrates in one family, an issue that I think is close to the heart of many families who experience diabetes.

This is not a visible condition that we are talking about.  Until I became public about being diagnosed as type two, nobody would have known that I had a personal history in relation to diabetes.

Of course all of you – the physicians, the nurse specialists, the dietitians, the scientists, the general practitioners – could have looked at my eating habits, the lack of exercise, the stressful nature of my lifestyle – and made a pretty educated guess; but for the general population it was unknown.

And I think this is one of the big themes of the Diabetes and Cardiovascular Disease Quality Improvement that all of us in this room will recognize as helping us sort through the priorities in the work-plan ahead.

It’s in the commitment to ensure there is reliable and consistent advice for people with diabetes; and for people who are overweight or obese.

It’s in the investment we must all make to strengthen networks of people to develop and promote innovative services and solutions.

And it’s in the dedicated efforts we must all take up, to not only improve access to good quality care, but also in diabetes management which imbues confidence and competence in our families to self-manage.

A critical component of self-management, is having the benefit of high quality diabetes education – and education which is sufficiently flexible to talk to the different cultural contexts for our population.

It may be in talking about some of the issues around manaakitanga – the obligation and the responsibility to be a good host.  I know that in our marae we have had a radical overhaul of our menu; believing that being a good host is also about taking responsibility for our collective wellbeing.

And so instead of fatty meats, we try for the lean, trim version; our tables are now groaning under the weight of all the fresh fruit; and instead of fizzy pop we have mineral water.

Indeed, I believe many marae have taken up the responsibility to promote healthy living; and of course the increasing energy being allocated to inter-marae sporting events is another very positive development.

This same fresh energy is what I am promoting with all of the providers that come to my table, as well as the central agencies.

I am passionate about a commitment to whanau ora.  In this, my focus is always about how the whanau are best able to manage their lives, to do for themselves.

I think the state has been limited by a historic mistrust of families, believing that Government knows best.  

There has been an intellectual apathy to thinking outside the realms of the funder/ provider split; or perhaps an overly risk-averse bureaucracy has preferred to focus on inputs and activities, on specifications and contracts, rather than taking a leap of faith in families.

I want to shift that focus, to develop a more responsive health system, to enable families to achieve their potential by doing what we can to enable them to take control on their lives.

You will be aware that a number of service specifications are being reviewed or updated this financial year: including the tier two and three annual review for people with disabilities; the tier three care and education; local diabetes team and at risk/high risk foot; the tier three service specification for children and young persons; and a review and update of the diabetes retinal screening.

All of these reviews provide us with an opportunity to evaluate how well people with diabetes are having their needs met; and to ensure that improving productivity is linked to achieving whanau ora. 

But there are other opportunities we might take up to be innovative which extend past a prescription of Glipizide or beyond the service specifications.

Last week I had a wonderful visit with Mighty Dogs who provide mobility assistance for people with physical disabilities.  They told me some incredible stories of dogs who had fetched a jacket to keep someone warm when they had fallen out of their chair; dogs who were able to retrieve the phone; open doors; and to provide reassurance to a person after a seizure.

And I have read recently about the training in the United Kingdom of special diabetic hypo-alert dogs. 

Apparently research from Queen's University in Belfast found that 65% of 212 people with insulin-dependent diabetes had reported that when they had a hypoglycemic episode their pets had reacted by whining, barking, licking or some other display.

The use of such dogs is certainly one idea that might warrant further examination.   And I am sure there are many more.

Each of you, will have come into contact with families, who demonstrate remarkable resilience and creative courage, in thinking about how they can ensure a focus on wellness dominates their lives.

As I looked through your programme, I was overwhelmed with the science of making a difference in the treatment of types one and two diabetes.  I would love to hear from you, as to the priorities you see ahead for diabetes management, and the outstanding issues and gaps that require our fullest attention.

I am sure you leave this forum richer with knowledge about glucose metabolism; renin-angiotensin; nutritional interventions; and insulin sensitivity.

You will return to your workplaces, buzzing with the latest research trends shared so generously by Professor Edwin Gale of the University of Bristol ; Associate Professor Merlin Thomas, Baker Heart Research Institute and the impressive range of keynote speakers and workshop presenters encompassed in the programme.

And no doubt there are other areas which will trigger your own course of inquiry when you return home – the provision of insulin pumps; the opportunity to invest in bariatric surgery; the value of a retinal screening teaching/test CD.

But I hope that you are also motivated to think about the things that create the sense of wellness, that bring joy into the lives of the people you care for.

I urge you all to encourage families to create their own champions – those who apply themselves to acquiring the latest knowledge and effective strategies to create wellness.

We know that unmanaged cases have been held responsible for more than half of all heart attacks and strokes, and two-thirds of cases of blindness.

We cannot continue in the path we are going, to stretch our health system even further.  We all need to work together and in collaboration – across sectors, across providers, across specialist disciplines, across Government and across our communities.

We must take every step to reduce the impact of diabetes on our nation.  

Finally, I want to thank you, most sincerely, for the amazing contribution you all make towards such an important goal.  

Let us continue to create the space to make a difference; to let the light in; and to put the energy into relationships of respect so that whanau ora can be experienced by all.