boriginal Canadians, including First Nations, Metis and Inuit people, are recognized to be at increased risk for major health problems. 1 The increasing prevalence and incidence of diabetes mellitus among Aboriginal Canadians is well documented, 1-3 with prevalence reaching three to five times higher among Aboriginal Canadians compared to the non-Aboriginal population. [1][2][3] In remote Aboriginal communities, age-adjusted prevalence exceeds 25%, 4 with increases of 45% over a 10-year period. 5 A variety of factors are believed to be contributing to these increased rates, including genetic susceptibility 6-9 and environmental factors associated with rapid socio-cultural changes, including change within urban Aboriginal populations as individuals move to the urban setting. [10][11][12][13] Sex differences in diabetes epidemiology among Aboriginal compared to non-Aboriginals are also well recognized. In the general population, men have higher prevalence and incidence rates of diabetes compared to women, 14,15 with the National Diabetes Surveillance System (NDSS) reporting diabetes prevalence rates of 5.4% and 4.9% for Canadian men and women, respectively. 16 The opposite is true among Aboriginal Canadians. 2,4,17 The reasons for these differences are not known, but may be due to higher rates of obesity among Aboriginal Canadian women, 18 or higher rates of gestational diabetes mellitus, which is associated with an increased risk of subsequent type 2 diabetes in mothers and their offspring. 2,19,20 Lifestyle and location of residence are also important determinants in the development of chronic diseases such as diabetes. [21][22][23] Location is also important in terms of access to care and health outcomes. It has been demonstrated, for example, that individuals living in rural areas have increased treatment gaps and acute complications with their diabetes. [24][25][26] Differences in health care utilization and costs between Aboriginal and non-Aboriginal Canadians have also been described. 27,28 Little is known, however, about

Objectives. Increasing type 2 diabetes in Aboriginal communities across North America raises concerns about metabolic syndrome in these populations. Some prevalence information for American Indians exists, but little has been available for Canada's First Nations. Study Design. We screened 60 % of the eligible population of a single First Nation in Alberta for diabetes, prediabetes, cardiovascular risk, and metabolic syndrome. Methods. NCEP/ATP III and IDF criteria were used to identify metabolic syndrome in participants aged ≥ 18; modified NCEP/ATP III criteria were used for participants aged < 18. Logistic regression identified factors associated with the metabolic syndrome. Results. 297 individuals were screened (176 adults, 84 children/adolescents, with complete data). 52.3 % of adults had metabolic syndrome using NCEP/ATP III criteria, and 50 % using IDF criteria. 40.5 % of individuals aged < 18 had the condition. Waist circumference was the most prevalent correlate. Bivariate analysis suggested that age, BMI, weight, A1c, LDL-C, ADA risk score and activity pattern were associated with metabolic syndrome. Conclusions. Our data represent the first available for Western Cree and are consistent with prevalence reported for Aboriginal populations in Ontario and Manitoba. High rates of obesity, pre-diabetes and metabolic syndrome for participants aged < 18 raise concerns about future prevalence of diabetes and cardiovascular disease.

Objective/Background: Aboriginals constitute a substantial portion of the population of Northern Alberta. Determinants such as poverty and education can compound health-care accessibility barriers experienced by Aboriginals compared to non-Aboriginals. A diabetes care enhancement study involved the collection of baseline and follow-up data on Aboriginal and non-Aboriginal patients with known type 2 diabetes in two rural communities in Northern Alberta. Analyses were conducted to determine any demographic or clinical differences existing between Aboriginals and non-Aboriginals. Methods: 394 diabetes patients were recruited from the Peace and Keeweetinok Lakes health regions. 354 self-reported whether or not they were Aboriginal; a total of 94 selfreported being Aboriginal. Baseline and follow-up data were collected through interviews, standardized physical assessments, laboratory testing and self-reporting questionnaires (RAND-12 and HUI3). Results: Aboriginals were younger, with longer duration of diabetes, more likely to be female, and less likely to have completed high school. At baseline, self-reported health status was uniformly worse, but the differences disappeared with adjustments for sociodemographic confounders, except for perceived mental health status. Aboriginals considered their mental health status to be worse than non-Aboriginals at baseline. Some aspects of health utilization were also different. Discussion: While demographics were different and some utilization differences existed, overall this analysis demonstrates that "Aboriginality" does not contribute to diabetes outcomes when adjusted for appropriate variables. MeSH terms: Aboriginal, North America; type 2 diabetes mellitus; practice guidelines; health status indicators; rural communities La traduction du résumé se trouve à la fin de l'article.

Our results indicate high rates of diabetes, undiagnosed diabetes, pre-diabetes and metabolic syndrome among adult Alberta Métis Settlement dwellers.

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