Complications of Type 2 Diabetes Among Aboriginal Canadians

Hanley, Anthony J.; Harris, Stewart B.; Mamakeesick, Mary; Goodwin, Ken; Fiddler, Edith; Hegele, Robert A.; Spence, J. David; House, Andrew A.; Brown, Edward; Schoales, Blair; McLaughlin, John; Klein, Ronald; Zinman, Bernard

doi:10.2337/diacare.28.8.2054

Cited by 74 publications

(75 citation statements)

References 16 publications

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“…8,16,17 It also explains our earlier observation that the time from diabetes diagnosis to end-stage renal disease is significantly longer among First Nations individuals, 2 despite evidence for poorer quality of diabetes care 18,19 and a larger proportion of patients with early diabetic nephropathy. 8,20 These findings are notable because they reveal an important mechanism underlying ethnicity-based disparities in endstage renal disease that has serious long-term implications for First Nations and other indigenous populations. They may also help to explain similar disparities in other diabetic complications.…”

Section: Discussionmentioning

confidence: 98%

“…They may also help to explain similar disparities in other diabetic complications. 20,21 Although differences in diabetes-related incidence of end-stage renal disease have diminished between First Nations and non-First Nations popu lations in Canada 2 and between comparable populations in the United States, 22 significant ethnicity-based disparities in end-stage renal disease persist 2,22 and have remained incompletely understood. Known contributing factors include genetic 3 and other prenatal determinants, 23 envi- ronmental factors such as glycemic and blood pressure control 8,24 and social determinants such as quality of and access to health care.…”

Section: Discussionmentioning

confidence: 99%

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Differential mortality and the excess burden of end-stage renal disease among First Nations people with diabetes mellitus: a competing-risks analysis

Jiang

Osgood

Lim

et al. 2013

CMAJ

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Differential mortality and the excess burden of end-stage renal disease among First Nations people with diabetes mellitus: a competing-risks analysis

Jiang

Osgood

Lim

et al. 2013

CMAJ

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“…In fact, the incidence of type 2 diabetes among this population is three to five times higher than in the general population (1-3) and the estimated prevalence rates are over 25% in some communities (4). While complications of diabetes are experienced in all populations, the impact has been particularly profound among First Nations peoples in Canada (5). Early age of onset and increased disease severity in these communities are likely linked to the severe long-term diabetic complications of blindness, limb amputations and skin wounds (6), cardiovascular disease (7-9) and a sevenfold greater risk of end-stage renal disease as compared with the general Canadian population (1,3,10,11).…”

Section: Introductionmentioning

confidence: 99%

Diabetes risk evaluation and microalbuminuria (DREAM) studies: ten years of participatory research with a First Nation’s home and community model for type 2 diabetes care in Northern Saskatchewan

Pylypchuk

Vincent

Wentworth³

et al. 2008

International Journal of Circumpolar Health

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Objectives. To review the DREAM studies and the role of participatory research using a Home and Community Care model in treating First Nations diabetes. Study Design. Population survey, pilot and prospective randomized trial Methods. Review documented history of these studies since inception. Collation of all data from the DREAM studies from 1998 to the present, including interviews with all providers and many of the participants.Results. The DREAM studies were a participatory process providing a needs assessment and became the foundation for this First Nation's Home and Community Care team involvement in providing community-based chronic-disease management. The findings motivated the community to find a process that would lead to needed changes. This participatory research enabled a culturally tailored algorithm of evidence-based management of hypertension and disease management strategies for people with diabetes. These studies demonstrated that in this community the Home and Community Care team could work together with primary care physicians and specialists to prevent the complications of diabetes. DREAM studies and participatory research involving multidisciplinary home careConclusions. The DREAM studies demonstrated in the first controlled trial that with participatory research a systems change is possible; a chronic-disease management model utilizing a trained multidisciplinary Home and Community Care team and informed patients can lead to lower blood pressure in a Canadian First Nations population with diabetes.

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“…This is true in the general populations of Canada and the United States (11,12), as well as in their Aboriginal communities (13)(14)(15). For example, only 45% of diabetic patients in the general population of the Canadian province of Saskatchewan achieved treatment targets for low-density lipoprotein (LDL) levels (below 2.5 mmol/L) (16); this was the case for only 39% of patients in the Oji-Cree community of Sandy Lake, Ontario (14).…”

Section: Introductionmentioning

confidence: 99%

Controlled trial of an intervention to improve cholesterol management in diabetes patients in remote Aboriginal communities

Bhattacharyya

Harris

Zwarenstein

et al. 2010

International Journal of Circumpolar Health

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Objectives. Aboriginal communities have a high prevalence of diabetes and heart disease, and limited resources to address them. The objective of this study was to test the effectiveness of prioritizing care with audit and feedback on cholesterol management of diabetic patients. Study design. A controlled before-after intervention trial was conducted among health care providers in Oji-Cree reserves in Sioux Lookout Zone, Ontario. Two communities were randomized to receive an interactive educational workshop and chart audit with feedback on cholesterol management; 2 control communities received usual care. Methods. The primary outcome measure used was the proportion of patients on statins, and the secondary outcome measure was the proportion of patients with LDL>2.5 mmol/L or TC/HDL>4.0 on statins. Outcomes were assessed by chart review at baseline and 10 months post-intervention. Results. Patients in the 2 intervention communities (n=170) and the 2 controls (n=170) were comparable at baseline. The intervention did not increase the proportion of diabetic patients on statins overall or in the subset of patients with elevated cholesterol. The proportion of patients with elevated cholesterol on statins went from 46% to 53% (p=0.48) in the intervention group and from 47% to 50% (p=0.25) in the control group. Conclusions. Audit and feedback listing patients requiring treatment did not increase statin prescription rates in diabetic patients in remote Aboriginal settings. This may be due to elevated baseline rates, the low intensity of feedback and the constraints of the practice environment, such as low staffing and high staff turnover.

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Complications of Type 2 Diabetes Among Aboriginal Canadians

Cited by 74 publications

References 16 publications

Differential mortality and the excess burden of end-stage renal disease among First Nations people with diabetes mellitus: a competing-risks analysis

Differential mortality and the excess burden of end-stage renal disease among First Nations people with diabetes mellitus: a competing-risks analysis

Diabetes risk evaluation and microalbuminuria (DREAM) studies: ten years of participatory research with a First Nation’s home and community model for type 2 diabetes care in Northern Saskatchewan

Controlled trial of an intervention to improve cholesterol management in diabetes patients in remote Aboriginal communities

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