Abstract
Objective
The goal of Screening for Limb, I-Eye, Cardiovascular, and Kidney complications of diabetes (SLICK) is to reduce the burden of diabetes among Alberta First Nations individuals. By analyzing the longitudinal results of SLICK over a six-year time span, our purpose was to examine both baseline diabetes-related health status and whether subsequent improvements occurred.
Methods
Diabetes complications screening, diabetes education, and community-based care were provided by mobile clinics which traveled to 43 Alberta First Nations communities biannually. Body mass index (BMI), waist circumference, hemoglobin A1c (HbA1c), total cholesterol and blood pressure, as well as the presence of foot and kidney abnormalities were assessed among 2,102 unique subjects with diabetes. Mean values of diabetes health indicators at baseline and subsequent visits for returning subjects were compared. Secular trends were sought by examining trends in mean baseline health indicators per year.
Results
High baseline rates of obesity, poor HbA1c concentrations, hypercholesterolemia, hypertension, foot abnormalities and kidney damage were observed. Significant improvements in BMI, blood pressure, total cholesterol and HbA1c concentrations were identified (p<0.01) in returning subjects. Similarly, significant decreasing secular trends in total cholesterol and HbA1c concentrations were observed (p<0.01). At baseline, females had a higher prevalence of obesity and abnormal waist circumference (p<0.05); however, males had more inadequate HbA1c concentrations (>8.4%), hypercholesterolemia, hypertension, foot abnormalities and kidney damage (p<0.05).
Discussion
Despite worrisome baseline clinical characteristics, diabetes-related health appears to be improving modestly in Alberta First Nations individuals.
Key words: Aboriginal, North American, type 2 diabetes mellitus, mobile screening, rural communities
Résumé
Objectifs
Le projet SLICK (dépistage des complications du diabète) vise à réduire le fardeau du diabète chez les Premières nations de l’Alberta. Nous avons examiné l’état de santé de référence des personnes diabétiques et ses améliorations ultérieures en analysant les résultats longitudinaux du projet sur six ans.
Méthode
Le dépistage des complications, la sensibilisation au diabète et les soins communautaires ont été assurés par des unités sanitaires mobiles qui ont visité deux fois l’an 43 communautés des Premières nations de l’Alberta. L’indice de masse corporelle (IMC), le périmètre ombilical, l’hémoglobine A1c (HbA1c), le cholestérol total, la pression artérielle et la présence d’anomalies du pied et des reins ont été évalués chez 2102 sujets diabétiques. Nous avons comparé les valeurs moyennes des indicateurs pendant la visite de référence et les visites ultérieures des sujets de retour, et déterminé les tendances à long terme d’après l’évolution moyenne annuelle des indicateurs de base.
Résultats
Des niveaux d’obésité élevés, des concentrations excédentaires en HbA1c, de l’hypercholestérolémie, de l’hypertension artérielle, des anomalies du pied et des insuffisances rénales ont été observés au départ. Chez les sujets de retour, des améliorations significatives (p<0,01) de l’IMC, de la pression artérielle, du cholestérol total et des concentrations en HbA1c ont été détectées. À long terme, il y a eu des baisses significatives (p<0,01) du cholestérol total et des concentrations en HbA1c. À la base, les femmes affichaient une prévalence accrue d’obésité et de périmètre ombilical anormal (p<0,05). Cependant, les concentrations excédentaires en HbA1c (>8,4 %), l’hypercholestérolémie, l’hypertension, les anomalies du pied et l’insuffisance rénale étaient plus présentes chez les hommes (p<0,05).
Discussion
Malgré un profil clinique de base inquiétant, l’état de santé lié au diabète semble s’améliorer modérément chez les Premières nations de l’Alberta.
Mots clés: Indiens d’Amérique nord, diabète de type 2, dépistage mobile, population rurale
Footnotes
(Previously First Nations and Inuit Health Branch (FNIHB), Health Canada)
Project Funding: Canada Health Infostructure Partnership Program (CHIPP), Health Canada and the University of Alberta.
Conflict of Interest: None to declare.
