Trends in cardiovascular care and event rates among First Nations and other people with diabetes in Ontario, Canada, 1996–2015

Chu, Anna; Han, Lina; Roifman, Idan; Lee, Douglas S.; Green, Michael E.; Jacklin, Kristen; Walker, Jennifer; Sutherland, Roseanne; Khan, Shahriar; Frymire, Eliot; Tu, Jack V.; Shah, Baiju R.

doi:10.1503/cmaj.190899

Cited by 14 publications

(23 citation statements)

References 35 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We reported on the use of lipid-lowering agents, which is similar for First Nations people and other people in Ontario, in another paper. 8…”

Section: Resultsmentioning

confidence: 99%

“…Because the OLIS data were acquired at ICES during the present study, we were unable to perform any longitudinal analysis of the links between the levels of glycemic control we observed and the high rates of complications reported in our other papers. [8][9][10][11][12] However, it is highly likely that HbA 1c level sare an important driver of the observed differences in outcomes, given the well-known strong association between glycemic control and complications of diabetes. Leiter and colleagues 47 highlighted the difficulties in achieving glycemic control in their recent report combining results from the Diabetes Mellitus Assessment of Clinical Management in Ontario (DM-ACTION) and Diabetes Mellitus Improving Patient Care in Our Communities (DM-IMPACT) studies.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Green¹,

Shah²,

Slater³

et al. 2020

CMAJ

Self Cite

View full text Add to dashboard Cite

D iabetes and its related complications are major contributors to morbidity and mortality worldwide. 1-3 Indigenous populations in Canada and around the world are disproportionately affected by diabetes owing to the complex relations among colonization, social disadvantage, stress, trauma and metabolic health. 4-7 In addition to our own work showing persistently higher rates of peripheral vascular disease, stroke, cardiac disease, renal dysfunction and ophthalmologic complications in Ontario First Nations, 8-12 other Canadian and international studies also showed higher complication rates in diverse Indigenous populations. 6,7,13-15 Glycemic control is fundamental to the management of diabetes and the prevention of complications. 16 Glycated hemoglobin (A 1c) is a reliable way to estimate the average level of glucose in the blood. 17 Since A 1c levels higher than 7.0% have been associated with an increased risk of microvascular complications, 18-20 treatment guidelines suggest A 1c should be measured every 3-6 months to ensure that glycemic goals are being met or maintained. 21 Since people with diabetes also have an elevated risk for cardiovascular disease, 22-24 management and control of cardiovascular risk factors, particularly lipids such as low-density lipoprotein (LDL) cholesterol, are also important. 25-27 Guidelines further recommend that a full lipid profile be measured every 1-3 years, depending on cardiovascular risk, and suggest that LDL be consistently less than 2.0 mmol/L. 28 Control of A 1c and lipids has been shown to be associated with reduced morbidity and mortality in patients with diabetes. 18,29-32 One possible reason for the high burden of complications among Indigenous people with diabetes may be failure to achieve control of these 2 key clinical parameters. We examined differences between Status First Nations people with diabetes in Ontario and all other Ontario residents with diabetes in rates of monitoring of A 1c and lipids, achievement of targets for A 1c and LDL outlined in clinical guidelines, and patterns of medication use to help attain these targets.

show abstract

“…We reported on the use of lipid-lowering agents, which is similar for First Nations people and other people in Ontario, in another paper. 8…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Green¹,

Shah²,

Slater³

et al. 2020

CMAJ

Self Cite

View full text Add to dashboard Cite

show abstract

“…They will be used to estimate the annual prevalence and incidence of diabetes, as well as describe measures of disease control, use of health care services and rates of complications of diabetes. 30,32…”

Section: Study Cohortmentioning

confidence: 99%

First Nations people with diabetes in Ontario: methods for a longitudinal population-based cohort study

Slater

Green

Shah

et al. 2019

cmajo

Self Cite

View full text Add to dashboard Cite

“…8 A recent study documented a decline in incident cardiac events among FN peoples with type 2 diabetes mellitus (T2DM) in Ontario, but rates continued to be significantly higher than those in non-FN individuals. 6 …”

mentioning

confidence: 99%

“…Data on the extent of CVD risk-factor management and use of cardioprotective medications in Indigenous peoples in Canada with T2DM are scarce. 6 , 18 The present analyses report modifiable risk-factor control in primary and secondary prevention of CVD, and prescription of cardioprotective medications for secondary prevention in a cross-section of FN peoples living on reserves across Canada.…”

mentioning

confidence: 99%

Primary and Secondary Cardiovascular Prevention Among First Nations Peoples With Type 2 Diabetes in Canada: Findings From the FORGE AHEAD Program

et al. 2020

View full text Add to dashboard Cite

Background First Nations (FN) peoples in Canada face spiraling rates of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Data on the extent of CVD risk-factor management in FN peoples with T2DM in Canada are scarce. Methods A T2DM registry with data from 7 FN communities in Canada was utilized to identify individuals eligible for primary and secondary CVD prevention. Proportions of individuals meeting clinical practice guideline–specified targets (hemoglobin A1c ≤7.0%; blood pressure ≤130/80 mm Hg; low-density lipoprotein ≤2 mmol/L) were calculated. Prescription of recommended cardioprotective medications (antithrombotic medication, lipid-lowering agents, renin-angiotensin-aldosterone system inhibitors, and beta-blockers) among those with CVD was assessed. χ 2 tests were employed to evaluate differences between CVD prevention groups and sexes. Results Of the 2098 individuals in the registry, 18% had documented CVD (female: male = 1.12). Overall, <10% met all 3 clinical practice guideline targets. Attainment of hemoglobin A1c and blood pressure targets was comparable between primary and secondary CVD prevention groups, with<50% achieving targets. A greater proportion of the secondary prevention group met low-density lipoprotein targets compared to those without CVD (61.6% vs 40.9%, P < 0.01). In the secondary prevention group, beta-blockers were prescribed to only 20%, and <60% were prescribed antithrombotics, lipid-lowering medications, or agents targeting the renin-angiotensin-aldosterone system; <2% were prescribed medications from all 4 classes of cardioprotective medications. Conclusions Primary and secondary CVD prevention recommendations for individuals with T2DM are not being met for an alarmingly high proportion of FN peoples. These findings serve as an urgent call for proactive measures to reduce CVD events and related mortality in this high-risk population.

show abstract

Trends in cardiovascular care and event rates among First Nations and other people with diabetes in Ontario, Canada, 1996–2015

Cited by 14 publications

References 35 publications

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

Monitoring, treatment and control of blood glucose and lipids in Ontario First Nations people with diabetes

First Nations people with diabetes in Ontario: methods for a longitudinal population-based cohort study

Primary and Secondary Cardiovascular Prevention Among First Nations Peoples With Type 2 Diabetes in Canada: Findings From the FORGE AHEAD Program

Contact Info

Product

Resources

About