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First Nations face new threat

Urgent diabetes interventions required  

When Europeans first landed in North America, the aboriginal population was decimated by the introduction of infectious diseases such as small-pox and measles. In the 20th century, tuberculosis further ravaged these communities.

Today, another epidemic is wreaking havoc on First Nations people: type 2 diabetes.

While the incidence of type 2 diabetes is steadily increasing among all Canadians, the disease among First Nations communities is skyrocketing at a “horrendously high rate — two-and-a-half to five times that of the general population,” says Dr. Stewart Harris, Professor of Family Medicine at the University of Western Ontario in London.

Dr. Harris has been studying diabetes in First Nations people for almost 20 years and recently completed the Canadian First Nations Diabetes Clinical Management Evaluation (CIRCLE), a three-year research project that looked at diabetes in 19 First Nations communities across Canada and recently presented
at the International Diabetes Federation meeting. According to Dr. Harris:

• Up to 40% of adults on First Nations reserves have type 2 diabetes (versus 7% of adults in the general population).

• Aboriginal people are diagnosed with diabetes 10 to 20 years younger than the general
population.

Of the participants with diabetes in the CIRCLE study, more than half had high blood pressure, and almost two-thirds had poorly controlled blood glucose and cholesterol levels. Almost one-quarter of the people in the study were overweight (i.e., BMI 25 — 29.9), another quarter were obese (i.e., BMI 30 — 34.9), and almost one-third were morbidly obese (i.e., BMI 35).

Particularly disturbing, says Dr. Harris, are the epidemiologic characteristics the CIRCLE study uncovered: “Because diabetes develops so much earlier in First Nations peoples — it is even a problem in adolescents and children — long-term complications are more prevalent and we are beginning to see them in much younger people.” For example, approximately one in five adults had established coronary artery disease, while about one in 20 had a diabetes-related amputation. In addition, rates of kidney disease among those living on reserves are 18 times higher than in the general population.

Another recent study offers similarly alarming results. Research by Dr. Roland Dyck of the Royal University Hospital in Saskatoon found an incidence of diabetes more than four times higher among First Nations women in Saskatchewan compared to non-First Nations women in the province. New diabetes cases peaked in First Nations people between ages 40 to 49, compared with a non-First Nations peak of age 70 plus.

Dr. Dyck suggests several reasons for the high rate of diabetes in First Nations women, including higher overweight/obesity rates and high rates of gestational diabetes, which is a predictor of post-pregnancy type 2 diabetes. As well, gestational diabetes is linked to an increase in the risk of type 2 diabetes in children. High obesity rates among First Nations people have both genetic and environmental roots.

“Aboriginal people have a genetic make-up that was ideal in their ancestors’ feast-famine environment, which made energy storage a priority," explains Dr. Harris. “But in today’s ‘feast-feast’ environment, the body stores energy as fat and puts this population at high risk of obesity and related disease, such as diabetes." 

Loss of traditional lifestyles and lack of access to affordable healthy food choices exacerbate the problem, he adds.

“Obesity and diabetes are going to be a major public health issue for the next generation of First Nations people unless we intervene,” Dr. Harris continues. “There is an urgent need for primary prevention initiatives and enhanced clinical care programs if we are going to prevent complications and reduce deaths related to diabetes in these communities.”