The study examined the health outcomes of 116 Aboriginal individuals in Alberta diagnosed with diabetes in youth (≤20 years old). The majority (86.2%) were Aboriginal, with an average current age of 30.5 years and average diabetes duration of 14.5 years. High rates of comorbidities were found, including obesity (82%), abnormal waist circumference (64.1%), metabolic syndrome (43.1%), hypertension (48.4%), and poor blood glucose control (61.1% had A1c >7%). Many also showed signs of diabetes complications like microalbuminuria (33%) and being at high risk for foot issues (11.4%). The results suggest diabetes takes a significant toll on health early in

1. f
Health outcomes of Aboriginal individuals with early onset diabetes
Richard T. Oster and Ellen L. Toth. Department of Medicine, University of Alberta
Background: Type 2 diabetes
excessively impacts the Canadian
Aboriginal population. Compounding this
public health crisis is a recent increase in
the diagnosis of young Aboriginal
individuals. Little is known about the
health outcomes of Aboriginal individuals
diagnosed with diabetes at a young age.
Purpose: Our objective was to examine
the diabetes-related health status and
outcomes of First Nations individuals
diagnosed with diabetes in youth.
Methods: From the databases of four
separate community-based diabetes
screening projects in Alberta we created a
subject pool of 116 individuals with
diabetes diagnosed in youth (≤ 20 years
of age). Present age, ethnicity, duration of
diabetes, body mass index, waist
circumference, hemoglobin A1c (A1c),
blood lipids, blood pressure, insulin use,
anti-diabetic medication use, and the
presence of the metabolic syndrome,
kidney complications, and foot
abnormalities were assessed.
Results: The vast majority of participants
were Aboriginal (86.2%) and the average
age was 30.5 years. Average duration of
diabetes was 14.5 years. Average A1c
was 8.4% and 61.1% had and A1c > 7%.
Eighty two percent of participants were
obese or overweight, whereas 64.1% had
an abnormal waist circumference and
43.1% had the metabolic syndrome.
Hypertension and hypercholesterolemia
were detected in 48.4% and 34.0% of
individuals respectively. Thirty three
percent had microalbumiuria, 22.4% had
proteinuria and 11.4% were at the highest
risk for foot abnormalities. Only 32.8%,
21.6%, and 5.3% of participants were
being managed with insulin alone, anti-
diabetic oral agents alone, and both
insulin and oral agents respectively.
Conclusions: Our results most likely
underestimate the disease burden but
they support similar research with First
Nations youth in Manitoba, and suggest
that diabetes co-morbidities and
complications are common early in the
disease course for Aboriginal individuals
diagnosed with diabetes in youth.
KS
BACKGROUND
Among Aboriginal youth with type 2 diabetes in Manitoba, neuropathy,
nephropathy, retinopathy, dyslipidemia, hypertension, fatty liver, and
poor quality of life have been reported (3). However, outcome data
years after diagnosis is scarce. Our results demonstrate that Aboriginal
individuals with youth-onset diabetes in Alberta carry a considerable
burden of co-morbidities and complications. Despite being young, the
health of these individuals is comparable (or worse) than older
Aboriginal individuals with diabetes (6).
Although the majority of subjects (68.5%) were being managed by
insulin or oral anti-diabetic agents, most (61.7%) had poor glucose
control. Reasons for this discrepancy could not be determined, but a
lack of cultural sensitivity on the part of healthcare system, as well as a
lack of understanding and familiarity with the biomedical system on the
part of First Nations individuals may be involved. The history of
colonialism, oppression, racism, marginalization and disempowerment
experienced by First Nations people likely leaves many wary and
suspicious of the mainstream healthcare system (7). Additionally,
current models of health practice have yet to acknowledge the
influence on First Nations health of colonialism-based historical and
social contexts, or ethno cultural affiliation (8). Strategies such as a ‘bi-
cultural approach’ to diabetes-related health should be explored.
