The DRAW Program Showcases T2DM Remission

Empowering First Nations Women

Type 2 Diabetes Mellitus (T2DM) continues to disproportionately affect Indigenous Peoples worldwide. In Australia specifically, First Nations people are diagnosed and hospitalised at rates multiple times higher than the broader population, with serious implications for life expectancy and quality of life. While many factors contribute to these disparities—most notably the historical impact of colonisation—new models of care that actively involve Indigenous communities in the design and delivery of services show promise. 

One such model is the Diabetes Remission in Aboriginal Women (DRAW) program, a feasibility study that combined culturally grounded practices and leading-edge technology to improve diabetes outcomes among First Nations women. The study has illustrated why integrated approaches—ones that merge cultural knowledge, group medical visits, and continuous glucose monitoring (CGM)—are not just viable but powerful pathways toward better, sustained health for people with T2DM. 

Culturally Responsive Care

In Australia, First Nations people face a legacy of disrupted traditions following colonisation, including displacement from ancestral lands, loss of language, restricted cultural practices, and intergenerational trauma. These factors compound to produce significant disparities in health, social, and economic outcomes—particularly when mainstream health services are perceived as culturally unsafe or disconnected from Indigenous perspectives.

Within this context, T2DM has become one of the most prevalent issues affecting Indigenous communities worldwide. In Australia, First Nations individuals are four times more likely to be diagnosed, five times more likely to be hospitalised, and six times more likely to die from the disease. Despite the severity of these statistics, many First Nations people remain reluctant to access mainstream care. Building culturally safe, community-led programs is therefore crucial to improving diabetes management, prevention, and even remission.

The DRAW Program

The DRAW program was co-designed with Waminda—a South Coast Aboriginal Women’s Health and Wellbeing organisation on Yuin Country in New South Wales. Co-design in this case meant a genuine partnership with community members, service staff, researchers, and participants, ensuring that program activities were grounded in Aboriginal cultural values and responsive to the lived realities of local women. This inclusive approach set a crucial foundation of trust and engagement.

A key innovation in DRAW was the use of Dexcom G6 continuous glucose monitors (CGMs). In this study, the CGMs provided real-time feedback not only to participants but also to the health team, allowing for more precise medication titration and timely intervention. Crucially, for the participants themselves, CGM data offered an immediate and motivating window into how food, stress, and activity influenced blood glucose levels.

Shared Medical Appointments (SMAs)—a model that has steadily gained traction for chronic disease management—were adapted here to align with traditional yarning circle practices. Each patient SMA session began with group-based education, where participants reviewed CGM data, shared personal experiences, and explored practical health and lifestyle strategies. This was followed by individual mini-consultations with a GP, conducted in the supportive presence of the group. Such a setting fostered shared learning, encouraged peer support, and allowed participants to ask questions in a culturally safe, trusting environment.

Central to DRAW’s cultural grounding was the Nyully Food program. Delivered over seven weeks, Nyully Food emphasises traditional, pre-colonisation eating patterns—foods that are locally sourced, nutrient-rich, and minimally processed. By tracing the historical diet of First Nations people in the region and substituting where necessary with modern equivalents, participants were guided toward high-protein, high-fiber, and lower-sugar meal choices. Preparing meals together in a communal kitchen and observing the immediate impact on blood sugar via CGM readings turned eating into a powerfully educational and affirming activity.

Progress was also evident in the psychological measures: higher Patient Activation (PAM-13) scores and lower diabetes-related distress (PAID). These findings imply that participants felt more in control of their health and less burdened by the emotional toll of chronic disease management, improving the likelihood of sustained lifestyle changes.

Although the study did not assess economic outcomes in detail, the shared appointments model and CGM integration have demonstrated cost-effectiveness in other contexts, particularly regarding medication use, hospitalisations, and overall complications. For communities and health services with limited resources, this integrated, culturally respectful approach offers a promising pathway to high-impact diabetes care.

Community Impact

The DRAW program showed promising results in improving the metabolic and psychosocial well-being of First Nations women living with T2DM. Participants who completed the program recorded an average decrease in HbA1c of 0.71%, with 28% of these women achieving remission (i.e., reducing HbA1c to below 6.5%), and many maintaining this improvement for at least 12 months. Weight, blood pressure, and liver enzyme levels also improved significantly, while real-time CGM data enabled more precise self-management and medication adjustments. Additionally, participants reported increased patient activation and decreased diabetes-related distress, indicating a stronger sense of control over their health and reduced emotional burden.

From a broader perspective, these outcomes highlight how culturally guided approaches can bolster both clinical and psychosocial gains in chronic disease management. As a feasibility study, DRAW lacked a control group and had a relatively small sample size. Future research could include larger, multi-site trials—co-designed with diverse First Nations communities—to more robustly assess the generalisability and efficacy of this integrated model. Investigations into cost-effectiveness, including reduced hospitalisations and long-term management expenses, would also shed light on the potential healthcare savings associated with culturally tailored interventions. Ultimately, building on these insights may lead to more scalable, community-driven frameworks that further enhance engagement, reduce health disparities, and help reverse or effectively manage T2DM in First Nations populations.

Paving the Way

For GPs and other healthcare professionals committed to sustainable T2DM management, the DRAW program demonstrates that genuine cultural partnership, real-time data feedback, and patient-driven self-management can combine to achieve significant metabolic and psychosocial gains. Grounding interventions in local cultural practices—such as group meetings modeled on yarning circles—and pairing them with technologies like CGM not only reinforces trust but also empowers patients to take active control of their day-to-day health decisions. Through ongoing peer support, practical cooking sessions tailored to ancestral knowledge, and continual real-time monitoring, participants demonstrated measurable decreases in HbA1c, body weight, and diabetes-related distress, indicating that remission and potentially lasting change are feasible outcomes.

These findings underscore the potential for primary care services, especially in rural or underserved areas, to adapt multifaceted strategies that integrate advanced medical tools with culturally anchored group care. Although this feasibility study focused on one community, its success paves the way for broader, more rigorous investigations that can refine and expand these methods. By pushing the boundaries of culturally safe, patient-centered models, researchers and clinicians alike can explore even more effective ways to move from mere “management” to genuine remission.

Stevens, J. et al (2025) Continuous Glucose Monitors and Programmed Shared Medical Appointments in Managing Type 2 Diabetes Mellitus Among First Nation Women in Australia: A Co-Designed Feasibility Study, American Journal of Lifestyle Medicine. Available at: https://journals.sagepub.com/doi/pdf/10.1177/15598276241312084