References
- 1.Yu CH, Zinman B. Type 2 diabetes and impaired glucose tolerance in Aboriginal populations: A global perspective. Diabetes Res Clin Pract. 2007;78(2):159–70. doi: 10.1016/j.diabres.2007.03.022. [DOI] [PubMed] [Google Scholar]
- 2.Oster RT, Hemmelgarn BR, Toth EL, King M, Crowshoe L, Ralph-Campbell K. Alberta Diabetes Atlas 2009. Edmonton, AB: Institute of Health Economics; 2009. Diabetes and the Status Aboriginal population in Alberta. [Google Scholar]
- 3.Young TK, Reading J, Elias B, O’Neil JD. Type 2 diabetes mellitus in Canada’s First Nations: Status of an epidemic in progress. CMAJ. 2000;163(5):561–66. [PMC free article] [PubMed] [Google Scholar]
- 4.Dannenbaum D, Kuzmina E, Lejeune P, Torrie J. Gangbe M. Prevalence of diabetes and diabetes-related complications in First Nations communities in northern Quebec (Eeyou Istchee), Canada. Can J Diabetes. 2008;32(1):46–52. doi: 10.1016/S1499-2671(08)21010-5. [DOI] [Google Scholar]
- 5.Molitch ME, DeFronzo RA, Franz MJ, Keane WF, Mogensen CE, Parving HH, et al. Nephropathy in diabetes. Diabetes Care. 2004;27(Suppl1):S79–S83. doi: 10.2337/diacare.27.2007.s79. [DOI] [PubMed] [Google Scholar]
- 6.Zhang Y, Lee ET, Devereux RB, Yeh J, Best LG, Fabsitz RR, et al. Prehyperten-sion, diabetes, and cardiovascular disease risk in a population-based sample: The Strong Heart study. Hypertension. 2006;47(3):410–14. doi: 10.1161/01.HYP.0000205119.19804.08. [DOI] [PubMed] [Google Scholar]
- 7.Hanley AJ, Harris SB, Mamakeesick M, Goodwin K, Fiddler E, Hegele RA, et al. Complications of type 2 diabetes among Aboriginal Canadians: Prevalence and associated risk factors. Diabetes Care. 2005;28(8):2054–57. doi: 10.2337/diacare.28.8.2054. [DOI] [PubMed] [Google Scholar]
- 8.Daniel M, Green LW, Marion SA, Gamble D, Herbert CP, Hertzman C, et al. Effectiveness of community-directed diabetes prevention and control in a rural Aboriginal population in British Columbia, Canada. Soc Sci Med. 1999;48(6):815–32. doi: 10.1016/S0277-9536(98)00403-1. [DOI] [PubMed] [Google Scholar]
- 9.Virani S, Strong D, Tennant M, Greve M, Young H, Shade S, et al. Rationale and implementation of the SLICK project: Screening for limb, I-eye, cardiovascular and kidney (SLICK) complications in individuals with type 2 diabetes in Alberta’s First Nations communities. Can J Public Health. 2006;97(3):241–47. doi: 10.1007/BF03405595. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Paradis G, Lévesque L, Macaulay AC, Cargo M, McComber A, Kirby R. Impact of a diabetes prevention program on body size, physical activity, and diet among Kanien’keha:ka (Mohawk) children 6 to 11 years old: 8-year results from the Kahnawake Schools Diabetes Prevention Project. Pediatrics. 2005;115(2):333–39. doi: 10.1542/peds.2004-0745. [DOI] [PubMed] [Google Scholar]
- 11.Bailie RS, Si D, Robinson GW, Togni SJ, D’Abbs PH. A multifaceted health-service intervention in remote Aboriginal communities: 3-year follow-up of the impact on diabetes care. Med J Aust. 2004;181(4):195–200. doi: 10.5694/j.1326-5377.2004.tb06235.x. [DOI] [PubMed] [Google Scholar]
- 12.McDermott R, Tulip F, Schmidt B, Sinha A. Sustaining better diabetes care in remote Indigenous Australian communities. BMJ. 2003;327(7412):428–30. doi: 10.1136/bmj.327.7412.428. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Shields R. IHS audit database. 2009. Unofficial IHS diabetes care: Past results. [Google Scholar]
