Saskatchewan aboriginal people are experiencing an epidemic of type 2 diabetes (T2DM) and diabetic end-stage renal disease (DESRD). The purpose of these investigations was to study the role of the intrauterine environment in the emergence of these diseases.
Epidemiologic studies were carried out using data from the Provincial Department of Health databases, the Saskatoon Health Region obstetrical unit, the Saskatchewan Renal Transplant Program, surveys of Saskatchewan aboriginal communities, and the Canadian Organ Replacement Registry. Parameters analyzed included rates, risk factors, and outcomes of T2DM, gestational diabetes (GDM), and DESRD; birth registration information; anthropometric measurements; and human leukocyte antigen profiles.
Aboriginal ethnicity is an independent predictor of GDM. High rates of GDM appear in remote aboriginal communities before the significant appearance of T2DM and are associated with increasing rates of high birth weight. A significant relationship between high-birth-weight rates and T2DM has strengthened over several decades. Finally, higher birth weights and older mother's age (both associated with GDM), and increased frequencies of the human leukocyte antigen-A2/DR4 and A2/DR8 haplotypes are associated with DESRD among aboriginal people.
It is likely that diabetic pregnancies play a key role in the initiation, progression, and perpetuation of the T2DM epidemic among Canadian aboriginal peoples, and may additionally increase the risk for DESRD. We speculate that an ancient survival advantage that promoted caloric conservation in young women and their unborn children is now a risk factor for prepregnancy obesity, GDM, and excess fetal nutrition. Infants are often large and have an increased risk for T2DM and its complications (hefty fetal-type hypothesis).
To determine the rates, causes and outcomes of non-diabetic end-stage renal disease (ESRD) among aboriginal and non-aboriginal people in Saskatchewan.
Retrospective population-based study using data from the Canadian Organ Replacement Register.
All patients with non-diabetic ESRD diagnosed between Jan. 1, 1981, and Dec. 31, 1990.
Age- and sex-specific as well as age-adjusted incidence rates of non-diabetic ESRD among aboriginal and non-aboriginal people in Saskatchewan, causes of non-diabetic ESRD, mortality rates, causes of death and renal transplantation rates.
The 10-year incidence rates of non-diabetic ESRD were higher in all age groups among aboriginal people than among non-aboriginal people. The overall risk ratio for aboriginal people was 2.56. Aboriginal people experienced non-diabetic ESRD at an earlier age and were twice as likely to have a form of glomerulonephritis as a cause. Crude mortality rates, causes of death and transplantation rates were similar in the 2 populations, although we were unable to adjust these for differences in age.
Although diabetes is the most common cause of ESRD among aboriginal people in Saskatchewan, this population also experiences an excessive burden of non-diabetic ESRD, which is largely explained by a higher rate of glomerulonephritis.
To determine the rates and outcomes of diabetic end-stage renal disease (ESRD) among registered native people and non-native people in Saskatchewan.
Retrospective population-based study using data from the Canadian Organ Replacement Registry.
All patients with diabetic ESRD diagnosed between Jan. 1, 1981, and Dec. 31, 1990.
Incidence rates of diabetic ESRD in the general population, rates of diabetic ESRD among patients with diabetes mellitus, nature of initial dialysis treatment, length of survival from start of dialysis, cause of death and renal transplant rates.
The 10-year incidence rates of diabetic ESRD were higher among all age groups among registered native people than among non-native people. The overall relative risk ratio for native people was 16.2. When a higher prevalence of diabetes among native people was taken into account, native diabetic people were still seven times as likely as non-native diabetic people to manifest diabetic ESRD. The median survival from start of dialysis was under 2 years in both groups, but more native people died of stroke and more non-native people died of heart disease. Non-native diabetic people were more likely than native diabetic people to receive renal transplants.
Although the overall incidence of diabetic ESRD in Saskatchewan is increasing, registered native people have a disproportionate risk for this serious complication.
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Intrauterine factors have been implicated in the pathogenesis of Type 2 diabetes mellitus (T2DM).
In a 1:1 matched pairs case-control study, high and low birthweight (HBW, LBW) rates in Saskatchewan Registered Indian (RI) diabetic cases were compared with corresponding rates in RI without diabetes, and non-RI people with and without diabetes.
Birthweights were available for 73% of the 1,366 cases and 3 x 1,366 controls. A greater proportion of RI diabetics were born with HBW (> 4000 grams) compared to RI non-diabetics (16.2% vs 10.7%; p
We investigated the contribution of gestational diabetes mellitus (GDM) to the historic epidemic of type 2 diabetes mellitus (T2DM) in Saskatchewan.
We constructed a population-level simulation model of the inter- and intragenerational interaction of GDM and T2DM for the period 1956 to 2006. The model was stratified by gender, ethnicity, and age; parameterized with primary and secondary data; and calibrated to match historic time series. Risk of diabetes was sigmoidally trended to capture exogenous factors.
Best-fit calibrations suggested GDM may be responsible for 19% to 30% of the cases of T2DM among Saskatchewan First Nations people, but only for approximately 6% of cases among other persons living in Saskatchewan. The estimated contribution of GDM to the growth in T2DM was highly sensitive to assumptions concerning the post-GDM risk of developing T2DM.
GDM may be an important driver for the T2DM epidemic in many subpopulations. Because GDM is a readily identifiable, preventable, and treatable condition, investments in prevention, rapid diagnosis, and evidence-based treatment of GDM in at-risk populations may offer substantial benefit in lowering the T2DM burden over many generations. Model-informed data collection can aid in assessing intervention tradeoffs.
To determine age-specific, sex-specific and total prevalence rates of diabetes mellitus among Saskatchewan First Nations adults and to compare these rates by tribal grouping, geography and with non-First Nations people.
A point prevalence study of all Saskatchewan reserves in 1990.
Age-adjusted rates of diabetes mellitus were higher (risk ratio 1.8) among First Nations adults (9.7%) than among non-First Nations adults (6.1%). These racial differences were greater between women (12.1 vs 6.6%) than men (7.2 vs 5.6%). First Nations diabetes rates were highest among individuals with Saulteaux and Sioux ancestry, and among those living on southern reserves.
The prevalence of diabetes mellitus among Saskatchewan First Nations people has increased from 0% to almost 10% within the adult population since 1934 and has more than doubled from 1980 to 1990. This epidemic manifests itself to a greater extent among women and certain tribal groups, possibly due to differences in exposure to non-traditional lifestyles.
Indigenous peoples worldwide are experiencing elevated rates of type 2 diabetes and its complications. To better understand the disproportionate burden of diabetic end stage renal disease (ESRD) among Canadian First Nations people (FN), we examined prevalence, determinants, and co-morbidities of chronic kidney disease (CKD) within this population.
The 2007 Canadian FN Diabetes Clinical Management and Epidemiologic (CIRCLE) study conducted a cross-sectional national medical chart audit of 885 FN adults with type 2 diabetes to assess quality of diabetes care. In this sub-study, participants were divided by estimated glomerular filtration rate (eGFR in ml/min/1.73 m2), as well as by albuminuria level in those with eGFRs = > 60. Those with eGFRs = > 60 and negative albuminuria were considered to have normal/near normal kidney function (non-CKD). Using univariate and logistic regression analysis, they were compared with participants having eGFRs = > 60 plus albuminuria (CKD-alb) and with participants having eGFRs 60, almost 60% of the latter had CKD-alb. Of the 15.5% of total participants with CKD-eGFR
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