Diabetes prevalence, incidence and mortality in First Nations and other people in Ontario, 1995–2014: a population-based study using linked administrative data

Walker, Jennifer; Slater, Morgan; Jones, Carmen; Shah, Baiju R.; Frymire, Eliot; Khan, Shahriar; Jacklin, Kristen; Green, Michael E.

doi:10.1503/cmaj.190836

Cited by 29 publications

(22 citation statements)

References 28 publications

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“…A few studies in our review reported a low prevalence of diabetes among some indigenous populations in LatAm [ 55 , 74 , 82 ], in parallel to some previous reports [ 283 – 286 ] about other indigenous groups in the region and in contrast with the higher prevalence of diabetes among American Indians in the USA [ 287 ] and the First Nations in Canada [ 288 ]. However, other studies in our review and in the current literature have documented elevated diabetes prevalence or risk among indigenous and other socioeconomically disadvantaged ethnic groups [ 48 , 50 , 73 , 76 , 77 , 83 , 90 , 91 , 166 , 289 – 293 ].…”

Section: Additional Observationssupporting

confidence: 85%

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

et al. 2020

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Purpose of Review Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. Recent Findings The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. Summary The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region. Keywords Latin America. Diabetes prevalence. Diabetes treatment. Control. Diabetes complications. Interventions. Health care This article is part of the Topical Collection on Diabetes Epidemiology

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Section: Additional Observationssupporting

confidence: 85%

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

et al. 2020

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“…First Nations people in Ontario have a high and growing prevalence of diabetes that exceeds that of other people in the province. 6 Previous research has also suggested that First Nations people have a disproportionate burden of peripheral arterial disease. 7 For example, a physical examination screening study in a northern Manitoba First Nations community showed a prevalence of impaired pulse of 41% and a prevalence…”

mentioning

confidence: 99%

Peripheral arterial disease in Ontario First Nations people with diabetes: a longitudinal population-based cohort study

Shah

Frymire

Jacklin

et al. 2019

cmajo

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Background: Peripheral arterial disease is an important vascular complication of diabetes that may lead to lower-extremity amputation. We aimed to compare the treatment and complications of peripheral arterial disease between First Nations people and other people in Ontario with diabetes.Methods: Using health care administrative databases, we identified annual cohorts, from 1995/96 to 2014/15, of all people aged 20-105 years in Ontario with a diagnosis of diabetes. We used the Indian Register to identify those who were First Nations people and compared them to all other people in Ontario. We identified revascularization procedures (angioplasty or bypass surgery) and lower-extremity amputation procedures in the 2 populations and determined the mortality rate among those who had had lowerextremity amputation.Results: First Nations people received revascularization procedures at a rate comparable to that for other people in Ontario. However, they had lower-extremity amputation procedures at 3-5 times the frequency for other Ontario residents. First Nations people had higher mortality than other people in Ontario after lower-extremity amputation (adjusted hazard ratio 1.15, 95% confidence interval 1.05-1.26), with median survival of 3.5 years versus 4.1 years.Interpretation: First Nations people in Ontario had a markedly increased risk for lower-extremity amputation compared to other people in Ontario, and their mortality rate after amputation was 15% higher. Future research is needed to understand what barriers First Nations people face to receive adequate peripheral arterial disease care and what interventions are necessary to achieve equitable outcomes of peripheral arterial disease for First Nations people in Ontario.

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“…Conversely, lipid control was slightly better among First Nations people with diabetes. First Nations people were more likely than other people in Ontario to be using insulin and less likely not to be prescribed any glucose-lowering medications, but further analysis is required to determine the intensity and appropriateness of treatment, particularly as diabetes onset is more common at younger ages among First Nations people 42 and the current analysis was limited to those aged 65 or older. The observed relations between increasing comorbidity and achievement of target A 1c levels for other people in Ontario and of lipid targets for all groups may be due to higher levels of access to and use of health care services by these patients.…”

Section: Discussionmentioning

confidence: 99%

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Green¹,

Shah²,

Slater³

et al. 2020

CMAJ

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D iabetes and its related complications are major contributors to morbidity and mortality worldwide. 1-3 Indigenous populations in Canada and around the world are disproportionately affected by diabetes owing to the complex relations among colonization, social disadvantage, stress, trauma and metabolic health. 4-7 In addition to our own work showing persistently higher rates of peripheral vascular disease, stroke, cardiac disease, renal dysfunction and ophthalmologic complications in Ontario First Nations, 8-12 other Canadian and international studies also showed higher complication rates in diverse Indigenous populations. 6,7,13-15 Glycemic control is fundamental to the management of diabetes and the prevention of complications. 16 Glycated hemoglobin (A 1c) is a reliable way to estimate the average level of glucose in the blood. 17 Since A 1c levels higher than 7.0% have been associated with an increased risk of microvascular complications, 18-20 treatment guidelines suggest A 1c should be measured every 3-6 months to ensure that glycemic goals are being met or maintained. 21 Since people with diabetes also have an elevated risk for cardiovascular disease, 22-24 management and control of cardiovascular risk factors, particularly lipids such as low-density lipoprotein (LDL) cholesterol, are also important. 25-27 Guidelines further recommend that a full lipid profile be measured every 1-3 years, depending on cardiovascular risk, and suggest that LDL be consistently less than 2.0 mmol/L. 28 Control of A 1c and lipids has been shown to be associated with reduced morbidity and mortality in patients with diabetes. 18,29-32 One possible reason for the high burden of complications among Indigenous people with diabetes may be failure to achieve control of these 2 key clinical parameters. We examined differences between Status First Nations people with diabetes in Ontario and all other Ontario residents with diabetes in rates of monitoring of A 1c and lipids, achievement of targets for A 1c and LDL outlined in clinical guidelines, and patterns of medication use to help attain these targets.

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Diabetes prevalence, incidence and mortality in First Nations and other people in Ontario, 1995–2014: a population-based study using linked administrative data

Cited by 29 publications

References 28 publications

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

Peripheral arterial disease in Ontario First Nations people with diabetes: a longitudinal population-based cohort study

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

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