1. Canadian Diabetes Association Clinical Practice Guidelines Type 2 Diabetes in Aboriginal Peoples
Chapter 38
Stewart B. Harris, Onil Bhattacharyya,
Roland Dyck, Mariam Naqshbandi Hayward,
Ellen L. Toth

2. Checklist for Aboriginal Populations
2013
SCREEN for diabetes and modifiable risk factors
PREVENT obesity and gestational diabetes as well as T2DM
TAILOR interventions to local cultural and geographic realities while following CPGs
Use Geetha’s Checks

3. 3-5 Times Higher Rates of Diabetes in First Nations than in General Population
Younger age of diagnosis
Female preponderance, especially in the reproductive years
Higher prevalence of micro- and macro-vascular disease

4. The Cause of DM in Aboriginal Groups is Complex
Genes
Social Stressors
Lifestyle

5. Inequities Caused by Colonization are the Main Risks
Decreased rates of physical activity
Stress
Dietary acculturation and an unhealthy diet
Food insecurity
Obesity/metabolic syndrome
High rates of diabetes during pregnancy

6. Screening
Screening every 1-2 years in adults those with ≥1 risk factors
Screening 2 years in children age ≥10 years or at puberty, with ≥1 risk factor
Appropriate dialogue, respect, planning, health education and follow-up

7. Prevention
Reducing risk factors, engaging the entire community and being culturally sensitive
Includes optimal management of diabetes in pregnancy to reduce macrosomia and diabetes risk in offspring

8. Treatment Strategies Should be Culturally and Locally Appropriate
Local tradition, language and culture should be considered with clinical practice guidelines
Remote communities present difficulties with access to care
Expand scope of practice for nurses or allied health
Mobile screening and treatment units
Surveillance systems with diabetes registries

9. Recommendation 1
Starting in early childhood, Aboriginal people should be evaluated for modifiable risk factors of diabetes (e.g. obesity, lack of physical activity, unhealthy eating habits), prediabetes, or metabolic syndrome [Grade D, Consensus].

10. Recommendation 2
Screening for diabetes in Aboriginal children and adults should follow guidelines for high-risk populations (i.e. earlier and at more frequent intervals depending on presence of additional risk factors) [Grade D, Consensus].

11. Recommendation 3
2013
Culturally appropriate primary prevention programs for children and adults should be initiated in and by Aboriginal communities with support from the relevant health system(s) and agencies to assess and mitigate the environmental risk factors, such as: [Grade D, Consensus]
Geographic and cultural barriers
Food insecurity
Psychological stress
Insufficient infrastructure
Settings that are not conducive to physical activity

12. Recommendation 4
2013
Management of prediabetes and diabetes in Aboriginal people should follow the same clinical practice guidelines as those for the general population with respect for, and sensitivity to, particular language, cultural, traditional beliefs and medicines, history and  geographic issues as they relate to diabetes care and education in Aboriginal communities across Canada. Programs should adopt a holistic approach to health that addresses a broad range of stressors shared by Aboriginal peoples [Grade D, Consensus].

13. Recommendation 5
2013
Aboriginal peoples in Canada should have access in their communities to a diabetes management program that would include an interprofessional nurse-led team, diabetes registries and ongoing quality assurance and surveillance programs [Grade D, Level 4].

14. Recommendation 6
2013
Aboriginal women should attempt to reach a healthy body weight prior to conception to reduce their risk for gestational diabetes [Grade D, Level 4].

15. Recommendation 7
2013
Programs to detect pre-gestational and gestational diabetes, provide optimal management of diabetes in pregnancy and timely post-partum follow-up should be instituted for all Aboriginal women to improve perinatal outcomes, manage persistent maternal dysglycemia, and reduce type 2 diabetes rates in their children [Grade D, Level 4].

16. CDA Clinical Practice Guidelines
– for professionals
1-800-BANTING ( )
– for patients