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The Mobile Diabetes Screening Initiative (MDSi)for Aboriginal off-reserve and remote communities in AlbertaDr. Ellen L. To...
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Rationale and design of the Mobile Diabetes Screening Initiative (MDSI) for Aboriginals off reserve and remote communities in Alberta

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2007 (Oct) Canadian Diabetes Association Annual Conference

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Transcript of "Rationale and design of the Mobile Diabetes Screening Initiative (MDSI) for Aboriginals off reserve and remote communities in Alberta"

  1. 1. The Mobile Diabetes Screening Initiative (MDSi)for Aboriginal off-reserve and remote communities in AlbertaDr. Ellen L. Toth,Medical LeadWhy screen Aboriginal people fordiabetes? Why do community-basedscreening?•Type 2 diabetes and obesity are more prevalent amongst Aboriginalpeoples, and generally amongst the disadvantaged. Cardiovasculardisease is also a concern.•Access to screening and diagnostic services is difficult for people livingin remote communities, such as in Northern Alberta.•Access to services is difficult for geographic, financial, cultural, andpractical reasons. For instance, fewer doctors work in these areas.•MDSi brings screening and diagnostic services to the communities.This way, MDSi reduces some of these accessibility barriers.The Process•Team : The multi-disciplinary MDSiteam travels to Métis, off-reserve andremote communities in NorthernAlberta, transporting testingequipment in two vans. MDSi visitseach community at least twice a year.•Screening : MDSi measuresclients’ height, weight, waistcircumference, blood pressure,cholesterol and blood glucose levels.Diabetes and cardiovascular risk areestimated.•Portable technology :MDSi uses equipment shown to beeffective in community-basedsettings. MDSi uses a rigorousQuality Assurance protocol.•Complications : For people whoalready have diabetes, MDSi tests forkidney damage (urine analysis) andeye damage (retinal photos). Footassessment is also provided to checkfor wounds and nerve damage.•Education and counseling:MDSi nurses and dietitians counselclients based on their personal testresults. Clients learn how to lead ahealthier lifestyle, and how to reducetheir risk of getting diabetes ordiabetes complications.Who has MDSi seen?• As of April 2007, MDSI had seen a total of 1796 clients in allcommunities visited. 1503 were screened for new diabetes. 293already had diabetes and were tested for complications.• 840 Métis clients living on-settlement have been screened fordiabetes: 693 adults ages 18-91, and 147 children ages 6-17.• 149 Métis clients living on-settlement who already had diabeteswere screened for diabetes complications.• 15% of Métis people living on-settlement have been screened fordiabetes or diabetes complications.• MDSi has visited each Settlement 4-7 times.ACADRE NetworkHow much diabetes has MDSi found?(Metis clients living on-Settlement, N = 840)Adults screened for diabetes, N = 693Males FemalesAt risk / pre-diabetes∗ 61% 46%Probable diabetes ∗ ∗ 6% 5%BMI Overweight/Obese 84% 82%Total Cholesterol Abnormal 83% 77%Abnormal, on no treatment 58% 66%Abnormal, on treatment 56% 23%Blood PressureFasting BloodGlucose20%46%ElevatedBlood Pressurepercentile22%24%Borderline/HighTotal Cholesterol60%60%Overweight/ObeseBMI percentile00Probable diabetes25%23%At risk / pre-diabetesFasting BloodGlucoseFemalesMalesChildren (ages 6-17) screened for diabetes, N = 147Discussion:Due to portable testing and issues with fasting vs non-fastingsamples, the cases of “probable diabetes” need confirmatory testing.Diabetes and pre-diabetes may be UNDERESTIMATED due to the lackof post-meal or glucose tolerance data.The significance of elevated fasting blood glucose (5.6-6.9, pre-diabetes) in the absence of postprandial glucose elevation is unclear.∗Fasting blood glucose 5.6- 6.9, ∗ ∗ fasting blood glucose 7.0 or greaterMDSi communities:Métis SettlementsBuffalo LakeEast PrairieElizabethFishing LakeGift LakeKikinoPaddle PrairiePeavineOther CommunitiesAnzacConklin (Métis)EvansburgGrande CacheHintonLa CreteMarlboro (Métis)Peerless Lake (First Nations)Trout Lake (First Nations)WabascaWildwood
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