NDMS

DIABETES FACTS

DIABETES IS AN ABORIGINAL PROBLEM

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First Nations women on reserve in Ontario have increased prevalence of diabetes in pregnancy and adverse outcomes
Compared to non-FN women, on-reserve FN women in Ontario had:
  • Higher prevalence of diabetes in pregnancy
  • Less preconception/antenatal care
  • Less postpartum care
  • Higher mean birth weight and rate of macrosomia
  • Higher rates of pre-term delivery, jaundice, neonatal hypoglycemia, shoulder dystocia
  • Less primary care after birth
Source:
Liu S, Shah B, Naqshbandi M, Tran V, Harris S. Increased rates of adverse outcomes for gestational diabetes and pre-pregnancy diabetes in on-reserve First Nations women in Ontario, Canada. Diabetic Med. 2012: in press.
Type 2 diabetes has reached epidemic proportions among Canadian Aboriginal peoples
  • The national age-adjusted prevalence is 2.5 to 5 times higher than that of the general population.
  • Age-adjusted prevalence rates as high as 26% have been found in individual communities.
Aboriginal peoples are diagnosed with type 2 diabetes at a much younger age, with high rates of diabetes in children and adolescents.

Sources:
Dyck R, Osgood N, Lin TS, Gao A, Stang MR. Epidemiology of diabetes mellitus among First Nations and non-First Nations adults. CMAJ. 2010; 182(3):249-256.

Green C, Blanchard J, Young TK, et al. The epidemiology of diabetes in the Manitoba-registered First Nation population: current patterns and comparative trends. Diabetes Care. 2003;26:1993–1998.

Harris SB, Gittelsohn J, Hanley A, et al. The prevalence of NIDDM and associated risk factors in Native Canadians. Diabetes Care. 1997;20:185–187.

Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr. 2000;136:664–672.
Self-reported diabetes among Aboriginal and First Nations populations is higher than in the non-Aboriginal populations.
Prevalence of self-reported diabetes  

 

Population
Data Source
Age of
Surveyed Population
Prevalence (%)
(95% confidence interval)
  
  
  
Crude
Age-standardized
Non-Aboriginal
2009-10
CCHS
12+
6.0
(5.8-6.3)
5.0
(4.3-5.7)
First Nations
(on-reserve)
2008-2010
RHS
18+
15.3
(14.2-61.4)
17.2
(16.5-19.0)
First Nations
(off-reserve)
2009-10
CCHS
12+
8.7
(7.0-10.4)
10.3
(3.4-17.2)
Inuit
2006 APS
15+
4
(3.3-5.6)
NA
Métis
2009-10
12+
5.8
(4.4-7.3)
7.3
(202-12.5)

 

APS = Aboriginal Peoples Survey
CCHS = Canadian Community Health Survey
RHS = First Nations Regional Longitudinal Health Survey

Source:
Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011. Available at: http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php?utm_source=Stakeholders&utm_medium=email_eng&utm_campaign=DiabetesReport2011 Accessed January 3, 2012.
Type 2 diabetes is often diagnosed in Aboriginals at a younger age than in non-Aboriginals.
Compared with the general population of people with type 2 diabetes, First Nations peoples were diagnosed with diabetes on average a decade earlier.

Age of diagnosis of type 2 diabetes

General population with type 2 diabetes in family practice setting
(2002-2003) (1)
General population with type 2 diabetes in family practice setting
(2005-2006) (2)
First Nations population with type 2 diabetes in 19 communities (2007) (3)
54.9 years 55 years 43.7 years

Sources:
  1. Harris S, et al. Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study). Diabetes Res Clin Pract 2005;70(1):90-97.

  2. Braga M, et al. Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada. Can J Cardiol. 2010;26(6):297-302.

  3. Harris SB, et al. Major gaps in diabetes clinical care among Canada's First Nations: results of the CIRCLE study. Diabetes Res Clin Pract. 2011;92(2):272-279
Canada's First Nations have higher rates of some serious complications of diabetes than the general Canadian population with type 2 diabetes.
Compared with the general population with type 2 diabetes, First Nations peoples with diabetes are younger, yet have higher rates of many of the serious complications of diabetes. This higher morbidity is reflected in double the number of diabetes-related health visits in First Nations than in the general population with type 2 diabetes.

Prevalance of selected complications by population

Complication First Nations population with type 2 diabetes in 19 communities
(2007) (1)
General population with type 2 diabetes in family practice setting
(2002-2003) (2)
Age at audit 54.9 62.7
Chronic kidney disease 55.1 6.0
Depression 21.1 14
Neuropathy 10.8 8.0
Retinopathy 10.7 7.0
Diabetic foot disease 5.5 2.0
Number of diabetes-related health visits 8.7 4.3

Sources:
  1. Harris SB, et al. Major gaps in diabetes clinical care among Canada's First Nations: results of the CIRCLE study. Diabetes Res Clin Pract. 2011;92(2):272-279.
  2. Harris S, et al. Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study). Diabetes Res Clin Pract. 2005;70(1):90-97.
Aboriginal women experience much higher rates of gestational diabetes than non-Aboriginal women.
Gestational diabetes mellitus (GDM) is defined as diabetes with onset or first recognition during pregnancy. It is a risk factor for later development of type 2 diabetes in the mother, as well as in the offspring.

Prevalence of GDM

Population Prevalence
Non-Aboriginal 0.5
First Nations 4.8
Inuit 4.0
Métis 2.2


Source:
Garnier R, et al for the Longitudinal Health and Administrative Data Research Team. The health of First Nations living off reserve, Inuit and Métis adults in Canada: the impact of socioeconomic status on inequalities in health. Working paper series. Ottawa, ON: Statistics Canada Health Analysis Division; 2010. (cited in Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011. Available at:http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes Accessed January 3, 2012)
A surveillance system will track type 2 diabetes and complications in First Nations communities
The First Nations Diabetes Surveillance System is a web-based surveillance application that will track type 2 diabetes and complication rates over time in First Nations communities. This information will allow the monitoring of the diabetes burden in each partnering community and can be used to inform and evaluate new quality improvement initiatives in communities. The goal of the Surveillance System is to monitor and track diabetes rates so that informed decisions can be made to improve community care. Similar programs in Aboriginal settings in the United States and Australia have been associated with sustained improvements in quality of care for people diagnosed with diabetes. Although this program is currently a 2-year pilot program, it is hoped that in the future the system will be expanded to include other communities, and that on-going financial support will help sustain the program. The Surveillance System has been generously funded by the Aboriginal Diabetes Initiative (ADI), First Nations and Inuit Health Branch (FNIHB) at Health Canada.

Source:
First Nations Surveillance System Newsletter. Issue Number 1. November 2010.

Diabetes:
Did You Know…?

These facts paint a picture of the impact of diabetes on our health, healthcare system and economy.


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