fHealth outcomes of Aboriginal individuals with early onset diabetesRichard T. Oster and Ellen L. Toth. Department of Medi...
Upcoming SlideShare
Loading in …5
×

Health outcomes of Aboriginal individuals with early onset diabetes

163 views
118 views

Published on

2010 (Oct) 3rd Conference on Recent Advances in the Prevention and Treatment of Childhood and Adolescent Obesity, poster presentation by BRAID Research

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
163
On SlideShare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Health outcomes of Aboriginal individuals with early onset diabetes

  1. 1. fHealth outcomes of Aboriginal individuals with early onset diabetesRichard T. Oster and Ellen L. Toth. Department of Medicine, University of AlbertaBackground: Type 2 diabetesexcessively impacts the CanadianAboriginal population. Compounding thispublic health crisis is a recent increase inthe diagnosis of young Aboriginalindividuals. Little is known about thehealth outcomes of Aboriginal individualsdiagnosed with diabetes at a young age.Purpose: Our objective was to examinethe diabetes-related health status andoutcomes of First Nations individualsdiagnosed with diabetes in youth.Methods: From the databases of fourseparate community-based diabetesscreening projects in Alberta we created asubject pool of 116 individuals withdiabetes diagnosed in youth (≤ 20 yearsof age). Present age, ethnicity, duration ofdiabetes, body mass index, waistcircumference, hemoglobin A1c (A1c),blood lipids, blood pressure, insulin use,anti-diabetic medication use, and thepresence of the metabolic syndrome,kidney complications, and footabnormalities were assessed.Results: The vast majority of participantswere Aboriginal (86.2%) and the averageage was 30.5 years. Average duration ofdiabetes was 14.5 years. Average A1cwas 8.4% and 61.1% had and A1c > 7%.Eighty two percent of participants wereobese or overweight, whereas 64.1% hadan abnormal waist circumference and43.1% had the metabolic syndrome.Hypertension and hypercholesterolemiawere detected in 48.4% and 34.0% ofindividuals respectively. Thirty threepercent had microalbumiuria, 22.4% hadproteinuria and 11.4% were at the highestrisk for foot abnormalities. Only 32.8%,21.6%, and 5.3% of participants werebeing managed with insulin alone, anti-diabetic oral agents alone, and bothinsulin and oral agents respectively.Conclusions: Our results most likelyunderestimate the disease burden butthey support similar research with FirstNations youth in Manitoba, and suggestthat diabetes co-morbidities andcomplications are common early in thedisease course for Aboriginal individualsdiagnosed with diabetes in youth.KSBACKGROUNDAmong Aboriginal youth with type 2 diabetes in Manitoba, neuropathy,nephropathy, retinopathy, dyslipidemia, hypertension, fatty liver, andpoor quality of life have been reported (3). However, outcome datayears after diagnosis is scarce. Our results demonstrate that Aboriginalindividuals with youth-onset diabetes in Alberta carry a considerableburden of co-morbidities and complications. Despite being young, thehealth of these individuals is comparable (or worse) than olderAboriginal individuals with diabetes (6).Although the majority of subjects (68.5%) were being managed byinsulin or oral anti-diabetic agents, most (61.7%) had poor glucosecontrol. Reasons for this discrepancy could not be determined, but alack of cultural sensitivity on the part of healthcare system, as well as alack of understanding and familiarity with the biomedical system on thepart of First Nations individuals may be involved. The