Type 2 Diabetes in Aboriginal Peoples

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee

Stewart B. Harris MD, MPH, FCFP, FACPM Onil Bhattacharyya PhD, MD, CCFP Roland Dyck MD, FRCPC Mariam Naqshbandi Hayward BA, MSc Ellen L. Toth MD, FRCPC

  • Key Messages
  • Recommendations
  • Figures
  • Highlights
  • Full Text
  • References

Key Messages

  • Aboriginal peoples living in Canada are among the highest risk populations for diabetes and related complications. Community-based and culturally appropriate prevention strategies and surveillance of diabetes indicators among this high risk population are essential to reducing health disparities.
  • Efforts to prevent diabetes should focus on diabetes risk factors, including prevention of childhood, adolescent, adult, and pregravid obesity; prevention and optimal management of gestational diabetes; and prevention of modifiable risk factors, such as smoking, inactivity, stress, and unhealthy eating habits.
  • Screening for diabetes in adults should be considered every 1 to 2 years in Aboriginal individuals with ≥1 additional risk factor(s). Screening every 2 years also should be considered from age 10 years or established puberty in Aboriginal children with ≥1 additional risk factor(s), including exposure to diabetes in utero.
  • Early identification of diabetes in pregnancy should be emphasized and post-partum screening for diabetes in those with gestational diabetes should be instituted with appropriate follow-up.
  • Treatment of diabetes in Aboriginal peoples should follow current clinical practice guidelines using community-specific diabetes management programs developed and delivered in partnership with the target communities.
  • Improvements in systematic care and medical management are needed to help close the substantial care gap between Aboriginal and non-Aboriginal peoples to mitigate diabetes-related morbidity and premature mortality.

Highlights of Revisions

  • The chapter highlights the importance of culturally appropriate prevention programs for children and adults in the Aboriginal community. This recommendation has been expanded and strengthened.
  • Two new recommendations regarding Aboriginal women and pregnancy have been added.

Recommendations

  1. 1.Starting in early childhood, Aboriginal people should be evaluated for modifiable risk factors of diabetes (e.g. obesity, lack of physical activity, unhealthy eating habits), prediabetes, or metabolic syndrome [Grade D, Consensus, see Type 2 Diabetes in Children and Adolescents, p. S163].
  2. 2.Screening for diabetes in Aboriginal children and adults should follow guidelines for high risk populations (i.e. earlier and at more frequent intervals depending on presence of additional risk factors) [Grade D, Consensus, see Screening for Type 1 and Type 2 Diabetes, p. S12; Type 2 Diabetes in Children and Adolescents, p. S163].
  3. 3.Culturally appropriate primary prevention programs for children and adults should be initiated in and by Aboriginal communities with support from the relevant health system(s) and agencies to assess and mitigate the environmental risk factors, such as:
    • geographic and cultural barriers
    • food insecurity
    • psychological stress
    • insufficient infrastructure
    • settings that are not conducive to physical activity
    • [Grade D, Consensus].
  4. 4.Management of prediabetes and diabetes in Aboriginal peoples should follow the same clinical practice guidelines as those for the general population with respect for, and sensitivity to, particular language, cultural history, traditional beliefs and medicines, and geographic issues as they relate to diabetes care and education in Aboriginal communities across Canada. Programs should adopt a holistic approach to health that addresses a broad range of stressors shared by Aboriginal peoples [Grade D, Consensus].
  5. 5.Aboriginal peoples in Canada should have access in their communities to a diabetes management program that would include an interprofessional nurse-led team, diabetes registries, and ongoing quality assurance and surveillance programs [Grade D, Level 4 (1-3)].
  6. 6.Aboriginal women should attempt to reach a healthy body weight prior to conception to reduce their risk for gestational diabetes [Grade D, Level 4 (4,5)].
  7. 7.Programs to detect pre-gestational and gestational diabetes, provide optimal management of diabetes in pregnancy, and timely post-partum follow-up should be instituted for all Aboriginal women to improve perinatal outcomes, manage persistent maternal dysglycemia, and reduce type 2 diabetes rates in their children [Grade D, Level 4 (6,7), see Diabetes and Pregnancy, p. S168].

References

  1. Harris SB, Naqshbandi M, Bhattacharyya O, et al. Major gaps in diabetes clinical care among Canada’s First Nations: results of the CIRCLE study. Diabetes Res Clin Pract 2011;92:272-9.
  2. Pylypchuk G, Vincent L, Wentworth J, et al. Diabetes Risk Evaluation and Microalbuminuria (DREAM) studies: ten years of participatory research with a First Nation’s home and community model for type 2 diabetes care in Northern Saskatchewan. Int J Circumpolar Health 2008;67:191-202.
  3. Tobe SW, Pylypchuk G, Wentworth J, et al. Effect of nurse-directed hypertension treatment among First Nations people with existing hypertension and diabetes mellitus: The Diabetes Risk Evaluation and Microalbuminuria (DREAM 3) randomized controlled trial. CMAJ 2006;174:1267-71.
  4. Harris SB, Gittelsohn J, Hanley A, et al. The prevalence of NIDDM and associated risk factors in Native Canadians. Diabetes Care 1997;20:185-7.
  5. Dyck R, Klomp H, Tan LK, et al. A comparison of rates, risk factors, and outcomes of gestational diabetes between Aboriginal and non-Aboriginal women in the Saskatoon health district. Diabetes Care 2002;25:487-93.
  6. Dabelea D, Knowler W, Pettitt D. Effect of diabetes in pregnancy on offspring: Follow-up research in the Pima Indians. J Matern Fetal Med 2000;9:83-8.
  7. Osgood N, Dyck R, Grassmann W. The inter-and intragenerational impact of gestational diabetes on the epidemic of type 2 diabetes. American Journal of Public Health 2011;101:173-9.

 

Reproduced with permission from Canadian Journal of Diabetes © 2013 Canadian Diabetes Association. To cite this article, please refer to For citation.

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