First Nations and diabetes

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There are high rates of diabetes in First Nation people compared to the general Canadian population. Statistics from 2011 showed that 17.2% of First Nations people living on reserves had type 2 diabetes. [1]

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Contributing factors to the high prevalence of type 2 diabetes between First Nation and the general population include a combination of environmental (lifestyle, diet, poverty), and genetic and biological factors (e.g. thrifty genotype hypothesis, thrifty phenotype). [2] To what extent each factor plays a role is not clear. [3]

Diabetes mellitus Type 2

Rates of obesity and type 2 diabetes (T2D) in First Nation communities were non-existent 20 years ago, but increased steeply. [4] Age-standardized rates of T2D show 17.2% prevalence of T2D among First Nations individuals living on reserves, compared to 5.0% in the non-Aboriginal population; [1]

Statistics indicate that the T2D prevalence rate in First Nations people is 3 to 5 times higher than the general Canadian population. [5] As well as having a higher rate of T2D than the general population, there are also differences in the disease pattern in First Nations T2D patients compared to the general population, especially in terms of age of onset and gestational diabetes. [6]

Diabetes in youth

Diabetes in First Nations has increasingly become a disease of the younger population, who thus experience a high burden of disease, diabetes-related complications and co-morbidity. To illustrate, in the general population type 2 diabetes is an old-age associated disease: New diabetes cases peaked in First Nations people between ages 40–49 compared with a non-First Nations peak of age 70+. [7]

This earlier onset of disease in First Nation population has serious health implications for the women, especially during her reproductive life-years: it increases the chance of her children to develop diabetes, contributing to diabetes prevalence and incidence in the future generations.

Diabetes in women

First Nations women in particular are at risk of developing diabetes, especially between ages 20–49. They have a four times higher incidence of diabetes than non-First Nation women [3] as well as experiencing higher rates of gestational diabetes than non-Aboriginal females, 8–18% compared to 2–4%. [1]

Gestational diabetes

A third type of diabetes, other than type 1 and type 2, is gestational diabetes mellitus. This is a temporary type of diabetes that occurs during pregnancy. Most women with gestational diabetes will return to normal glucose levels after delivery of the baby; if a woman does not return to normal glucose levels she will be re-diagnosed with type 2 diabetes and is no longer considered to have gestational diabetes. [8]

Gestational diabetes carries risks for both the mother and the baby. It increases the likelihood of the infant developing T2D, and giving birth to high body-weight baby. High body-weight increases risk of the child developing diabetes even if mother does not have it. [8]

Screening programs

The Review of Guidelines for Screening and Treatment affirms the use of fasting plasma glucose test (FPG) or a 2-hour plasma glucose (2hPG) as a screening tool. [9] Due to the higher incidence of diabetes in Aboriginals, more frequent screening is recommended to improve diabetes management and prevention strategies. Instead of a standard screening every third year, aboriginal adults in Canada with a higher risk of developing diabetes are called upon to be screened every one or two years. [3]

Children above the age of ten identified as at high risk for developing diabetes are recommended for screening, especially important in First Nations and Aboriginal populations, as the age of onset of diabetes is lower (happening in at earlier age) compared to the general population. [3] Obese children (BMI > 99.5) should undergo an oral glucose tolerance test each year. [10] Even though a range of different screening programs for Aboriginals exist, there is a need for screening programs in partnership with communities. [9]

Current policies

The Government of Canada has policies and programs in place aimed at improving the health of Aboriginal people. One such measure was the implementation of the Aboriginal Diabetes Initiative (ADI) in 1999. The ADI has been funded continuously over three phases: Phase 1 (1999–2004); Phase 2 (2005–2010), and; Phase 3 (2011–2015).

The goal of ADI is to reduce the prevalence of type 2 diabetes through health promotion campaigns and initiatives implemented by trained community diabetes workers and health professionals. The ADI has four main components from which the program expects to achieve its objectives.

  1. Community-based health promotion and primary prevention
  2. Screening and management activities in order to diagnose disease early
  3. Capacity building and training activities to equip community health workers and health professional
  4. Knowledge mobilization activities to enhance sharing of knowledge

The current Phase 3 includes healthy living initiatives for children, youth, parents, and families; diabetes in pre-pregnancy and pregnancy; community-led food security planning; and enhanced training for health professionals on clinical practice guidelines and chronic disease management strategies. [11]

See also

Related Research Articles

Insulin resistance (IR) is a pathological condition in which cells either fail to respond normally to the hormone insulin or downregulate insulin receptors in response to hyperinsulinemia.