history ofcolonialism, oppression, racism, marginalization and disempowermentexperienced by First Nations people likely leaves many wary andsuspicious of the mainstream healthcare system (7). Additionally,current models of health practice have yet to acknowledge theinfluence on First Nations health of colonialism-based historical andsocial contexts, or ethno cultural affiliation (8). Strategies such as a ‘bi-cultural approach’ to diabetes-related health should be explored.METHODSRESULTSCONCLUSIONSABSTRACTREFERENCESDiabetes has become a major health crisis among Aboriginalpopulations in Canada. It is well recognized that the occurrence ofdiabetes and its complications is much higher (2-5 times) among FirstNations individuals than Canadian population at large (1,2). Perhapsmore alarming are reports of increasing obesity and emerging type 2diabetes in Aboriginal youth, which will only further perpetuate theimpact of diabetes (3). The health outcomes of Aboriginals with youth-onset diabetes have not been explored.The objective was to examine the diabetes-related health status andoutcomes of First Nations individuals diagnosed with diabetes in youth.Data was derived from three separate diabetes screening projects, twoof which are traveling ‘point of care’ screening programs. SLICK(Screening for Limb, I-Eye, Cardiovascular, and Kidney complications ofdiabetes) and MDSi (Mobile Diabetes Screening Initiative) providediabetes risk assessment, diabetes complications screening, andcommunity-based care to each of the 44 Alberta First Nationscommunities and to rural Aboriginal Alberta communities respectively(4, 5). The third project is an outpatient diabetes care/screening servicein a single rural First Nations community in Alberta. The projects areongoing. The information presented was collected between 2002-2010.Included subjects were diagnosed with diabetes in youth (≤ 20 years ofage) and identified within the communities to local bookers and healthprofessionals, with help from local advertising. Medications, chartreview, or nurse history were used to confirm diabetes. Age atdiagnosis, ethnicity, duration of diabetes, body mass index (BMI), waistcircumference, hemoglobin A1c (A1c), blood lipids, blood pressure,insulin use, anti-diabetic medication use, and the presence of themetabolic syndrome, kidney complications, and foot abnormalities wereassessed. Using PASW version 18.0 (Chicago, IL), descriptive statisticswere determined.Each screening project was approved by the Health Research EthicsBoard at the University of Alberta. This research was approached as apartnership between Alberta’s Métis communities, Alberta First Nationscommunities and the University of Alberta.1. Young TK et al. Type 2 diabetes mellitus in Canadas first nations: status of an epidemic in progress. CMAJ. 2000 Sep;163(5):561-6. 5. Ralph-Campbell K et al. Increasing rates of diabetes and cardiovascular risk in Métis Settlements in northern Alberta. Int J Circumpolar Health. 2009.2. Dyck R et al. Epidemiology of diabetes mellitus among First Nations and non-First Nations adults. CMAJ. 2010 Feb;182(3):249-56. Dec;68(5):433-42.3. Sellers AC et al. Clinical management of type 2 diabetes in indigenous youth. Pediatr Clin N Am. 2003. 56:1441-59. 6. Hanley AJ et al. Complications of Type 2 Diabetes Among Aboriginal Canadians: prevalence and associated risk factors. Diabetes Care. 2005. Aug;28(8):2054-7.4. Oster RT et al. Diabetes care and health status of First Nations individuals with type 2 diabetes in Alberta. Can Fam Physician. 2009. 7. King M et al. Indigenous health part 2: The underlying causes of the health gap. Lancet. 