2007 (Oct) Canadian Diabetes Association Conference, poster presentation by BRAID Research

1. Screening Métis Settlement Clients in Alberta for Undiagnosed Diabetes and Cardiovascular Risk Factors
Ellen L. Toth MD1, Shannon McEwen MSc1, Kelli Ralph-Campbell BA1, Tracy Connor BScN1,
Community Health Council #52, Tri-Settlements Health Council3,
Department of Medicine, University of Alberta1, Aspen Regional Health Authority2, Peace Country Regional Health3
email: mdsi@ualberta.ca
Abstract
Diabetes prevalence and complications are known to be higher in Aboriginal populations, but there
is only one survey reporting the burden of diabetes amongst the Métis in Canada. Rates of
undiagnosed diabetes and pre-diabetes have been studied in a small number of First Nation
communities, and range from 2.5% – 10.7%, and 5% - 19.8%, respectively.
Diabetes and cardiovascular risk factor screening is underway in Alberta’s 8 Métis settlements as
part of the Mobile Diabetes Screening Initiative (MDSi). Baseline data is collected through risk
assessment questionnaires, physical examinations, and laboratory testing using portable diagnostic
equipment.
From November 2003 and February 2005, 624 Métis participants were screened: 518 adults and
106 children (6-17 years old).
Diabetes and cardiovascular risk factors are very high in a volunteer sample of Alberta’s Métis
peoples, consistent with population based screening data in one Alberta First Nation (Kaler,
personal communication).
Introduction
•Cardiovascular disease, Type 2 diabetes, and obesity are highly prevalent
in Aboriginal peoples
•Type 2 diabetes is often accompanied or preceded by the metabolic
syndrome
•MDSi’s mandate is to screen for diabetes and its complications in off-
reserve Aboriginal and remote communities in Northern Alberta
Methods
•Portable technology is used with a rigorous Quality Assurance protocol
•Clients are recruited by a community member on each of the eight Métis
settlements in Alberta, Canada
•Procedures: Family history, ADA risk questionnaire, anthropometrics,
medications, fasting or random glucose, A1c, lipids, urine and other
measurements are collected
•Analyses: cardiovascular risk and diabetes risk are calculated
Results
Ethics
As MDSi works with Aboriginal Peoples, special attention is required and will
be paid to ownership, control, access, and possession (OCAP) of data that
belongs to the people. This research is approached as a partnership with the
participating communities, the regional health authorities, Alberta Health and
Wellness, and the University of Alberta.
Benefits
Data is collected in the communities using a mobile team and portable
technology so multiple trips are not required to an urban centre for testing.
Conclusion
These results show that a high number of Alberta Métis screened are at a high
risk for developing diabetes or have undiagnosed diabetes. The people who
have been screened are also at high risk for cardiovascular disease. Baseline
results reveal that the Métis children screened are at high risk for developing
diabetes. MDSi continues to complete repeat visits (approx. every 6 months)
with these Métis communities to assist in further screening, intervention and
education. We are working with the communities to support further
intervention, prevention, and health promotion activities.
FBG=Fasting Blood Glucose; BP=Blood Pressure; TG=Fasting Triglycerides;
HDL=High Density Lipoprotein; Waist=Waist Circumference
ACADRE
Diabetes
Research
Group
Criteria
Adults
(N=518)
(% abnormal)
Children^
(N=106)
(% abnormal)
Undiagnosed diabetes
(FPG ≥7.0)
4% 5%
Pre diabetes
(FPG* 5.6-6.9)
50% 13%
BMI (overweight) 32% 10%
BMI (obese) 50% 50%
Elevated Total Cholesterol 36% 27%
Elevated Blood Pressure 46% 33%
Metabolic syndrome
(ATP III criteria)
50% 51%
The results of the first year of screening of Métis Adults and Children
without previously diagnosed diabetes showed a high prevalence of pre-
diabetes.
^ MDSi defines children as anyone 6-17 years of age; * FPG denotes Fasting Plasma Glucose
* >85 Percentile denotes a child is overweight
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