Diabetes prevalence and associated factors among pasifika adults in Australia: findings from the pasifika preventing diabetes programme

Background: Given the paucity of evidence on diabetes and associated risk factors among Pasifika communities in Australia, this analysis aimed to estimate the prevalence of diabetes and associated risk factors in this population. Methods: A whole-of-community-based cross-sectional analysis was conducted using baseline health screening data from adults aged ≥18 years in the Pasifika Preventing Diabetes Programme, a stepped-wedge randomised controlled trial evaluating the effectiveness of a “through the church” behaviour change intervention on diabetes prevention and management in Pasifika communities in Greater Sydney. HbA1c, random blood glucose, blood pressure, and anthropometric measurements were collected alongside sociodemographic, health behaviour, diabetes knowledge, and quality-of-life questionnaire data. Diabetes was defined by HbA1c ≥ 6.5% or self-reported diagnosis. Multivariable binary logistic regression was conducted to identify significant factors associated with the odds of having diabetes. Results: Among 1161 participants, 33.9% (95% CI: 31.1–36.7) had diabetes, of whom 34.3% were previously undiagnosed. Only 2.5% met fruit and vegetable guidelines; 34.3% met minimum physical activity recommendations, 95.8% were obese/overweight, and 68.0% had high blood pressure. The adjusted odds ratio (AOR) of having diabetes increased with family history of diabetes (AOR, 2.23; 95% CI: 1.56–3.20), high blood pressure (AOR, 1.65; 95% CI: 1.15–2.38), and older age (AOR, 1.06; 95% CI: 1.05–1.07). A high level of physical activity was associated with a 41% lower odds of diabetes compared to a low level of physical activity (AOR, 0.59; 95% CI: 0.38–0.94). Conclusions: This study demonstrates a high burden of diabetes among Pasifika adults in Australia, including a substantial proportion of previously undiagnosed cases. Older age, family history of diabetes, and high blood pressure were associated with higher odds of diabetes, while high physical activity was associated with lower odds. These findings highlight the need for culturally safe, community-based approaches to strengthen diabetes screening, early diagnosis, and integrated prevention strategies in this underserved high-risk population.