METHODS
RESULTS
CONCLUSIONS
ABSTRACT
REFERENCES
Diabetes has become a major health crisis among Aboriginal
populations in Canada. It is well recognized that the occurrence of
diabetes and its complications is much higher (2-5 times) among First
Nations individuals than Canadian population at large (1,2). Perhaps
more alarming are reports of increasing obesity and emerging type 2
diabetes in Aboriginal youth, which will only further perpetuate the
impact of diabetes (3). The health outcomes of Aboriginals with youth-
onset diabetes have not been explored.
The objective was to examine the diabetes-related health status and
outcomes of First Nations individuals diagnosed with diabetes in youth.
Data was derived from three separate diabetes screening projects, two
of which are traveling ‘point of care’ screening programs. SLICK
(Screening for Limb, I-Eye, Cardiovascular, and Kidney complications of
diabetes) and MDSi (Mobile Diabetes Screening Initiative) provide
diabetes risk assessment, diabetes complications screening, and
community-based care to each of the 44 Alberta First Nations
communities and to rural Aboriginal Alberta communities respectively
(4, 5). The third project is an outpatient diabetes care/screening service
in a single rural First Nations community in Alberta. The projects are
ongoing. The information presented was collected between 2002-2010.
Included subjects were diagnosed with diabetes in youth (≤ 20 years of
age) and identified within the communities to local bookers and health
professionals, with help from local advertising. Medications, chart
review, or nurse history were used to confirm diabetes. Age at
diagnosis, ethnicity, duration of diabetes, body mass index (BMI), waist
circumference, hemoglobin A1c (A1c), blood lipids, blood pressure,
insulin use, anti-diabetic medication use, and the presence of the
metabolic syndrome, kidney complications, and foot abnormalities were
assessed. Using PASW version 18.0 (Chicago, IL), descriptive statistics
were determined.
Each screening project was approved by the Health Research Ethics
Board at the University of Alberta. This research was approached as a
partnership between Alberta’s Métis communities, Alberta First Nations
communities and the University of Alberta.
1. Young TK et al. Type 2 diabetes mellitus in Canada's first nations: status of an epidemic in progress. CMAJ. 2000 Sep;163(5):561-6. 5. Ralph-Campbell K et al. Increasing rates of diabetes and cardiovascular risk in Métis Settlements in northern Alberta. Int J Circumpolar Health. 2009.
2. Dyck R et al. Epidemiology of diabetes mellitus among First Nations and non-First Nations adults. CMAJ. 2010 Feb;182(3):249-56. Dec;68(5):433-42.
3. Sellers AC et al. Clinical management of type 2 diabetes in indigenous youth. Pediatr Clin N Am. 2003. 56:1441-59. 6. Hanley AJ et al. Complications of Type 2 Diabetes Among Aboriginal Canadians: prevalence and associated risk factors. Diabetes Care. 2005. Aug;28(8):2054-7.
4. Oster RT et al. Diabetes care and health status of First Nations individuals with type 2 diabetes in Alberta. Can Fam Physician. 2009. 7. King M et al. Indigenous health part 2: The underlying causes of the health gap. Lancet. 2009. 374:76-85.
Apr;55(4):386-93. 8. Hunter LM et al. Aboriginal healing: Regaining balance and culture. Journal of Transcultural Nursing. 2006. 17:13-22.