<span class="mw-page-title-main">Type 2 diabetes</span> Type of diabetes mellitus with high blood sugar and insulin resistance

Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, feeling tired, and sores (wounds) that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

<span class="mw-page-title-main">Gestational diabetes</span> Medical condition

Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms; however, it increases the risk of pre-eclampsia, depression, and of needing a Caesarean section. Babies born to mothers with poorly treated gestational diabetes are at increased risk of macrosomia, of having hypoglycemia after birth, and of jaundice. If untreated, diabetes can also result in stillbirth. Long term, children are at higher risk of being overweight and of developing type 2 diabetes.

Maturity-onset diabetes of the young (MODY) refers to any of several hereditary forms of diabetes mellitus caused by mutations in an autosomal dominant gene disrupting insulin production. Along with neonatal diabetes, MODY is a form of the conditions known as monogenic diabetes. While the more common types of diabetes involve more complex combinations of causes involving multiple genes and environmental factors, each forms of MODY are caused by changes to a single gene (monogenic). GCK-MODY and HNF1A-MODY are the most common forms.

<span class="mw-page-title-main">Diseases of affluence</span> Health conditions thought to be a result of increasing wealth in society

Diseases of affluence, previously called diseases of rich people, is a term sometimes given to selected diseases and other health conditions which are commonly thought to be a result of increasing wealth in a society. Also referred to as the "Western disease" paradigm, these diseases are in contrast to so-called "diseases of poverty", which largely result from and contribute to human impoverishment. These diseases of affluence have vastly increased in prevalence since the end of World War II.

<span class="mw-page-title-main">Large for gestational age</span> Medical condition

Large for gestational age (LGA) is a term used to describe infants that are born with an abnormally high weight, specifically in the 90th percentile or above, compared to other babies of the same developmental age. Macrosomia is a similar term that describes excessive birth weight, but refers to an absolute measurement, regardless of gestational age. Typically the threshold for diagnosing macrosomia is a body weight between 4,000 and 4,500 grams, or more, measured at birth, but there are difficulties reaching a universal agreement of this definition.

<span class="mw-page-title-main">Birth weight</span> Weight of a human baby at birth

Birth weight is the body weight of a baby at its birth. The average birth weight in babies of European and African descent is 3.5 kilograms (7.7 lb), with the normative range between 2.5 and 4.0 kilograms. On average, babies of Asian descent weigh about 3.25 kilograms (7.2 lb). The prevalence of low birth weight has changed over time. Trends show a slight decrease from 7.9% (1970) to 6.8% (1980), then a slight increase to 8.3% (2006), to the current levels of 8.2% (2016). The prevalence of low birth weights has trended slightly upward from 2012 to the present.

<span class="mw-page-title-main">College of Family Physicians of Canada</span> Professional organization

The College of Family Physicians of Canada is a professional association and the legal certifying body for the practice of family medicine in Canada. This national organization of family physicians was founded in 1954 and incorporated in 1968. Although membership is not mandatory to practice medicine, it currently numbers over 38,000 members. Members of the CFPC belong to the national College, as well as to their provincial or territorial chapters. The CFPC uses both English and French as official communication languages.

The term diabetes includes several different metabolic disorders that all, if left untreated, result in abnormally high concentrations of a sugar called glucose in the blood. Diabetes mellitus type 1 results when the pancreas no longer produces significant amounts of the hormone insulin, usually owing to the autoimmune destruction of the insulin-producing beta cells of the pancreas. Diabetes mellitus type 2, in contrast, is now thought to result from autoimmune attacks on the pancreas and/or insulin resistance. The pancreas of a person with type 2 diabetes may be producing normal or even abnormally large amounts of insulin. Other forms of diabetes mellitus, such as the various forms of maturity-onset diabetes of the young, may represent some combination of insufficient insulin production and insulin resistance. Some degree of insulin resistance may also be present in a person with type 1 diabetes.

<span class="mw-page-title-main">Diabetes and pregnancy</span> Effects of pre-existing diabetes upon pregnancy

For pregnant women with diabetes, some particular challenges exist for both mother and child. If the pregnant woman has diabetes as a pre-existing disorder, it can cause early labor, birth defects, and larger than average infants. Therefore, experts advise diabetics to maintain blood sugar level close to normal range about 3 months before planning for pregnancy.

