Trends in diabetes-related health indicators in Aboriginal communities in Norhtern Alberta
TRENDS IN DIABETES-RELATED HEALTH INDICATORS INABORIGINAL COMMUNITIES OF NORTHERN ALBERTARichard T. Oster, Department of Medicine, University of Alberta-1.5 -1 -0.5 0 0.5 1 1.5-2 -1.5 -1 -0.5 0 0.5 1 1.5 2kABSTRACTIntroduction: The Mobile DiabetesScreening initiative (MDSi) screens fordiabetes and related risk factors in northernAlberta remote and off-reserve Aboriginalcommunities. In addition to providingdiabetes screening, diabetes education, andcommunity-based care, MDSi also aims toidentify and refer individuals needingmedical attention. Our objective was toexamine, longitudinally, diabetes-relatedrisk factors among returning MDSi clients.Methods: Data was collected betweenNovember 2003 and December 2009 asmobile vans equipped with healthprofessionals and portable diagnosticequipment traveled to the communities.Body mass index (BMI), waistcircumference, hemoglobin A1c (A1c),blood pressure and total cholesterol atbaseline and subsequent visits werecompared over time for 809 self-referredadult (≥ 20 years of age) individuals (mostlyMétis; 180 with diabetes; 629 withoutdiabetes). A mixed effects model wasapplied to get overall trend slopes for eachrisk factor longitudinally.Results: Significant improvements in BMI,blood pressure, total cholesterol and A1cconcentrations were identified (P < 0.05) inreturning subjects with diabetes.Conversely, for clients without knowndiabetes, improvements were only observedin blood pressure (P < 0.05), and BMI andwaist circumference actually increased overtime (P < 0.05).Discussion: Although baseline clinicalcharacteristics were worrisome, diabetes-related health seems to be improvingamongst MDSi clients with diabetes.Unfortunately, this is not the case for thosewithout diabetes, whose health appears tobe worsening.SUPERVISOR: Dr. Ellen L. TothKSINTRODUCTIONOver the past century, Canadian Aboriginals (First Nations, Inuit andMétis) have experienced a profound epidemiological shift in their healthstatus (1). The starvation, infectious diseases and depopulation thataccompanied colonization has given way to both re-population and anaccelerated increase in chronic diseases, including type 2 diabetes (2).Among First Nations peoples, type 2 diabetes and its complications are2-5 times more common than in the non-First Nations population (3).Although prevalence rates appear to be higher than that of the generalpopulation (4), very little is known about diabetes-related health statusamong Métis people in Canada.The Mobile Diabetes Screening initiative (MDSi) is part of the 10 yearAlberta Diabetes Strategy (2003-2013). MDSi serves Métis and off-reserve Aboriginal communities in northern Alberta, providing diabetesand cardiovascular risk screening, diabetes education, and community-based care. The objective of this study was to examine, longitudinally,the diabetes-related health status of returning MDSi clients.Statistical analyses were done with SPSS 17.0. Mean baseline andsubsequent indicators were compared for individuals over time with aunivariate general linear mixed effect model. Those with and withoutdiabetes were analyzed separately. Resultant overall trend estimatesfor each indicator were considered significant if P < 0.05.MDSi was implemented as a partnership between Alberta Health andWellness, Alberta’s Métis communities and the University of Alberta.MDSi was approved by the Health Research Ethics Board at theUniversity of Alberta, and individuals consented to aggregate analysis.Mobile vans, equipped withportable diagnostic equipment andhealth professionals, travelled tocommunities (including all 8 MétisSettlements) twice per year. Adultsubjects (aged ≥ 20) enrolledthrough self-referral in response tolocal advertising. Diabetes wasconfirmed by medications, chartreview, or infrequently, nursehistory. A total of 809 individuals(180 with diabetes, 629 withoutknown diabetes) were included.Subjects were mostly Métis(65.8%), with some non-Aboriginal(17.9%) and First Nations (16.3%).Indicators of diabetes-related health measured included