1. The National Diabetes Management Strategy: Diabetes Facts and Figures By using these slides, you agree to the terms on the next slide. The development of these slides was made possible through financial support by Merck.

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3. Diabetes is an Aboriginal Problem

4. Diabetes is an Epidemic in Aboriginal Populations The national age-adjusted prevalence is 2.5 to 5 times higher than that of the general population. Age-adjusted prevalence rates as high as 26% have been found in individual communities. Aboriginal peoples are diagnosed with type 2 diabetes at a much younger age, with high rates of diabetes in children and adolescents. Dyck R, et al. CMAJ. 2010; 182(3):249-256. Green C, et al. Diabetes Care. 2003;26:1993–1998. Harris SB, et al. Diabetes Care. 1997;20:185–187. Fagot-Campagna A, et al.. J Pediatr. 2000;136:664–672.

5. Aboriginals are Disproportionately Affected by Diabetes PopulationData sourceAge of surveyed population Prevalence (%) (95% confidence interval) CrudeAge- standardized Non- Aboriginal 2009-10 CCHS 12+ 6.0 (5.8-6.3) 5.0 (4.3-5.7) First Nations (on-reserve) 2008-2010 RHS 18+15.3 (14.2- 61.4) 17.2 (16.5- 19.0) First Nations (off-reserve) 2009-10 CCHS 12+ 8.7 (7.0-10.4) 10.3 (3.4-17.2) Inuit2006 APS15+ 4 (3.3-5.6) NA Métis2009-10 CCHS 12+ 5.8 (4.4-7.3) 7.3 (2.2-12.5) Self-reported diabetes among Aboriginal and First Nations populations is higher than in the non-Aboriginal populations. APS = Aboriginal Peoples Survey; CCHS = Canadian Community Health Survey; RHS = First Nations Regional Longitudinal Health Survey

6. Younger Age of Diagnosis Among First Nations Peoples General population with type 2 diabetes in family practice setting (2003-2003) (1) General population with type 2 diabetes in family practice setting (2005-2006) (2) First Nations population with type 2 diabetes in 19 communities (2007)(3) 54.9 years 55 years43.7 years Compared with the general population of people with type 2 diabetes, First Nations peoples were diagnosed with diabetes on average a decade earlier. 1. Harris S, et al. Diabetes Res Clin Pract. 2005;70(1):90-97. 2. Braga M, et al. Can J Cardiol. 2010;26(6):297-302. 3 Harris SB, et al. Diabetes Res Clin Pract. 2011;92(2):272-279.

7. Higher Rates of Complications in First Nations Peoples With Diabetes ComplicationFirst Nations population with type 2 diabetes in 19 communities (2007) 1) General population with type 2 diabetes in family practice setting (2002- 2003) (2) Age at audit54.962.7 Chronic kidney disease55.16.0 Depression21.114 Neuropathy10.88.0 Retinopathy10.77.0 Diabetic foot disease5.52.0 Number of diabetes-related health visits8.74.3 Compared with the general population with type 2 diabetes, First Nations peoples with diabetes are younger, yet have higher rates of many of the serious complications of diabetes. This higher morbidity is reflected in double the number of diabetes-related health visits in First Nations than in the general population with type 2 diabetes. 1.Harris SB, et al. Diabetes Res Clin Pract. 2011;92(2):272-279. 2.Harris S, et al. Diabetes Res Clin Pract. 2005;70(1):90-97..

8. High Rates of GDM in Aboriginal Women PopulationPrevalence (%) Non-Aboriginal0.5 First Nations4.8 Inuit4.0 Métis2.2 Gestational diabetes mellitus (GDM) is defined as diabetes with onset or first recognition during pregnancy. It is a risk factor for later development of type 2 diabetes in the mother, as well as in the offspring. Garnier R, et al. Statistics Canada Health Analysis Division; Ottawa, ON: 2010. PHAC. Diabetes in Canada: Facts and Figures from a Public Health Perspective. Ottawa, ON: 2011

9. Increased Prevalence of Diabetes in Pregnancy and Adverse Outcomes Liu S, et al. Diabetic Med. 2012: [Epub ahead of print] Compared to non-FN women, FN women on- reserve in Ontario had: –Higher prevalence of diabetes in pregnancy –Less preconception/antenatal care –Less postpartum care –Higher mean birth weight and rate of macrosomia –Higher rates of pre-term delivery, jaundice, neonatal hypoglycemia, shoulder dystocia –Less primary care after birth

10. Aboriginal Population Growth Type 2 diabetes has reached epidemic proportions among Canadian Aboriginal peoples. The national age-adjusted prevalence is 2.5 to 5 times higher than that of the general population, and age-adjusted prevalence rates as high as 26% have been found in individual communities. 1-3 Aboriginal peoples are diagnosed with type 2 diabetes at a much younger age, with high rates of diabetes in children and adolescents. 4 Due primarily to a high birth rate, from 1996 to 2003, the Aboriginal population grew by 45%, nearly 6 times the growth rate of non-Aboriginals. 5 1. Dyck R, et al. CMAJ. 2010; 182(3):249-256. 2. Green C, et al. Diabetes Care. 2003;26:1993–1998. 3. Harris SB, et al. Diabetes Care. 1997;20:185–187. 4. Fagot-Campagna A, et al. J Pediatr. 2000;136:664–672. 5. Statistics Canada. Aboriginal population in 2017.

11. Diabetes Surveillance System for First Nations Communities The First Nations Diabetes Surveillance System is a web-based surveillance application that will track type 2 diabetes and complication rates over time in First Nations communities. This information will allow the monitoring of the diabetes burden in each partnering community and can be used to inform and evaluate new quality improvement initiatives in communities. The goal of the Surveillance System is to monitor and track diabetes rates so that informed decisions can be made to improve community care. First Nations Surveillance System Newsletter. November 2010.

12. Diabetes Surveillance System for First Nations Communities Similar programs in Aboriginal settings in the United States and Australia have been associated with sustained improvements in quality of care for people diagnosed with diabetes. Although this program is currently a 2-year pilot program, it is hoped that in the future the system will be expanded to include other communities, and that ongoing financial support will help sustain the program. The Surveillance System has been generously funded by the Aboriginal Diabetes Initiative, First Nations and Inuit Health Branch at Health Canada. First Nations Surveillance System Newsletter. November 2010.