- 14.Oster RT, Virani S, Strong D, Shade S, Toth EL. Diabetes care and health status of First Nations individuals with type 2 diabetes in Alberta. Can Fam Phys. 2009;55(4):386–93. [PMC free article] [PubMed] [Google Scholar]
- 15.Majumdar SR, Johnson JA, Bowker SL, Booth GL, Dolovich L, Ghali W, et al. A Canadian consensus for the standardized evaluation of quality improvement interventions in type 2 diabetes. Can J Diabetes. 2005;29(3):220–29. [Google Scholar]
- 16.Expert Panel on Detection, Evaluation,Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) JAMA. 2001;285(19):2486–97. doi: 10.1001/jama.285.19.2486. [DOI] [PubMed] [Google Scholar]
- 17.Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999–2000. JAMA. 2002;288(14):1728–32. doi: 10.1001/jama.288.14.1728. [DOI] [PubMed] [Google Scholar]
- 18.Fernández JR, Redden DT, Pietrobelli A, Allison DB. Waist circumference per-centiles in nationally representative samples of African-American, European-American, and Mexican-American children and adolescents. J Pediatr. 2004;145(4):439–44. doi: 10.1016/j.jpeds.2004.06.044. [DOI] [PubMed] [Google Scholar]
- 19.Meltzer S, Leiter L, Daneman D, Gerstein HC, Lau D, Ludwig S, et al. 1998 clinical practice guidelines for the management of diabetes in Canada. Canadian Diabetes Association. CMAJ. 1998;159(Suppl8):S1–S29. [PMC free article] [PubMed] [Google Scholar]
- 20.Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes. 2003;27(Suppl2):S1–S152. doi: 10.1016/j.jcjd.2013.01.009. [DOI] [PubMed] [Google Scholar]
- 21.National High Blood Pressure Education Program Working Group on High Blood Pressure in ChildrenAdolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114(Suppl2):555–76. [PubMed] [Google Scholar]
- 22.World Health Organization Expert Committee on Diabetes Mellitus. Second report. World Health Organ Tech Rep Ser. 1980;646:1–80. [PubMed] [Google Scholar]
- 23.Statistics Canada. Aboriginal peoples in Canada in 2006: 2006 census: First Nations people. 2006. [Google Scholar]
- 24.Wilson C, Gilliland S, Cullen T, Moore K, Roubideaux Y, Valdez L, et al. Diabetes outcomes in the Indian health system during the era of the Special Diabetes Program for Indians and the Government Performance and Results Act. Am J Public Health. 2005;95(9):1518–22. doi: 10.2105/AJPH.2004.053710. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.UK Prospective Diabetes Study Group UKPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) Lancet. 1998;352(9131):837–53. doi: 10.1016/S0140-6736(98)07019-6. [DOI] [PubMed] [Google Scholar]
- 26.UK Prospective Diabetes Study Group UKPDS. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. UKPDS 38. BMJ. 1998;317(7160):703–13. doi: 10.1136/bmj.317.7160.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Hayward LM, Burden ML, Burden AC, Blackledge H, Raymond NT, Botha JL, et al. What is the prevalence of visual impairment in the general and diabetic populations: Are there ethnic and gender differences? Diabet Med. 2002;19(1):27–34. doi: 10.1046/j.0742-3071.2001.00603.x. [DOI] [PubMed] [Google Scholar]
- 28.Wandell PE, Gafvels C. Patients with type 2 diabetes aged 35–64 years at four primary health care centres in Stockholm County, Sweden. Prevalence and complications in relation to gender and socio-economic status. Diabetes Res Clin Pract. 2004;63(3):195–203. doi: 10.1016/j.diabres.2003.08.011. [DOI] [PubMed] [Google Scholar]
- 29.Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: Meta-analysis of 37 prospective cohort studies. BMJ. 2006;332(7533):73–78. doi: 10.1136/bmj.38678.389583.7C. [DOI] [PMC free article] [PubMed] [Google Scholar]