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Diabetes care and health status of First Nations individuals with type 2 diabetes in Alberta

Shainoor Virani, MD FRCPC
Senior Medical Specialist at the Centre for Immunization and Respiratory Infectious Diseases, Clinical Assistant Professor in the Faculty of Medicine and Dentistry at the University of Alberta, and Adjunct Clinical Professor in the Faculty of Medicine at the University of Calgary

David Strong, MD FRCPC
Deputy Medical Officer of Health for the Calgary Health Region, and formerly worked for the First Nations and Inuit Health Branch of Health Canada

Sandra Shade, RN
Director of Home Care for the Blood Tribe Department of Health

Ellen L. Toth, MD FRCPC
Professor in the Division of Endocrinology of the Department of Medicine at the University of Alberta

Correspondence: Mr Richard T. Oster, University of Alberta, Medicine, 362C Heritage Medical Research Centre, Edmonton, AB T6G 2S2; telephone 780 407–8456; e-mailroster{at}ualberta.ca

OBJECTIVE To dcescribe the state of diabetes care among Alberta First Nations individuals with diabetes living on reserves.

DESIGN Survey and screening for diabetes-related complications.

SETTING Forty-three Alberta First Nations communities.

PARTICIPANTS A total of 743 self-referred First Nations individuals with known diabetes.

MAIN OUTCOME MEASURES Clinical measurements (glycated hemoglobin A_1c levels, body mass index, waist circumference, total cholesterol, blood pressure, and the presence of kidney complications or proteinuria, retinopathy, and foot abnormalities), self-reported health services utilization, clinical history, and knowledge of and satisfaction with diabetes services.

RESULTS Female participants tended to be more obese (P < .05) and to have abnormal waist circumferences more often than men (P < .05). Male participants, however, had a higher proportion of proteinuria (P < .05), hypertension (P < .05), limb complications (P < .05), and retinopathy (P < .05). Family physicians were the main diabetes care providers for most participants. Nearly half the participants felt they did not have care from a diabetes team. A total of 38% had never seen dietitians. Diabetes-related concerns were responsible for 24% of all hospitalizations and emergency department visits. Approximately 46% and 21% of participants had recommended hemoglobin A_1c testing and foot examinations, respectively. Only 24% of participants with kidney complications were receiving treatment. A considerable proportion of participants had undiagnosed complications of diabetes: kidney damage or proteinuria (23%), high cholesterol (22%), foot complications (11%), hypertension (9%), and retinopathy (7%).

CONCLUSION Diabetes care is suboptimal in Alberta First Nations communities. Rural physicians caring for First Nations individuals on reserves should be involved, along with other members of diabetes health care teams, in strategies to improve diabetes care. Our results justify the need for community-based screening for diabetes control and complications in First Nation communities.

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				N. Pimlott Caring for aboriginal peoples Can Fam Physician, April 1, 2009; 55(4): 331 - 331. [Full Text] [PDF]

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