Complications of Type 2 Diabetes Among Aboriginal Canadians

Abstract

Prevalence and associated risk factors Anthony J.G. Hanley, PHD12, Stewart B. Harris, MD3, Mary Mamakeesick, RPN4, Ken Goodwin4, Edith Fiddler4, Robert A. Hegele, MD5, J. David Spence, MD5, Andrew A. House, MD6, Ed Brown, MD7, Blair Schoales, MD8, John R. McLaughlin, PHD9, Ronald Klein, MD10 and Bernard Zinman, MD1291Leadership Sinai Centre for Diabetes, Mt. Sinai Hospital, Toronto, Ontario, Canada2Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada3Centre for Studies in Family Medicine, University of Western Ontario, London, Ontario, Canada4Sandy Lake Health and Diabetes Project, Sandy Lake, Ontario, Canada5Robarts Research Institute, London, Ontario, Canada6Department of Medicine, University of Western Ontario, London, Ontario, Canada7Northern Ontario Remote Telecommunication Health (NORTH) Network, Toronto, Ontario, Canada8Department of Surgery, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada9Samuel Lunenfeld Research Institute, Mt. Sinai Hospital, Toronto, Ontario, Canada10Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, WisconsinAddress correspondence and reprint requests to Anthony Hanley, PhD, Leadership Sinai Centre for Diabetes, Lebovic Building, Room 5-210, Mt. Sinai Hospital, 600 University Ave., Toronto, Ontario, M5G 1X5, Canada. E-mail: hanley{at}mshri.on.caIMT, intimal-media thicknessNPDR, nonproliferative diabetic retinopathyPDR, proliferative diabetic retinopathyDespite a dramatically increasing burden of type 2 diabetes in Aboriginal Canadian communities (1–5), relatively little information is available regarding the prevalence of, and risk factors for, the complications of type 2 diabetes in this population (6). Although previous studies have documented micro- and macrovascular disease in Aboriginal Canadians with diabetes, the majority of these reports have relied heavily on hospital records, chart reviews, and disease registries (6). These approaches may underestimate the magnitude of the complications burden because only those with the severest disease are included, and standardized methods are infrequently used to document complications. The objective of the present research project was to systematically determine, using validated methods, the prevalence of micro- and macrovascular complications among Aboriginal Canadians who have type 2 diabetes and to identify risk factors that are associated with these conditions. RESEARCH DESIGN AND METHODS The Sandy Lake Diabetes Complications Study has been presented in detail previously (6). Briefly, all community members known to have type 2 diabetes were invited to participate; 189 of 250 (76%) eligible subjects were enrolled, although the sample size varies given time-limited access to certain equipment. Participants were older than nonparticipants and more likely to be male but did not differ in diabetes treatment. Signed informed consent was obtained from all participants, and the study was approved by the Sandy Lake First Nation Band Council and the Mount Sinai Hospital Ethics Review Committee. We used validated measures to assess retinopathy, neuropathy, nephropathy, and cardiovascular disease risk factors, as described previously (6). Digital fundus photography was performed using a nonmydriatic retinal camera, with …