boriginal Canadians, including First Nations, Metis and Inuit people, are recognized to be at increased risk for major health problems. 1 The increasing prevalence and incidence of diabetes mellitus among Aboriginal Canadians is well documented, 1-3 with prevalence reaching three to five times higher among Aboriginal Canadians compared to the non-Aboriginal population. [1][2][3] In remote Aboriginal communities, age-adjusted prevalence exceeds 25%, 4 with increases of 45% over a 10-year period. 5 A variety of factors are believed to be contributing to these increased rates, including genetic susceptibility 6-9 and environmental factors associated with rapid socio-cultural changes, including change within urban Aboriginal populations as individuals move to the urban setting. [10][11][12][13] Sex differences in diabetes epidemiology among Aboriginal compared to non-Aboriginals are also well recognized. In the general population, men have higher prevalence and incidence rates of diabetes compared to women, 14,15 with the National Diabetes Surveillance System (NDSS) reporting diabetes prevalence rates of 5.4% and 4.9% for Canadian men and women, respectively. 16 The opposite is true among Aboriginal Canadians. 2,4,17 The reasons for these differences are not known, but may be due to higher rates of obesity among Aboriginal Canadian women, 18 or higher rates of gestational diabetes mellitus, which is associated with an increased risk of subsequent type 2 diabetes in mothers and their offspring. 2,19,20 Lifestyle and location of residence are also important determinants in the development of chronic diseases such as diabetes. [21][22][23] Location is also important in terms of access to care and health outcomes. It has been demonstrated, for example, that individuals living in rural areas have increased treatment gaps and acute complications with their diabetes. [24][25][26] Differences in health care utilization and costs between Aboriginal and non-Aboriginal Canadians have also been described. 27,28 Little is known, however, about

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