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Question 1:  Is It Like This Off The Reserve?

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Who are the people suffering from type 2 diabetes?  The answer is virtually everyone.  Formerly a disease of the elderly, it now frequently affects the middle-aged, and is increasing in young persons, including adolescents and teens.  It touches both men and women, and crosses virtually all ethnic and racial groups.  It is a disease truly global in scope.  However, like many things global in scope, there are marked variations in incidence and prevalence across social, gender, and ethnic lines.  Type 2 diabetes disproportionately impacts indigenous peoples.

 

The health of indigenous peoples is a product of genetic, environmental, social, political, and cultural factors.  The interactions between these factors are complex and poorly understood.  However, their effects on health outcomes are well-documented.  Canada is frequently cited as a nation having one of the best qualities of life in the world (United Nations Development Programme).  In contrast, Canadian “Aboriginal women and men are characterized by a health profile one would normally associate with the developing world“ [1].  As Waldram and colleagues describe, this health profile is linked not only to poverty, but to the “historical position [of Aboriginal peoples] within the Canadian social system“ [2].

 

Type 2 diabetes is of particular concern to Aboriginal peoples in Canada.  Prevalence rates of type 2 diabetes are three to five times higher in Aboriginal peoples than in the non-Aboriginal population [3].  This disparity is further exacerbated by increased death rates from diabetes of two to four times [4].

 

Similar findings are documented for indigenous people in the United States.  The Pima Indians have been subjects of a large study spanning over 30 years.  While previously free of diabetes, over the past half-century, the prevalence has risen to 40-50% [5].  The complications of diabetes are also higher in Native Americans.  Studies of Native Americans in Oklahoma found that the morbidity associated with diabetes was greater in the indigenous population.  Complications of diabetes including lower extremity amputation, diabetic retinopathy, and cardiovascular disease all showed higher rates among indigenous people when compared to non-indigenous people [4].

Comparable statistics illustrating higher prevalence rates of diabetes among indigenous peoples exist for many other populations.  The Micronesian Nauru have a prevalence rate similar to the Pima Indians (approximately 40%) [5] [6].  In Australia, the prevalence of diabetes is 2-3% among Caucasians; whereas it is 11% among Aborigines [6].  Indigenous Fijians show an elevated rate of 7-15% when compared to the non-indigenous population [6].  If the baseline rate of type 2 diabetes is approximately 5% in people of European ancestry it is obvious that rates of up to 40% among indigenous peoples illustrate a crisis based on ethnicity.

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1. Stout MD, Kipling GD, Stout R. Aboriginal women’s health research synthesis project - final report. Centres of Excellence for Women’s Health; 2001.

2. Waldram JB, Herring DA, Young TK. Aboriginal health in : historical, cultural, and epidemiological perspectives. Toronto: University of Toronto Press; 1995.

3. Health Canada. Aboriginal Diabetes Initiative [monograph on the Internet]. Health Canada; c2000 [updated 2005 Mar 4; cited 2006 Jan 2]. Available from: www.hc-sc.gc.ca/fnih-spni/pubs/diabete/2000_reserve-program/index_e.html

4. Szathmáry, EJE Non-insulin dependent diabetes mellitus among aboriginal North Americans. Annual Reviews of Anthropology. 1994; 23: 457-82.

5. Abate N, Chandalia M. The impact of ethnicity on type 2 diabetes. Journal of Diabetes and Its Complications. 2003; 17: 39-58.

6. Lako JV. Dietary trend and diabetes: its association among indigenous Fijians 1952 to 1994. Asia Pacific Journal of Clinical Nutrition. 2001; 10: 183-187.

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