DIABETES IN INDIGENOUS PEOPLES

Diabetes in Indigenous Peoples

Diabetes in Indigenous Peoples

Introduction

Type 2 diabetes mellitus (DM) and its associated long-term complications are emerging as critical, worldwide public health problems. Although few groups have been spared increases in the burden of these conditions, indigenous populations around the world (defined by the United Nations as distinct, precolonial ethnic/cultural groups with strong attachments to ancestral territories) suffer from remarkably high rates of type 2 DM and related complications and risk factors. his increasing burden of diabetes and associated morbidities among the world's indigenous groups highlights the urgent need for (1) comprehensive, evidence-based programs for the clinical management of type 2 DM in indigenous populations and (2) culturally appropriate, community-based intervention programs focusing on primary prevention (Zimmet. 2001).

At the recent 66th Scientific Sessions of the American Diabetes Association (ADA) in Washington, DC, a joint International Diabetes Federation/ADA symposium addressed the issue of diabetes in indigenous populations, focusing on 3 high-risk groups from different regions of the world: Aboriginal Canadians, Native Americans, and the people of the Torres Straight Islands, which extend from the tip of the Cape York Peninsula of Australia almost to the Papua New Guinea coastline.

Discussion

Although the global pandemic of type 2 DM has left few populations untouched, the degree to which indigenous groups have been affected is remarkable. Stewart Harris, MD, MPH, of the Centre for Studies in Family Medicine, The University of Western Ontario, London, Ontario, Canada, presented data indicating that, among the populations that have the highest reported prevalence rates of type 2 DM and impaired glucose tolerance (IGT), the vast majority are indigenous groups in the Americas or Asia-Pacific region. For example, the prevalence of type 2 DM is 2-3 times higher in Native Americans compared with US adults (Young et al. 2000).

Between 1994 and 2002, the prevalence of clinically diagnosed diabetes increased 33.2% among Native Americans, with increases in all age and sex groups. Similarly, findings from recent national surveys of self-reported diabetes in Canada indicated that the condition is more common in the Aboriginal population than in the general population in all age and sex categories. Studies in the United States and Canada that have assessed diabetes status directly with standardized oral glucose tolerance testing protocols have documented that Native American and Aboriginal Canadian communities experience diabetes prevalence rates that are among the highest in the world.[6-12] Further, these studies have shown that the onset of diabetes in these groups occurs at a much younger age than in most other populations, and that pediatric type 2 DM is emerging as an important health issue. Finally, data from a recent community-based screening program among individuals age 15 years and older from 9 communities in the Torres Strait Islands indicate a diabetes prevalence rate of 26%, which is 6-fold higher than in the general population of Australia on the basis of data from the Australian Diabetes, Obesity and Lifestyle Study (Lee et al. 1995).

Rising Tide of Obesity

The causes of this explosion of diabetes in indigenous populations ...