<span class="mw-page-title-main">Impaired fasting glucose</span> Medical condition

Impaired fasting glucose is a type of prediabetes, in which a person's blood sugar levels during fasting are consistently above the normal range, but below the diagnostic cut-off for a formal diagnosis of diabetes mellitus. Together with impaired glucose tolerance, it is a sign of insulin resistance. In this manner, it is also one of the conditions associated with metabolic syndrome.

A diabetic diet is a diet that is used by people with diabetes mellitus or high blood sugar to minimize symptoms and dangerous complications of long-term elevations in blood sugar.

The thrifty gene hypothesis, or Gianfranco's hypothesis is an attempt by geneticist James V. Neel to explain why certain populations and subpopulations in the modern day are prone to diabetes mellitus type 2. He proposed the hypothesis in 1962 to resolve a fundamental problem: diabetes is clearly a very harmful medical condition, yet it is quite common, and it was already evident to Neel that it likely had a strong genetic basis. The problem is to understand how disease with a likely genetic component and with such negative effects may have been favoured by the process of natural selection. Neel suggested the resolution to this problem is that genes which predispose to diabetes were historically advantageous, but they became detrimental in the modern world. In his words they were "rendered detrimental by 'progress'". Neel's primary interest was in diabetes, but the idea was soon expanded to encompass obesity as well. Thrifty genes are genes which enable individuals to efficiently collect and process food to deposit fat during periods of food abundance in order to provide for periods of food shortage.

<span class="mw-page-title-main">Voglibose</span> Alpha-glucosidase inhibitor

Voglibose is an alpha-glucosidase inhibitor used for lowering postprandial blood glucose levels in people with diabetes mellitus. Voglibose delays the absorption of glucose thereby reducing the risk of macrovascular complications. Voglibose is a research product of Takeda Pharmaceutical Company, Japan's largest pharmaceutical company. Vogilbose was discovered in 1981, and was first launched in Japan in 1994, under the trade name BASEN, to improve postprandial hyperglycemia in diabetes mellitus.

<span class="mw-page-title-main">Prediabetes</span> Predisease state of hyperglycemia with high risk for diabetes

Prediabetes is a component of the metabolic syndrome and is characterized by elevated blood sugar levels that fall below the threshold to diagnose diabetes mellitus. It usually does not cause symptoms but people with prediabetes often have obesity, dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension. It is also associated with increased risk for cardiovascular disease (CVD). Prediabetes is more accurately considered an early stage of diabetes as health complications associated with type 2 diabetes often occur before the diagnosis of diabetes.

This article provides a global overview of the current trends and distribution of metabolic syndrome. Metabolic syndrome refers to a cluster of related risk factors for cardiovascular disease that includes abdominal obesity, diabetes, hypertension, and elevated cholesterol.

A predictive adaptive response (PAR) is a developmental trajectory taken by an organism during a period of developmental plasticity in response to perceived environmental cues. This PAR does not confer an immediate advantage to the developing organism; however, if the PAR correctly anticipates the postnatal environment it will be advantageous in later life, if the environment the organism is born into differs from that anticipated by the PAR it will result in a mismatch. PAR mechanisms were first recognized in research done on human fetuses that investigated whether poor nutrition results in the inevitable diagnosis of Type 2 diabetes in later life. PARs are thought to occur through epigenetic mechanisms that alter gene expression, such as DNA methylation and histone modification, and do not involve changes to the DNA sequence of the developing organism. Examples of PARs include greater helmet development in Daphnia cucullata in response to maternal exposure to predator pheromones, rats exposed to glucocorticoid during late gestation led to an intolerance to glucose as adults, and coat thickness determination in vole pups by the photoperiod length experienced by the mother. Two hypotheses to explain PAR are the "thrifty phenotype" hypothesis and the developmental plasticity hypothesis.

<span class="mw-page-title-main">Epidemiology of diabetes</span>

Globally, an estimated 537 million adults are living with diabetes, according to the latest 2019 data from the International Diabetes Federation. Diabetes is the 9th leading cause of mortality globally in 2020, attributing to over 2 million deaths annually due to diabetes directly and kidney disease due to diabetes. The primary causes of type 2 diabetes is diet and physical activity, which can contribute to increased BMI, poor nutrition, hypertension, alcohol use and smoking, while genetics is also a factor. Diabetes prevalence is increasing rapidly; previous 2019 estimates put the number at 463 million people living with diabetes, with the distributions being equal between both sexes icidence peaking around age 55 years old. The number is projected to 643 million by 2030, or 7079 individuals per 100,000, with all regions around the world continue to rise. Type 2 diabetes makes up about 85-90% of all cases. Increases in the overall diabetes prevalence rates largely reflect an increase in risk factors for type 2, notably greater longevity and being overweight or obese. The prevalence of African Americans with diabetes is estimated to triple by 2050, while the prevalence of whites is estimated to double. The overall prevalence increases with age, with the largest increase in people over 65 years of age. The prevalence of diabetes in America is estimated to increase to 48.3 million by 2050.

