Risk reduction for type 2 diabetes in Aboriginal children in Canada

Question 1

What is the prevalence of type 2 diabetes in the Oji-Cree Nation of northern Manitoba and northwest Ontario?

Answer 1

4.6%

Question 2

What is the prevalence of type 2 diabetes in the Mohawks on the Kahnawake reserve in Quebec?

Answer 2

12% adults 45-60yo

Question 3

What are some causes/risk factors for type 2 diabetes?

Answer 3

1. IDM
2. Obsesity
3. Physical inactivity
4. Increased intake of high-calorie food

Question 4

What are physical signs of insulin resistance and metabolic syndrome?

Answer 4

1. Acanthosis nigricans (hyperpigmentation and thickening of the skin in the neck and axillary regions)
2. PCOS - hirsutism, irregular menses
3. Hypertension
4. Dyslipidemia
5. Steatohepatitis

Question 5

What are some examples of successful community action primary prevention programs?

Answer 5

1. Kahnawake Schools Diabetes Prevention Program (KSDPP) - Mohawk culture is a the core of every intervention with healthy food served at the school, weekly teaching related to health lifestyles and eating, basic concepts of diabetes, and physical activity encouraged and in the curriculum
2. Sandy Lake First Nation School Diabetes Prevention Program - 1. Classroom curriculum, 2. Family outreach 3. Student activities 4. Advocacy for changes in school and store environment

Question 6

What are the screening guidelines for type 2 diabetes?

Answer 6

All of the following:

1. Aboriginal descent
2. BMI >85th percentile expected for age
3. Age >10yo

And any ONE of the following:

1. Sedentary lifstyle
2. Children born to mothers who had GDM
3. First or second degree relative with T2DM
4. Acanthosis nigricans
5. Dyslipidemia
6. Hypertension
7. PCOS

Question 7

What are suggested screening methods?

Answer 7

1. Fasting BG (>7.0 diagnostic)
2. Random BG (>11.1 diagnostic)
3. OGTT w/ fasting and 2h post glucose load BG

Question 8

What are the CPS recommendations?

Answer 8

1. Culturally based and community-run diabetes prevention programs should be established in First Nations communities, with each being unique to the community and run by the community. Our vision is for community groups to take charge and implement these recommendations within their own communities/
2. Traditional values, including traditional diets, activities and lifestyles, should be encouraged in an effort to prevent and/or control type 2 diabetes. Group activities, including those with elders, may be most effective.
3. Breastfeeding is the most natural component of a traditional diet and should be encouraged as a proven method of reducing obesity in children.
4. Daily physical activity for at least 60 min to 90 min, as outlined in Canada’s Physical Activity Guide, is recommended for all children. Activities for endurance, flexibility and strength should be encouraged and one-third of the activity should be of moderate intensity.
5. Schools, daycares and Head Start programs should implement incorporate at least 30 min of high-energy, daily physical activity for all students.
6. Schools, daycares and Head Start programs should incorporate programs that explain the need for healthy active living and healthy eating into their curriculums.
7. Schools should be discouraged from selling candy or other sweets for fundraising purposes.
8. A healthy diet based on Canada’s Food Guide which incorporates traditional diets is the desired nutritional goal. A food guide for northern Aboriginal communities has been developed.
9. All Aboriginal community leaders (including band councils, health care providers, teachers, etc) should provide ample access to safe physical activities within the communities. Examples include, but are not limited to, parks with safe recreation equipment, playfields, seasonal recreational sports leagues, after-school physical activities, nonsports-oriented physical activities, gymnasiums, arenas and safe paths to walk to school. School equipment and gymnasiums should be available after hours for community use.
10. Community members must be active role models for the children.
11. Local stores should be encouraged to stock healthy foods and to place high-caloried ‘junk’ food in less obvious locations in the store (ie, not at the check-out counter).
12. Passive activities such as watching television, playing video games and using the computer should be limited to a maximum of 1.5 h to 2 h per day.
13. Health care providers working with First Nations populations must be aware of the possibility of type 2 diabetes in this special population of children and initiate opportunistic screening for type 2 diabetes