Screening Métis clients in Alberta for undiagnosed diabetes and cardiovascular risk factors
Screening Métis Settlement Clients in Alberta for Undiagnosed Diabetes and Cardiovascular Risk FactorsEllen L. Toth MD1, Shannon McEwen MSc1, Kelli Ralph-Campbell BA1, Tracy Connor BScN1,Community Health Council #52, Tri-Settlements Health Council3,Department of Medicine, University of Alberta1, Aspen Regional Health Authority2, Peace Country Regional Health3email: firstname.lastname@example.orgAbstractDiabetes prevalence and complications are known to be higher in Aboriginal populations, but thereis only one survey reporting the burden of diabetes amongst the Métis in Canada. Rates ofundiagnosed diabetes and pre-diabetes have been studied in a small number of First Nationcommunities, and range from 2.5% – 10.7%, and 5% - 19.8%, respectively.Diabetes and cardiovascular risk factor screening is underway in Alberta’s 8 Métis settlements aspart of the Mobile Diabetes Screening Initiative (MDSi). Baseline data is collected through riskassessment questionnaires, physical examinations, and laboratory testing using portable diagnosticequipment.From November 2003 and February 2005, 624 Métis participants were screened: 518 adults and106 children (6-17 years old).Diabetes and cardiovascular risk factors are very high in a volunteer sample of Alberta’s Métispeoples, consistent with population based screening data in one Alberta First Nation (Kaler,personal communication).Introduction•Cardiovascular disease, Type 2 diabetes, and obesity are highly prevalentin Aboriginal peoples•Type 2 diabetes is often accompanied or preceded by the metabolicsyndrome•MDSi’s mandate is to screen for diabetes and its complications in off-reserve Aboriginal and remote communities in Northern AlbertaMethods•Portable technology is used with a rigorous Quality Assurance protocol•Clients are recruited by a community member on each of the eight Métissettlements in Alberta, Canada•Procedures: Family history, ADA risk questionnaire, anthropometrics,medications, fasting or random glucose, A1c, lipids, urine and othermeasurements are collected•Analyses: cardiovascular risk and diabetes risk are calculatedResultsEthicsAs MDSi works with Aboriginal Peoples, special attention is required and willbe paid to ownership, control, access, and possession (OCAP) of data thatbelongs to the people. This research is approached as a partnership with theparticipating communities, the regional health authorities, Alberta Health andWellness, and the University of Alberta.BenefitsData is collected in the communities using a mobile team and portabletechnology so multiple trips are not required to an urban centre for testing.ConclusionThese results show that a high number of Alberta Métis screened are at a highrisk for developing diabetes or have undiagnosed diabetes. The people whohave been screened are also at high risk for cardiovascular disease. Baselineresults reveal that the Métis children screened are at high risk for developingdiabetes. MDSi continues to complete repeat visits (approx. every 6 months)with these Métis communities to assist in further screening, intervention andeducation. We are working with the communities to support furtherintervention, prevention, and health promotion activities.FBG=Fasting Blood Glucose; BP=Blood Pressure; TG=Fasting Triglycerides;HDL=High Density Lipoprotein; Waist=Waist CircumferenceACADREDiabetesResearchGroupCriteriaAdults(N=518)(% abnormal)Children^(N=106)(% abnormal)Undiagnosed diabetes(FPG ≥7.0)4% 5%Pre diabetes(FPG* 5.6-6.9)50% 13%BMI (overweight) 32% 10%BMI (obese) 50% 50%Elevated Total Cholesterol 36% 27%Elevated Blood Pressure 46% 33%Metabolic syndrome(ATP III criteria)50% 51%The results of the first year of screening of Métis Adults and Childrenwithout previously diagnosed diabetes showed a high prevalence of pre-diabetes.^ MDSi defines children as anyone 6-17 years of age; * FPG denotes Fasting Plasma Glucose* >85 Percentile denotes a child is overweight0%10%20%30%40%50%60%70%80%90%100%AdultPercentofClientsFPGBPHDLTG0%10%20%30%40%50%60%70%80%90%100%Children w ith MSPercentofClientsFPGBPHDLTGWaistAdult Metabolic Syndrome ResultsChild Metabolic Syndrome ResultsAdult FPG Results0%10%20%30%40%50%60%70%Male FemalePercentofclientsNormal / Low riskAt RiskPossible diabetesChildren FPG Results0%10%20%30%40%50%60%70%80%90%100%Male FemalePercentofclientsNormal / Low riskAt RiskPossible diabetesChildren BMI Results0%10%20%30%40%50%60%70%<25 25-75 75-85 > 85BMI PercentilePercentofClientsMaleFemaleAdult BMI Results01020304050607080Male FemalePercentofclientsUnderweightIdealOverweightObese
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