'Diabetes epidemic in Indigenous populations' highlights disparity

About eight in 10 Indigenous Canadians who are young adults will develop Type 2 diabetes in their lifetimes compared with five in 10 in the general population, a new study suggests.

To make the projection published in Monday's issue of the Canadian Medical Association Journal, researchers in Alberta used data on a population of 2.8 million adults who were free of diabetes in the province and followed their health records for 20 years.

If 20-year-olds are followed for the rest of their lifetimes, the researchers estimated about eight in 10 First Nations people and about five in 10 non-First Nations people will develop diabetes, Tanvir Chowdhury Turin, of the family medicine department at the University of Calgary, and his co-authors said.

"The numbers we find are staggering and concerning," Turin said in an interview.

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The risk was higher among First Nations people for all age groups and for both sexes.

Differences included:

• Rural First Nations people had a higher risk of lifetime Type 2 diabetes compared with urban First Nations people.
• Type 2 diabetes onset was earlier among First Nations people than non-First Nations people.
• Men had a higher lifetime risk of diabetes than women of similar age groups in the non-first Nations group, but women had a higher lifetime risk than men in the First Nations group.

The findings should reset an alarm across Canada, Turin said.

"The problem was always with us. The alarm was on. People started working on it. But somehow the snooze button got pressed," he said, referring to a gradual indifference that set in over time.

The study's authors hope that the estimates will increase public awareness and interest in prevention as well as guide health care planners and decision makers.

"The prevention activities need to be done from a much younger age," Turin suggested.

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Suspected reasons for the differences include genetic susceptibility, dietary changes, adoption of sedentary lifestyles and increasing prevalence of obesity.

"Overall, the First Nations populations in Canada, and similarly other Indigenous groups worldwide, are vulnerable to developing diabetes," the study's authors said.

Little control over diet

"It also appears that inequities in the social, cultural, historical, economic and political determinants of health, lack of access to nutritionally adequate food and barriers to proper health care play major roles in the diabetes epidemic in Indigenous populations."

John LaForme tested positive for Type 2 diabetes while he was living on the streets in Toronto. He has a long family history with it.  

"My reservation, we only have one convenience store," LaForme said. "All our food is either grown or we go to a convenience store where you can buy non-healthy stuff."

As a former client of Anishnawbe Health, LaForme is now focused on eating a more nutritious diet and exercising more.

Lack of access to healthy, affordable food, along with poverty, underpins the disease, said Spenta Mazkoori, a registered dietitian at the clinic. 

"They don't have control over what they eat, because they're in … temporary housing", Mazkoori said. "It might take up to six months for them to have permanent."

The top dietary culprit that comes to her mind is a beverage. Some clients drink up to two litres of pop a day, which she said increases their blood sugar levels dramatically. 

The study was based on data from Alberta Health and Alberta Health Services.