Document Sample
					COMMENTARY: TYPE 2 DIABETES EPIDEMIC                                      IN    FIRST NATIONS PEOPLE                  OF    CANADA
Diabetes is a chronic condition that results in                           Bilal B. Ayach, MSc, PhD; Holly Korda, MA, PhD
the body’s inability to either produce or
respond to insulin. Abnormal insulin produc-
tion and sensitivity lead to improper blood
glucose levels and energy storage required for
                                                  PATHOLOGY OF DIABETES                           PREVALENCE OF DIABETES
homeostatic organ maintenance. Over 151
million people worldwide, including 7% of the         Diabetes is a chronic condition that             Type 2 diabetes is the most common
US and 5% of Canadian populations have            results in the body’s inability to either       type of diabetes and exists in all popula-
been diagnosed with diabetes, and the prev-                                                       tions with prevalence varying greatly
                                                  produce or respond to the hormone
alence varies greatly by race and ethnicity.
                                                  insulin. Normally, insulin is produced          across racial and ethnic groups, as low as
However, since the end of World War II, the
people with the greatest risk include First       by ß-cells in the islets of Langerhans in       1% in Japan and as great as 40% in the
Nations people, including Canada’s aboriginal,    the pancreas and is then secreted into          Pima Indian population of Arizona. In
Inuit and Native Indian populations with up to    the circulation in response to high             2000, more than 151 million people with
a 5-fold greater prevalence than the general                                                      diabetes worldwide were reported, and
                                                  blood glucose levels after a meal, and
population. Prevalence can vary from 8% to
                                                  this stimulates the uptake of blood             that number is predicted to reach 324
48% among the sexes and tribes. Understand-
ing the prevalence and causes of this epidemic    sugar into muscle and fat cells for             million in 2025.3 According to a 2005
is immediately needed as diabetes precedes        storage.1 This mechanism ensures that           report (2002 data) by the Centers for
various other endocrine and cardiovascular        there are energy stores available for           Disease Control and Prevention, approx-
diseases. Here we review the current under-                                                       imately 21 million people in the United
                                                  periods of starvation. This adaptation is
standing of diabetes risk in Canada’s First
                                                  considered an evolutionary benefit to           State (7%) were diagnosed with diabetes.4
Nations people in the hope to bring greater
awareness among healthcare professionals and      the human species with specific thrifty         Diabetes continues to be a significant
implementation of measures to prevent spread      genes that help in survival during              health problem in Canada with approx-
of this disease. (Ethn Dis. 2010;20:300–303)      periods without food. 2 When this               imately 4.8% of the population affected
                                                  insulin mechanism is impaired, either           (Health Canada Report).5 Similar to the
Key Words: Type 2 Diabetes, First Nations,
Canada, Aboriginal Health, Inuit, Population      insulin is not being produced in                great increase in risk of diabetes in Pima
Health                                            sufficient levels or is not effectively         Indians, Canada’s First Nations people
                                                  signalling through its receptor, blood          (aboriginal, Inuit and Native Indians)
                                                  sugar levels remain high and lead to the        have also reported a higher prevalence of
                                                  development of diabetes mellitus. There         diabetes, averaging 8% in men and 13%
                                                  are two forms of diabetes mellitus,             in women across Canada, and as high as
                                                  insulin dependent (type 1) and insulin          25% in some areas. When age-adjusted to
                                                  independent (type 2).1 Type 1 diabetes          the Canadian population the prevalence
                                                  is an autoimmune disorder in which the          was 3.6 to 5.3 times higher among First
                                                  body’s own immune system attacks and            Nations men and women when compared
                                                  kills ß-cells in the pancreas leading to a      to the general population.6
                                                  reduction or a complete cessation of                 In one community of the Oji-Cree of
                                                  insulin production. Patients with type 1        Sandy Lake in northwestern Ontario, the
                                                  diabetes can manage their disease with          prevalence of diabetes reached 25%
                                                  daily injections of synthetic insulin.          among all adults and 80% among women
                                                  Type 2 diabetes is more common and              aged 50–64 years.6 Rates among women
                                                  accounts for 90% of cases and is                aged 35 years or older in two Algonquin
                                                  characterized by the body’s resistance          communities in Quebec and the Haidi
                                                  to insulin. Type 2 diabetes normally            Gwaii in British Columbia were between
                                                  occurs in adults and may be attributed          22% and 48% respectively, and 17% of
                                                  to obesity, aging, or alcohol use.              all adults had type 2 diabetes.7,8
     From School of Medicine, St. George’s
University, Grenada (BA); and Altarum             Uncontrolled, diabetes leads to other                Increasingly, type 2 diabetes is also
Institute (HK).                                   serious medical complications such as           being diagnosed in First Nations chil-
                                                  hypertension and cardiovascular diseas-         dren and adolescents, even as young as
     Address correspondence to Holly Korda,       es, retinal and renal damage, or nerve          8 years of age in the Island Lake region
MA, PhD; Altarum Institute; 4 Milk St., 3rd                                                       of northeastern Manitoba, and the
Floor; Portland, Maine 04102; 207-772-
                                                  damage from wounds and ulcers, and a
1410; 207-772-1650 (fax); Holly.Korda@            substantial increase in premature mor-          prevalence among females, aged 10–                                       bidity and mortality.1                          19 years has been reported to be 3.6%.9

300                                                 Ethnicity & Disease, Volume 20, Summer 2010