Canadian Diabetes Association Clinical Practice Guidelines Type 2 Diabetes in Aboriginal Peoples...

Canadian Diabetes Association Clinical Practice Guidelines

Type 2 Diabetes in Aboriginal Peoples

Chapter 38

Stewart B. Harris, Onil Bhattacharyya,

Roland Dyck, Mariam Naqshbandi Hayward,

Ellen L. Toth

guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association

Checklist for Aboriginal Populations

SCREEN for diabetes and modifiable risk factors

PREVENT obesity and gestational diabetes as well as T2DM

TAILOR interventions to local cultural and geographic realities while following CPGs

2013


3-5 Times Higher Rates of Diabetes in First Nations than in General Population

• Younger age of diagnosis

• Female preponderance, especially in the reproductive years

• Higher prevalence of micro- and macro-vascular disease


The Cause of DM in Aboriginal Groups is Complex

Genes

Social Stressors Lifestyle


Inequities Caused by Colonization are the Main Risks

• Decreased rates of physical activity• Stress • Dietary acculturation and an unhealthy diet• Food insecurity• Obesity/metabolic syndrome• High rates of diabetes during pregnancy


Screening

• Screening every 1-2 years in adults those with ≥1 risk factors

• Screening 2 years in children age ≥10 years or at puberty, with ≥1 risk factor

• Appropriate dialogue, respect, planning, health education and follow-up


Prevention

• Reducing risk factors, engaging the entire community and being culturally sensitive

• Includes optimal management of diabetes in pregnancy to reduce macrosomia and diabetes risk in offspring


Treatment Strategies Should be Culturally and Locally Appropriate

• Local tradition, language and culture should be considered with clinical practice guidelines

• Remote communities present difficulties with access to care– Expand scope of practice for nurses or allied health– Mobile screening and treatment units– Surveillance systems with diabetes registries


Recommendation 1

1. Starting in early childhood, Aboriginal people

should be evaluated for modifiable risk factors

of diabetes (e.g. obesity, lack of physical activity,

unhealthy eating habits), prediabetes, or metabolic

syndrome [Grade D, Consensus].


Recommendation 2

2. Screening for diabetes in Aboriginal children and

adults should follow guidelines for high-risk

populations (i.e. earlier and at more frequent

intervals depending on presence of additional risk

factors) [Grade D, Consensus].


Recommendation 3

3. Culturally appropriate primary prevention programs for children and adults should be initiated in and by Aboriginal communities with support from the relevant health system(s) and agencies to assess and mitigate the environmental risk factors, such as: [Grade D, Consensus]

• Geographic and cultural barriers

• Food insecurity

• Psychological stress

• Insufficient infrastructure

• Settings that are not conducive to physical activity

2013


Recommendation 4

4. Management of prediabetes and diabetes in

Aboriginal people should follow the same clinical

practice guidelines as those for the general

population with respect for, and sensitivity to,

particular language, cultural, traditional beliefs

and medicines, history and geographic issues

as they relate to diabetes care and education in

Aboriginal communities across Canada. Programs

should adopt a holistic approach to health that

addresses a broad range of stressors shared by

Aboriginal peoples [Grade D, Consensus].

2013


Recommendation 5

5. Aboriginal peoples in Canada should have access in

their communities to a diabetes management

program that would include an interprofessional

nurse-led team, diabetes registries and ongoing

quality assurance and surveillance programs [Grade D, Level 4].

2013


Recommendation 6

6. Aboriginal women should attempt to reach a

healthy body weight prior to conception to

reduce their risk for gestational diabetes [Grade D,

Level 4].

2013


Recommendation 7

7. Programs to detect pre-gestational and gestational

diabetes, provide optimal management of diabetes

in pregnancy and timely post-partum follow-up

should be instituted for all Aboriginal women to

improve perinatal outcomes, manage persistent

maternal dysglycemia, and reduce type 2

diabetes rates in their children [Grade D, Level 4].

2013

CDA Clinical Practice Guidelines

www.guidelines.diabetes.ca – for professionals

1-800-BANTING (226-8464)

www.diabetes.ca – for patients

http://guidelines.diabetes.ca/

http://diabetes.ca/

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