Male Female Total
Age (years) 30.7 ± 15.4 29.9 ± 13.3 30.2 ± 14.1
Age diagnosed (years) 16.0 ± 4.0 15.6 ± 4.1 15.7 ± 4.0
Duration of diabetes (years) 14.5 ± 14.6 14.3 ± 12.0 14.4 ± 13.0
BMI (kg/m2; adults only) 34.4 ± 8.8 33.3 ± 8.6 33.8 ± 8.6
Waist Circumference (cm; adults only) 113.3 ± 24.4 107.5 ± 20.5 109.8 ± 22.1
Systolic blood pressure (mmHg) 127.0 ± 17.6 122.0 ± 16.7 123.9 ± 17.2
Diastolic blood pressure (mmHg) 77.7 ± 10.1 75.7 ± 10.5 76.5 ± 10.3
Mean arterial pressure (mmHg) 92.7 ± 11.4 90.5 ± 12.3 91.3 ± 11.9
A1c (%) 8.3 ± 2.4 8.5 ± 2.7 8.4 ± 2.6
Total cholesterol (mmol/L) 4.8 ± 1.2 4.8 ± 1.4 4.8 ± 1.3
Urine microalbumin/creatinine ratio 4.1 ± 6.2 2.2 ± 2.7 3.2 ± 4.8
Male Female Total
% overweight (25-29.9, adults; 85th – 94th
percentile, youth)
32.4 (17.3 - 47.5) 24.6 (13.4 - 35.8) 27.6 (18.6 - 36.6)
% obese (> 30 adults; > 95th percentile youth) 59.5 (43.7 - 75.3) 56.1 (43.2 - 69.0) 57.4 (47.4 - 67.4)
% overweight or obese 91.9 (84.1 - 99.7) 80.7 (70.5 - 90.9) 85.0 (77.8 - 92.2)
% with abnormal waist circumference (>102
males, > 88 females, adults; > 90th
percentile, youth)
60.6 (43.9 - 77.3) 79.2 (68.3 - 90.1) 72.1 (62.6 - 81.6)
% with hypertension (> 130/80, adults; > 95th
percentile, youth)
59.1 (44.6 - 73.6) 35.2 (24.1 - 46.3) 44.3 (35.2 - 53.4)
% with poor A1c (> 7%) 58.1 (43.4 - 72.8) 63.9 (52.8 - 75.0) 61.7 (52.8 - 70.6)
% with hypercholesterolemia (> 5.2) 23.7 (10.2 - 37.2) 36.4 (24.8 - 48.0) 31.7 (22.8 - 40.6)
% with abnormal microalbumin/creatinine ratio
(>2 males; >2.8 females)
36.7 (19.5 - 53.9) 32.1 (14.8 - 49.4) 34.5 (22.3 - 46.7)
% with proteinuria 11.5 (0.1 - 22.9) 28.0 (15.6 - 40.4) 22.4 (13.0 - 31.8)
% with metabolic syndrome 37.0 (23.0 - 51.0) 45.2 (33.8 - 56.6) 42.0 (33.1 - 50.9)
% with no abnormality (0) 73.1 (56.1 - 90.1) 77.3 (64.9 - 89.7) 75.7 (65.7 - 85.7)
% at low foot risk (1) 7.7 (0.2 - 15.2) 9.1 (0.6 - 17.6) 8.6 (2.0 - 15.2)
% at moderate foot risk (2) 11.5 (0.1 - 22.9) 2.3 (0.2 - 4.4) 5.7 (0.3 - 11.1)
% at high foot risk (3) 7.7 (0.3 - 15.1) 11.4 (2.0 - 20.8) 10.0 (0.3 - 17.0)
% taking insulin 53.2 (38.9 - 67.5) 41.1 (29.8 - 52.4) 45.8 (36.9 - 54.7)
% taking oral agents 30.4 (17.1 - 43.7) 17.8 (9.0 - 26.6) 22.7 (15.2 - 30.2)
% taking insulin and oral agents 15.2 (4.9 - 25.5) 5.5 (0.2 - 10.7) 9.2 (4.0 - 14.4)
Table 1. Clinical parameters of subjects (N = 126). Values expressed as means ± SD.
Table 2. Prevalence (95% CI) of selected conditions among subjects.
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Year diagnosed
Numberofsubjects
A total of 126 subjects were included in the analysis (96 adults and 30
youth). Subjects ranged from 9 to 76 years of age (mean 30.2), and the
majority (61.1%) were female. All subjects were of Aboriginal descent,
of which 95.2% were First Nations individuals. Type 2 diabetes
comprised 94.4% of the diagnoses.
Figure 1. Number of subjects with youth-onset diabetes by year of diagnosis. (N = 126).
High rates of co-morbidities were identified as 85.0% of participants
were obese or overweight, 72.1% had an abnormal waist
circumference, 42.0% had the metabolic syndrome, 44.3% were
hypertensive, 31.7% had hypercholesterolemia, 34.5% had
microalbumiuria, 22.4% had proteinuria and 11.4% were at the highest
risk for foot abnormalities. In total, 45.8%, 22.7%, and 9.2% of
participants were being managed with insulin alone, anti-diabetic oral
agents alone, and both insulin and oral agents respectively.