Kelli Ralph-Campbell

hIGh RATES OF ThE METABOLIc SYNDROME IN A FIRST NATIONS cOMMUNITY IN WESTERN cANADA: PREVALENcE AND DETERMINANTS IN ADULTS AND chILDREN

Objectives. Increasing type 2 diabetes in Aboriginal communities across North America raisesconcerns about metabolic syndrome in these populations. Some prevalence information for AmericanIndians exists, but little has been available for Canada’s First Nations. Study Design. Wescreened 60 % of the eligible population of a single First Nation in Alberta for diabetes, prediabetes, cardiovascular risk, and metabolic syndrome. Methods. NCEP/ATP III and IDF criteria were used to identify metabolic syndrome in participantsaged ≥ 18; modified NCEP/ATP III criteria were used for participants aged < 18. Logisticregression identified factors associated with the metabolic syndrome. Results. 297 individuals were screened (176 adults, 84 children/adolescents, with complete data).52.3 % of adults had metabolic syndrome using NCEP/ATP III criteria, and 50 % using IDFcriteria. 40.5 % of individuals aged < 18 had the condition. Waist circumference was the mostprevalent correlate. Bivariate analysis suggested that age, BMI, weight, A1c, LDL-C, ADA riskscore and activity pattern were associated with metabolic syndrome. Conclusions. Our data represent the first available for Western Cree and are consistent withprevalence reported for Aboriginal populations in Ontario and Manitoba. High rates of obesity, pre-diabetes and metabolic syndrome for participants aged < 18 raise concerns about future prevalenceof diabetes and cardiovascular disease.

Increasing rates of diabetes and cardiovascular risk in Métis settlements in northern Alberta

Abstract Objectives. To determine the prevalence of diabetes (using secondary data analysis), as well as undiagnosed diabetes and pre-diabetes (using primary research methods) among adult Métis Settlement dwellers in northern Alberta. We also sought to identify cardiovascular risk factors. Study design. Quantitative research study utilizing both population census and community-based diabetes screening data. Methods. Self-reported diabetes was analyzed from the results of the Métis Settlement specific censuses in 1998 and 2006. Mobile clinics travelled into each of the 8 Métis Settlement communities in Alberta recruiting 693 subjects for screening for undiagnosed diabetes, pre-diabetes and metabolic syndrome. Logistic regression analyses (adjusted for age and sex) were used to identify associated factors. Results. According to the censuses, 4,312 Métis individuals were living on Settlements in 1998 and 5,059 in 2006. Self-reported age-adjusted prevalence of diabetes increased significantly from 5.1% in 1998 to 6.9% in 2006 (p<0.01), with a crude prevalence increase of 66% (p<0.01). In 2006, diabetes prevalence was higher among females than males, 7.8% vs. 6.1% respectively (p<0.05). Of the 266 adults screened in the fasting state, 5.3% had undiagnosed diabetes, whereas 20.3% (Canadian Diabetes Association criteria) and 51.9% (American Diabetes Association criteria) had 434 International Journal of Circumpolar Health 68:5 2009 pre-diabetes. Rates of obesity and metabolic syndrome were 49.4% (n=693) and 46.4% (n=266), respectively. Hemoglobin A1c>6.1% was strongly associated with diabetes, pre-diabetes and metabolic syndrome. Conclusions. Our results indicate high rates of diabetes, undiagnosed diabetes, pre-diabetes and metabolic syndrome among adult Alberta Métis Settlement dwellers.

Emerging Longitudinal Trends in Health Indicators for RuralResidents Participating in a Diabetes and Cardiovascular ScreeningProgram in Northern Alberta, Canada

Background. Geographic isolation, poverty, and loss of culture/tradition contribute to “epidemic” rates of diabetes amongst indigenous Canadians. The Mobile Diabetes Screening Initiative travels to rural indigenous and other remote communities in Alberta to screen for diabetes and cardiovascular risk. We sought to examine risk factors longitudinally. Methods. Clinical and anthropometric measurements were undertaken for 809 adults (aged 20–91) between November 2003 and December 2009. For those who had more than one MDSi visit, trend estimates (actual changes) were calculated for body mass index (BMI), weight, waist circumference, hemoglobin A1c (A1c), total cholesterol, and blood pressure. Results. Among those without diabetes (N = 629), BMI and weight increased (P < .01) and blood pressure decreased (P < .05). For those with diabetes (N = 180), significant improvements (P < .05) were observed for all indicators except waist circumference. Conclusion. Improvements observed suggest that MDSis model may effectively mediate some barriers and support subjects in managing their health.

Increasing Incidence and Prevalence of Diabetes Among Status Aboriginal Men in Rural and Urban Alberta 1995 to 2006

Increasing Incidence and Prevalence of Diabetes Among Status Aboriginal Men in Rural and Urban Alberta, 1995 to 2006. JEFFREY A. JOHNSON, STEPHANIE U. VERMEULEN, GREG HUGEL, ELLEN TOTH, BRENDA R. HEMMELGARN, KELLI RALPH-CAMPBELL, MALCOLM KING. School of Public Health, University of Alberta, Edmonton, AB. Institute of Health Economics, Edmonton, AB, Department of Medicine, University of Alberta, Edmonton, AB, Department of Medicine, University of Calgary, Calgary, AB. The increase in diabetes rates among Status Aboriginal (SA) Canadians is well documented. Less is known about the epidemiology of diabetes for this population by location of residence. Trends of diabetes incidence and prevalence between SA men and women living in urban and rural areas of Alberta were compared. The Alberta Diabetes Surveillance System (ADSS) tracks diabetes population trends using diagnostic codes from administrative records from Alberta Health and Wellness (AHW) (1995 to 2006 in adults aged >20 years). Aboriginal Status was identified as registered Indians in the AHW Stakeholder Registry. Location of residence was defined by postal code. Multivariable logistic regression was used to compare prevalence and incidence rates over time, by sex and location of residence. Age-sex adjusted diabetes prevalence increased 35%, from 10.9% (10.4-11.5) in 1995 to 14.7% (14.2-15.2) in 2006 in rural SA and 22%, from 9.4% (8.5-10.3) in 1995 to 11.5% (10.9-12.1) in 2006 among urban SA. The greatest increases were for men, at 40% and 43% compared to 12% and 30% for women (p<0.0001), in urban and rural settings, respectively. SA men with urban residences had the greatest increase in diabetes incidence at 45%, from 7.4 (4.9-10.6) per 1000 in 1995 to 10.7 (8.3-13.5) per 1000 in 2006. Incidence increased 25% for SA women in urban locations, but did not significantly change for women in rural locations (p=0.109). Significant increases in incidence and prevalence of diabetes over the past decade were observed amongst the SA population in Alberta. Prevalence and incidence were highest in SA women, but these rates have increased faster in men over the past decade, regardless of where they lived. ABSTRACT #29