A quarter of Pacific people in New Zealand are on track to become Type-2 diabetics by 2040.
The projected epidemic was the key finding of a new report on the disease which already struck Pasifika at twice the rate of the general population.
The Economic and Social Cost of Type 2 Diabetes report put the annual bill from the chronic medical condition at $NZ2.1-billion.
Left unabated, the cost was pegged to blow out to $3.5-billion, a 63 percent increase, by 2040.
By that stage, one in four Pacific people could be diagnosed with the illness, compared with fewer than one in 20 for the general population.
The comparison put into stark relief the health inequities which continued to widen for Pasifika.
But the report offered some hope too, in new opportunities to better understand the way Type-2 Diabetes affected Pacific people.
The Auckland Pacific health and social services provider, the Fono, engaged with the community to help provide advice and data to the research.
Community input was to ensure Pacific voices were clearly articulated, said Fono Chief Executive Tevita Funaki.
"I'm hoping that this research project will help inform policies that are much friendlier in terms of addressing the challenges within the Pacific communities," he said.
"It also helped inform some of the funding, in terms of the interventions, that actually work through in supporting Pasifika families."
Type 2 Diabetes was a social and economic challenge for Pasifika but so too was the lack of cultural competency within the health sector, added Funaki.
The Minister Responsible for Māori Health, Peeni Henare, said he wanted to see equity naturally embedded within health sector reform.
"We've got a large number of opportunities here to look across the entire health system to change some of that," said Henare.
His Pacific Health counterpart Aupito William Sio looked to a holistic approach being taken.
"Laying foundations to build on long-term and bringing (on board) all government departments. And holding government departments responsible for resourcing and supporting Pacific communities."
One of the report's Pacific researchers, Tupa'ilevaililigi Dr Ridvan Tupa'i-Firestone, said she was pleased at the support from the two ministers. Yet she added that better cohesion was needed throughout the health sector so as to understand the inequities Pasifika communities and families experienced.
"How do we actually collectively work together, not just within the communities but across the health sector?" questioned Tupa'i-Firestone.
Part of the answer lay in more Pasifika health professionals working across all sectors, she said, to help reverse the worsening statistics.
Representative health workforce
The Pasifika biomedical scientist and researcher Dianne Sika-Paotonu, in her role as Associate Dean Pacific for the University of Otago Medical School in Wellington, emphasised the importance of "ensuring that we have a health workforce that is appropriate and that represents the population groups that it seeks to serve."
But it was one of a suite of answers to ensure that equitable health outcomes were achieved for Pasifika.
Matire Ropiha has the illness and is one of three generations of diabetes sufferers.
"And when I was first diagnosed as having diabetes, I thought of the journey that my mother had, and my mother's mother. And so it's impacted me in a way that I want to stop diabetes affecting my daughter."
In order to improve her quality of life, Ropiha made significant dietary changes.
"I don't eat bread, I don't eat pasta, I don't eat rice. I eat, the majority is a plant based diet and also I fast, every day. And that's so that I can bring down my blood sugar levels in a way that I can then live without my diabetes medication."
Other interventions were recommended in the report to stop the 15 percent of Pasifika currently suffering Type-2 diabetes turning into 25 percent by 2040.
With Pasifika having the country's largest proportion of youth, and with diabetes sufferers being diagnosed younger, the economic toll was increasing.
Treating diabetes when diagnosed at age 75 presented a lifetime cost of $44,000 but for those increasingly diagnosed at 25 years, the lifetime cost was $521,000 representing a 13 fold increase.
This was a main target of the four proposed diabetes specific interventions which aimed for better health outcomes but also offered better economic ones.
Targeted lifestyle change programmes aimed at preventing Type-2 are projected to save the country $130-million while another aimed at reversing the illness could represent $83-million not being spent on treatment, representing a significant return on investment.
They also battle comorbidities including hypertension, obesity and kidney disease.
The other two interventions involve innovations in new diabetes medications offering net benefits in excess of $1.4-billion, while better foot screening could save 390 lower limbs from being amputated every year and over 200 minor amputations.
Another Pasifika health researcher involved in Type 2 diabetes called for immediate action.
The Maurice Wilkins Centre's Dr Ofa Dewes said it was vital the health sector worked with Pacific communities and families to implement recommendations made in the research.
"It's important that we all here work together in community with Maori and Pacific peoples. We know that the prevalence of Type 2 diabetes is increasing amongst our population groups not only at an older age but at a younger age."
She said existing strategies had failed.
"Unless we do something differently, we will only achieve the same result."