<span class="mw-page-title-main">Diabetes</span> Medical condition

Diabetes, also known as diabetes mellitus, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body not responding properly to the insulin produced. Diabetes, if left untreated, leads to many health complications. Untreated or poorly treated diabetes accounts for approximately 1.5 million deaths per year.

Diabetes, in particular, non-insulin-dependent diabetes, is prevalent in the Aboriginal and Torres Strait Islander populations of Australia. As many as 1 in 20 Australians are said to suffer from diabetes. Aboriginal people are three times as likely to become diabetic in comparison to non-Aboriginal people. In contrast with type 1 diabetes, which is a predisposed autoimmune condition, type 2 diabetes or insulin-resistant diabetes, is a preventable disease, heavily influenced by a multitude of socioeconomic factors. Sufferers of the disease are consequently more susceptible to chronic health issues, including heart disease and kidney failure. Conclusively, this has contributed to the 17 year life expectancy gap between Aboriginal people and non-Aboriginal people and has led to health inequities between Aboriginal people and non-Aboriginal people.

References

  1. 1 2 3 "Highlights: in Canada: Facts and figures from a public health perspective". Public Health Agency of Canada. 15 December 2011. Retrieved 14 January 2020.
  2. ↑ Pollard, Tessa M. (2008). "The thrifty genotype versus thrifty phenotype debate: efforts to explain between population variation in rates of type 2 diabetes and cardiovascular disease". Western Diseases. Cambridge University Press. pp. 50–74. doi:10.1017/CBO9780511841118.005. ISBN   9780521851800.
  3. 1 2 3 4 Dyck, Roland; Osgood, Nathaniel; Lin, Ting Hsiang; Gao, Amy; Stang, Mary Rose (23 February 2010). "Epidemiology of diabetes mellitus among First Nations and non-First Nations adults". CMAJ. 182 (3): 249–256. doi: 10.1503/cmaj.090846 . ISSN   0820-3946. PMC   2826466 . PMID   20083562.
  4. ↑ Shubair, MM; Tobin, PK (2010). "Type 2 diabetes in the First Nations population: a case example of clinical practice guidelines". Rural and Remote Health. 10 (4): 1505–1511. PMID   20958092.
  5. ↑ "Ontario Aboriginal Diabetes Strategy from the Ministry of Health and Long Term Care" (PDF). 2011. Retrieved 6 February 2012.
  6. ↑ Sellers, EA; Moore, K; Dean, HJ (December 2009). "Clinical management of type 2 diabetes in indigenous youth". Pediatric Clinics of North America. 56 (6): 1441–59. doi:10.1016/j.pcl.2009.09.013. PMID   19962030.
  7. ↑ Dyck, Roland; Osgood, Nathaniel; Hsiang Lin, Ting; Gao, Amy; Stang, Mary Rose (23 February 2010). "Epidemiology of diabetes mellitus among First Nations and non-First Nations adults". CMAJ. 182 (3): 249–56. doi:10.1503/cmaj.090846. PMC   2826466 . PMID   20083562.
  8. 1 2 "Gestational Diabetes and First Nations Women: A literature review" (PDF). First Nations Centre, National Aboriginal Health Organization. 2009. Archived from the original (PDF) on 26 August 2011.
  9. 1 2 "Diabetes in Aboriginal Populations: Review of Guidelines for Screening and Treatment" (PDF). Health Technology Inquiry Service. 25 August 2010.
  10. ↑ Ur, Ehud; Chiasson, Jean-Louis; Ransom, Tom; Rowe, Richard (2008) Screening for Type 1 and Type 2 Diabetes. In Canadian Diabetes Association Clinical Practice Guidelines Expert Committee (ed.) 2008 Clinical Practice Guidelines.
  11. ↑ "Aboriginal Diabetes Initiative: Program Framework 2010-2015". Health Canada. 2011. Retrieved 6 February 2012.
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