2009. 374:76-85.Apr;55(4):386-93. 8. Hunter LM et al. Aboriginal healing: Regaining balance and culture. Journal of Transcultural Nursing. 2006. 17:13-22.Male Female TotalAge (years) 30.7 ± 15.4 29.9 ± 13.3 30.2 ± 14.1Age diagnosed (years) 16.0 ± 4.0 15.6 ± 4.1 15.7 ± 4.0Duration of diabetes (years) 14.5 ± 14.6 14.3 ± 12.0 14.4 ± 13.0BMI (kg/m2; adults only) 34.4 ± 8.8 33.3 ± 8.6 33.8 ± 8.6Waist Circumference (cm; adults only) 113.3 ± 24.4 107.5 ± 20.5 109.8 ± 22.1Systolic blood pressure (mmHg) 127.0 ± 17.6 122.0 ± 16.7 123.9 ± 17.2Diastolic blood pressure (mmHg) 77.7 ± 10.1 75.7 ± 10.5 76.5 ± 10.3Mean arterial pressure (mmHg) 92.7 ± 11.4 90.5 ± 12.3 91.3 ± 11.9A1c (%) 8.3 ± 2.4 8.5 ± 2.7 8.4 ± 2.6Total cholesterol (mmol/L) 4.8 ± 1.2 4.8 ± 1.4 4.8 ± 1.3Urine microalbumin/creatinine ratio 4.1 ± 6.2 2.2 ± 2.7 3.2 ± 4.8Male Female Total% overweight (25-29.9, adults; 85th – 94thpercentile, youth)32.4 (17.3 - 47.5) 24.6 (13.4 - 35.8) 27.6 (18.6 - 36.6)% obese (> 30 adults; > 95th percentile youth) 59.5 (43.7 - 75.3) 56.1 (43.2 - 69.0) 57.4 (47.4 - 67.4)% overweight or obese 91.9 (84.1 - 99.7) 80.7 (70.5 - 90.9) 85.0 (77.8 - 92.2)% with abnormal waist circumference (>102males, > 88 females, adults; > 90thpercentile, youth)60.6 (43.9 - 77.3) 79.2 (68.3 - 90.1) 72.1 (62.6 - 81.6)% with hypertension (> 130/80, adults; > 95thpercentile, youth)59.1 (44.6 - 73.6) 35.2 (24.1 - 46.3) 44.3 (35.2 - 53.4)% with poor A1c (> 7%) 58.1 (43.4 - 72.8) 63.9 (52.8 - 75.0) 61.7 (52.8 - 70.6)% with hypercholesterolemia (> 5.2) 23.7 (10.2 - 37.2) 36.4 (24.8 - 48.0) 31.7 (22.8 - 40.6)% with abnormal microalbumin/creatinine ratio(>2 males; >2.8 females)36.7 (19.5 - 53.9) 32.1 (14.8 - 49.4) 34.5 (22.3 - 46.7)% with proteinuria 11.5 (0.1 - 22.9) 28.0 (15.6 - 40.4) 22.4 (13.0 - 31.8)% with metabolic syndrome 37.0 (23.0 - 51.0) 45.2 (33.8 - 56.6) 42.0 (33.1 - 50.9)% with no abnormality (0) 73.1 (56.1 - 90.1) 77.3 (64.9 - 89.7) 75.7 (65.7 - 85.7)% at low foot risk (1) 7.7 (0.2 - 15.2) 9.1 (0.6 - 17.6) 8.6 (2.0 - 15.2)% at moderate foot risk (2) 11.5 (0.1 - 22.9) 2.3 (0.2 - 4.4) 5.7 (0.3 - 11.1)% at high foot risk (3) 7.7 (0.3 - 15.1) 11.4 (2.0 - 20.8) 10.0 (0.3 - 17.0)% taking insulin 53.2 (38.9 - 67.5) 41.1 (29.8 - 52.4) 45.8 (36.9 - 54.7)% taking oral agents 30.4 (17.1 - 43.7) 17.8 (9.0 - 26.6) 22.7 (15.2 - 30.2)% taking insulin and oral agents 15.2 (4.9 - 25.5) 5.5 (0.2 - 10.7) 9.2 (4.0 - 14.4)Table 1. Clinical parameters of subjects (N = 126). Values expressed as means ± SD.Table 2. Prevalence (95% CI) of selected conditions among subjects.02468101214195019551955196519671969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008Year diagnosedNumberofsubjectsA total of 126 subjects were included in the analysis (96 adults and 30youth). Subjects ranged from 9 to 76 years of age (mean 30.2), and themajority (61.1%) were female. All subjects were of Aboriginal descent,of which 95.2% were First Nations individuals. Type 2 diabetescomprised 94.4% of the diagnoses.Figure 1. Number of subjects with youth-onset diabetes by year of diagnosis. (N = 126).High rates of co-morbidities were identified as 85.0% of participantswere obese or overweight, 72.1% had an abnormal waistcircumference, 42.0% had the metabolic syndrome, 44.3% werehypertensive, 31.7% had hypercholesterolemia, 34.5% hadmicroalbumiuria, 22.4% had proteinuria and 11.4% were at the highestrisk for foot abnormalities. In total, 45.8%, 22.7%, and 9.2% ofparticipants were being managed with insulin alone, anti-diabetic oralagents alone, and both insulin and oral agents respectively.

×