body massindex (BMI), waist circumference (using a standard measuring tape atthe iliac crest), hemoglobin A1c (A1c), blood pressure (BP), and totalcholesterol. Blood was collected via a single finger puncture with theAccu-Chek Safe-T-Pro (Roche Diagnostics) lancet. Cholesterol and A1cconcentrations were analyzed using the Cholestech L.D.X™ portableanalyzer and the Bayer DCA2000®+ analyzer respectively.Criteria from the National Cholesterol Education Program AdultTreatment Panel III (NCEP-ATP III) (5), were utilized to defineoverweight (BMI 25-29.9), obesity (BMI 30) and abnormal waistcircumference (≥ 102 cm for males; ≥ 88 cm for females). Poor glucosecontrol was assessed according to the Canadian Diabetes AssociationClinical Practice Guidelines (CPGs) cutoff (A1c ≥ 7%) (6). BP ≥ 140/90mmHg for those without diabetes and ≥ 130/80 for those with diabeteswas used to identify hypertension, whereas total cholesterolconcentration ≥ 5.24 mM indicated hypercholesterolemia (5).For returning subjects with diabetes, significant improvements inoverall trend estimates for BMI, blood pressure, total cholesterol andA1c concentrations were observed (P < 0.05).DISCUSSIONThe observed improvements amongst adults with known diabetesimply that MDSi’s care model may play a role in supporting clients toimprove their health. However, since no control group was included,MDSi’s contribution cannot be quantitated. Secular improvements indiabetes health are likely due to a combination of effects including theavailability of CPGs and the federal Aboriginal Diabetes Initiative. Forthose without diabetes, risk appears to be increasing. Further work willbe required to address this risk.REFERENCES1. Adelson N. 2005. Can J Public Health. 2. Gracey M, King M. 2009. Lancet. 374:65-75.96(S2):S45-S61.3. Young TK et al. 2000. CMAJ. 163:561-566. 4. Ralph-Campbell et al. 2009. Int J CircumpolarHealth. 68(5):433-442.5. NCEP Expert Panel. 2002. Circulation . 6. Canadian Diabetes Association. 2008. Can J106(25):3143-3421. Diabetes. 32(S1):S1-S201.In contrast, subjects without known diabetes experiencedimprovements only in blood pressure (P < 0.05), whereas both BMIand waist circumference increased over time (P < 0.05).BMIWaistA1cSystolic BPDiastolic BPMAPCholesterolBMIWaistA1cSystolic BPDiastolic BPMAPCholesterolHealth indicators of returning subjects with diabetes (N = 180).Values are estimates for the average change per year with 95% CI.Baseline diabetes health indicators. Values are means (± SD) orprevalences (95% CI).Health indicators of returning subjects without diabetes (N = 629).Values are estimates for the average change per year with 95% CI.RESULTSSubjects ranged from 20 to 91 years of age (mean 49). The majority ofsubjects (69.0%) were female. We identified high baseline rates ofoverweight and obesity (87.3%), abnormal waist circumference(78.7%), poor glucose control (12.6%), hypertension (26.1%) andhypercholesterolemia (33.8%). Baseline indicators were more severeamong those with diabetes compared to those without the disease.Estimate of average changeEstimate of average changeMETHODSCanadian AboriginalIssues Database,www.ualberta.ca/~walld/map.htmlVariablesWith diabetes(N = 180)Without diabetes(N = 629)Total(N = 809)BMI (kg/m2)% Overweight (25-29.9)% Obese (≥ 30)33.4 ± 6.229.5%(17.0 - 42.0)67.1%(58.6 - 75.7)31.0 ± 6.332.0%(25.6 - 38.4)52.8%(47.4 - 58.2)31.5 ± 6.331.4%(25.7 - 37.1)55.9%(51.3 - 60.5)Waist circumference (cm)% Abnormal (≥ 102males; ≥ 88 females)108.6 ± 13.995.9%(92.9 - 98.9)101.6 ± 14.772.8%(68.7 - 76.9)103.2 ± 14.878.7%(75.5 - 81.9)A1c (%)% Poor glucose control( ≥ 7%)7.3 ± 1.650.0%(41.3 - 58.7)5.5 ± 0.81.6%(0.1 - 3.1)N AN ASystolic BP (mmHg)Diastolic BP (mmHg)MAP (mmHg)% Hypertensive (≥130/80 with diabetes;140/90 without diabetes)136.9 ± 19.077.4 ± 9.897.3 ± 12.169.5%(61.3 - 77.7)123.8 ± 21.475.3 ± 10.491.5 ± 12.621.8%(14.9 - 28.7)126.7 ± 20.375.8 ± 10.392.7 ± 12.432.3%(26.6 - 38.0)Total cholesterol (mM)% Hypercholesterolemia(≥ 5.24)4.7 ± 1.130.8%(18.4 - 43.2)4.9 ± 1.134.6%(28.3 - 40.9)4.8 ± 1.133.8%(28.1 - 39.5)
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