OBJECTIVE -To determine possible differences in gestational diabetes mellitus (GDM) between aboriginal and non-aboriginal people in the Saskatoon Health District.RESEARCH DESIGN AND METHODS -This was a prospective survey of all women admitted for childbirth to the Saskatoon Royal University Hospital between January and July 1998. We compared prevalence rates, risk factors, and outcomes of GDM between aboriginal and non-aboriginal women.RESULTS -Information was obtained from 2,006 women, of whom 252 aboriginal and 1,360 non-aboriginal subjects had been tested for GDM. The overall rates of GDM were 3.5% for women in the general population and 11.5% for aboriginal women. For those living within the Saskatoon Health District, GDM rates were 3.7 and 6.4%, respectively. Multivariate analysis demonstrated that aboriginal ethnicity, most notably when combined with obesity, was an independent predictor for GDM. Pregravid BMI Ն27 kg/m 2 and maternal age Ն33 years were the most important risk factors for GDM in aboriginal women, whereas previous GDM, family history of diabetes, and maternal age Ն38 years were the strongest predictors for GDM in non-aboriginal women.CONCLUSIONS -There may be fundamental differences in GDM between aboriginal and non-aboriginal people. Because GDM contributes to an increased risk for type 2 diabetes in aboriginal women and their offspring, the impact of prevention and optimal treatment of GDM on the type 2 diabetes epidemic in susceptible populations are important areas for further investigation. Diabetes Care 25:487-493, 2002

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Aims: To determine links between birth related factors and end-stage renal disease (ESRD). Methods: This 1:3 age, sex, and source population (registered Indians [SkRI] and other Saskatchewan people [OSkP]) matched case-control study, compared maternal age and parity, gestational age, low birth weight (LBW), and high birth weight (HBW), between subjects with and without ESRD. Results: Of 1,162 subjects, 277 cases (48 SkRI and 229 OSkP) and 601 controls (112 SkRI and 489 OSkP) had birth weight information. A trend for increased LBW rates occurred among SkRI and OSkP cases compared to controls (10.4 vs. 5.3% and 6.6 vs. 4.3%), and was significant for OSkP female cases (OR 3.66; 95% confidence interval [CI] 1.05, 12.73). Higher HBW rates occurred in SkRI cases (14.6% compared to 11.6% controls; N/S), and 3/5 female SkRI diabetic ESRD (DESRD) cases were over 3,750 g compared to 1/14 controls (p < 0.05). Only maternal age ≧30 years was an independent predictor for ESRD, particularly for OSkP non-DESRD cases (OR 2.45; 95% CI 1.03, 5.8). Cases with older mothers had lower mean birth weights than controls (3,236 vs. 3,434 g; p = 0.005). Conclusions: Older maternal age may predispose offspring to ESRD through mechanisms that differ for DESRD versus non-DESRD, and that may relate to ethnicity.

Di erences in glycemic control and survival predict higher ESRD rates in diabetic rst nations adults Abstract Purpose: Diabetic First Nations people (FN) have higher ESRD rates than other Canadians but the reasons remain unclear. We sought to better understand this disparity by comparing demographic, laboratory and survival features of diabetic FN and other Saskatchewan residents (OSK) by renal function stage.Methods: Prevalent diabetes cases in 2005/06 were identi ed in Saskatchewan's two largest health regions using administrative databases, and linked with centralized laboratory tests. ey were sub-divided into ve stages of renal function using estimated glomerular ltration rates (eGFR) that were determined in 992 of 2,321 FN (42.7%) and 14,054 of 21,886 OSK (64.2%). Age, sex, urine microalbumin (MA), glycosylated hemoglobin (A1C), low density lipoprotein cholesterol (LDL-C) and two year mortality risk was compared for all subjects.Results: Diabetic FN were younger (mean age 52.7 vs. 64.2, p<0.0001), more likely to be female (59.6% vs.45.4%, p<0.001), had increased MA (56.6% vs. 48.4%, p<0.0001) and displayed higher mean A1C levels (8.16% vs.7.36%, p<0.0001) than OSK. Despite a larger proportion having eGFR's >60 ml/min (87.0% vs.77.3%, p<0.001), FN were also more likely to have ESRD (2.3% vs.0.8%, p<0.001). Although FN with eGFR's >30 ml/min experienced higher age/sex adjusted mortality risk than OSK, the trends for both adjusted and unadjusted mortality risks for those with advanced pre-ESRD renal failure were lower for FN than for OSK.Conclusions: Elevated rates of ESRD experienced by FN with diabetes are related to poorer glycemic control at all levels of renal function, and lower age-related mortality at advanced stages of chronic kidney disease. ORIGINAL RESEARCH © 2010 CIMClin In E390 Diabetes mellitus is the most common cause of end stage renal disease (ESRD) in Canada [1] but the burden of diabetic ESRD upon indigenous peoples is of particular concern. In 1994, a disproportionate incidence of ESRD was reported among Saskatchewan First Nations (FN) people with diabetes [2] and a recent study shows that such disparities persist [3]. While the mechanisms underlying these observations are incompletely understood, there are two possibilities. First, FN with diabetes may be more prone to the initial development of diabetic glomerulosclerosis, which can lead to ESRD. is is supported by reports that diabetic FN have higher rates of microalbuminuria [4]. Second, FN with early diabetic glomerulosclerosis may progress to ESRD more frequently than others because of a more rapid course and/or lower mortality rates. Although our recent ndings that FN are diagnosed at a a younger age and experience a longer duration between diabetes and ESRD diagnoses are consistent with a di erential mortality e ect [5] other studies report lower survival rates among FN with all-cause advanced chronic kidney disease (CKD) [6].Identifying the mechanisms underlying ethnicity-based di erences in diabetic ESRD is important for understa...

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