Recent epidemiologic trends of diabetes mellitus among status Aboriginal adults

Oster, Richard T.; Johnson, Jeffrey; Hemmelgarn, Brenda R.; King, M.; Balko, Stephanie U.; Svenson, Larry; Crowshoe, Lindsay; Toth, Ellen L.

doi:10.1503/cmaj.101882

Cited by 47 publications

(50 citation statements)

References 15 publications

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“…This result is consistent with our results and with the increased numbers of young women of child-bearing age with type 2 diabetes that we and others have documented in First Nations populations [6,7]. As with GDM, pre-existing diabetes prevalence is lower among Alberta First Nations (1.0% crude) compared with Ontario First Nations women.…”

Section: Discussionsupporting

confidence: 93%

Diabetes in pregnancy among First Nations women in Alberta, Canada: a retrospective analysis

Oster

King

Morrish

et al. 2014

BMC Pregnancy Childbirth

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BackgroundIn addition to increasing the risk of adverse birth outcomes, diabetes in pregnancy is thought to be an important driver of the epidemic of type 2 diabetes affecting Canada’s First Nations population. The relative contributions of gestational diabetes mellitus (GDM) and pre-existing diabetes are not well understood. We generated a comprehensive epidemiological profile of diabetes in pregnancy over a 10-year period among the First Nations population of Alberta, Canada.MethodsDe-identified administrative data for 427,058 delivery records were obtained for the years 2000–2009. Pregnancy risk factors and delivery outcomes were described and compared by ethnicity (First Nations vs. non-First Nations) and diabetes status. Age-adjusted prevalence values for GDM and pre-existing diabetes were calculated and were compared by ethnicity. Longitudinal changes over time were also examined. Predictors were explored using logistic regression analysis.ResultsFirst Nations women had more antenatal risk factors and adverse infant outcomes that were compounded by diabetes. First Nations descent was an independent predictor of diabetes in pregnancy (p < 0.001). GDM prevalence was significantly higher among First Nations (6.1%) compared to non-First Nations women (3.8%; p < 0.001), but prevalence values increased significantly over time only in non-First Nations women (4.5 average annual percent change; p < 0.05). The prevalence of pre-existing diabetes was stable over time in both groups, but First Nations women experienced a 2.5-fold higher overall prevalence compared with non-First Nations women (1.5% vs. 0.6%, respectively; p < 0.001).ConclusionsAlthough First Nations women experience a higher overall prevalence of diabetes in pregnancy, the lack of increase in the prevalence over time is encouraging. However, because high-risk pregnancies and poor outcomes are more common among First Nations women, particularly those with diabetes, strategies to improve perinatal care must be implemented.

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Section: Discussionsupporting

confidence: 93%

Diabetes in pregnancy among First Nations women in Alberta, Canada: a retrospective analysis

Oster

King

Morrish

et al. 2014

BMC Pregnancy Childbirth

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“…Most particularly, we noted a decline in mortality rates of people with diabetes from 2001 to 2014, which is consistent with results from other studies [18, 22, 23, 26–28, 31]. The 40% decrease in mortality rates observed in our study over 14 years is similar to the 37.2% decrease in mortality witnessed in Ontario between 1996 and 2009 [29].…”

Section: Discussionsupporting

confidence: 92%

Factors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysis

Thibault

Bélanger

LeBlanc

et al. 2016

Diabetol Metab Syndr

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BackgroundThe prevalence of diabetes has increased since the last decade in New Brunswick. Identifying factors contributing to the increase in diabetes prevalence will help inform an action plan to manage the condition. The objective was to describe factors that could explain the increasing prevalence of type 2 diabetes in New Brunswick since 2001.MethodsA critical literature review was conducted to identify factors potentially responsible for an increase in prevalence of diabetes. Data from various sources were obtained to draw a repeated cross-sectional (2001–2014) description of these factors concurrently with changes in the prevalence of type 2 diabetes in New Brunswick. Linear regressions, Poisson regressions and Cochran Armitage analysis were used to describe relationships between these factors and time.ResultsFactors identified in the review were summarized in five categories: individual-level risk factors, environmental risk factors, evolution of the disease, detection effect and global changes. The prevalence of type 2 diabetes has increased by 120% between 2001 and 2014. The prevalence of obesity, hypertension, prediabetes, alcohol consumption, immigration and urbanization increased during the study period and the consumption of fruits and vegetables decreased which could represent potential factors of the increasing prevalence of type 2 diabetes. Physical activity, smoking, socioeconomic status and education did not present trends that could explain the increasing prevalence of type 2 diabetes. During the study period, the mortality rate and the conversion rate from prediabetes to diabetes decreased and the incidence rate increased. Suggestion of a detection effect was also present as the number of people tested increased while the HbA1c and the age at detection decreased. Period and birth cohort effect were also noted through a rise in the prevalence of type 2 diabetes across all age groups, but greater increases were observed among the younger cohorts.ConclusionsThis study presents a comprehensive overview of factors potentially responsible for population level changes in prevalence of type 2 diabetes. Recent increases in type 2 diabetes in New Brunswick may be attributable to a combination of some individual-level and environmental risk factors, the detection effect, the evolution of the disease and global changes.

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“…15 This phenomenon occurs in the formerly perplexing context of higher age-adjusted mortality among First Nations individuals with diabetes. 8,16,17 It also explains our earlier observation that the time from diabetes diagnosis to end-stage renal disease is significantly longer among First Nations individuals, 2 despite evidence for poorer quality of diabetes care 18,19 and a larger proportion of patients with early diabetic nephropathy. 8,20 These findings are notable because they reveal an important mechanism underlying ethnicity-based disparities in endstage renal disease that has serious long-term implications for First Nations and other indigenous populations.…”

Section: Discussionmentioning

confidence: 80%

Differential mortality and the excess burden of end-stage renal disease among First Nations people with diabetes mellitus: a competing-risks analysis

Jiang

Osgood

Lim

et al. 2013

CMAJ

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Recent epidemiologic trends of diabetes mellitus among status Aboriginal adults

Cited by 47 publications

References 15 publications

Diabetes in pregnancy among First Nations women in Alberta, Canada: a retrospective analysis

Diabetes in pregnancy among First Nations women in Alberta, Canada: a retrospective analysis

Factors that could explain the increasing prevalence of type 2 diabetes among adults in a Canadian province: a critical review and analysis

Differential mortality and the excess burden of end-stage renal disease among First Nations people with diabetes mellitus: a competing-risks analysis

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