Characterizing risk of type 2 diabetes in First Nations people living in First Nations communities in Ontario: a population-based analysis using cross-sectional survey data

External validation and application of the Diabetes Population Risk Tool (DPoRT) for prediction of type 2 diabetes onset in the US population

INTRODUCTION

Characterizing diabetes risk in the population is important for population health assessment and diabetes prevention planning. We aimed to externally validate an existing 10-year population risk model for type 2 diabetes in the USA and model the population benefit of diabetes prevention approaches using population survey data.

RESEARCH DESIGN AND METHODS

The Diabetes Population Risk Tool (DPoRT), originally derived and validated in Canada, was applied to an external validation cohort of 23 477 adults from the 2009 National Health Interview Survey (NHIS). We assessed predictive performance for discrimination (C-statistic) and calibration plots against observed incident diabetes cases identified from the NHIS 2009-2018 cycles. We applied DPoRT to the 2018 NHIS cohort (n=21 187) to generate 10-year risk prediction estimates and characterize the preventive benefit of three diabetes prevention scenarios: (1) community-wide strategy; (2) high-risk strategy and (3) combined approach.

RESULTS

DPoRT demonstrated good discrimination (C-statistic=0.778 (males); 0.787 (females)) and good calibration across the range of risk. We predicted a baseline risk of 10.2% and 21 076 000 new cases of diabetes in the USA from 2018 to 2028. The community-wide strategy and high-risk strategy estimated diabetes risk reductions of 0.2% and 0.3%, respectively. The combined approach estimated a 0.4% risk reduction and 843 000 diabetes cases averted in 10 years.

CONCLUSIONS

DPoRT has transportability for predicting population-level diabetes risk in the USA using routinely collected survey data. We demonstrate the model's applicability for population health assessment and diabetes prevention planning. Our modeling predicted that the combination of community-wide and targeted prevention approaches for those at highest risk are needed to reduce diabetes burden in the USA.

Diabetic foot complications among Indigenous peoples in Canada: a scoping review through the PROGRESS-PLUS equity lens

Introduction

Indigenous peoples in Canada face a disproportionate burden of diabetes-related foot complications (DRFC), such as foot ulcers, lower extremity amputations (LEA), and peripheral arterial disease. This scoping review aimed to provide a comprehensive understanding of DRFC among First Nations, Métis, and Inuit peoples in Canada, incorporating an equity lens.

Methods

A scoping review was conducted based on Arksey and O'Malley refined by the Joanna Briggs Institute. The PROGRESS-Plus framework was utilized to extract data and incorporate an equity lens. A critical appraisal was performed, and Indigenous stakeholders were consulted for feedback. We identified the incorporation of patient-oriented/centered research (POR).

Results

Of 5,323 records identified, 40 studies were included in the review. The majority of studies focused on First Nations (92%), while representation of the Inuit population was very limited populations (< 3% of studies). LEA was the most studied outcome (76%). Age, gender, ethnicity, and place of residence were the most commonly included variables. Patient-oriented/centered research was mainly included in recent studies (16%). The overall quality of the studies was average. Data synthesis showed a high burden of DRFC among Indigenous populations compared to non-Indigenous populations. Indigenous identity and rural/remote communities were associated with the worse outcomes, particularly major LEA.

Discussion

This study provides a comprehensive understanding of DRFC in Indigenous peoples in Canada of published studies in database. It not only incorporates an equity lens and patient-oriented/centered research but also demonstrates that we need to change our approach. More data is needed to fully understand the burden of DRFC among Indigenous peoples, particularly in the Northern region in Canada where no data are previously available. Western research methods are insufficient to understand the unique situation of Indigenous peoples and it is essential to promote culturally safe and quality healthcare.

Conclusion

Efforts have been made to manage DRFC, but continued attention and support are necessary to address this population's needs and ensure equitable prevention, access and care that embraces their ways of knowing, being and acting.

Systematic review registration

Open Science Framework https://osf.io/j9pu7, identifier j9pu7.

The Growing Epidemic of Diabetes Among the Indigenous Population of Canada: A Systematic Review

Diabetes is one of the most well-known and well-researched non-communicable diseases known to humankind. The goal of this article is to show that the prevalence of diabetes is constantly increasing among indigenous people, a major population subgroup in Canada. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct this systematic review, and the databases used were PubMed and Google Scholar. Studies that were published in the last 15 years (2007-2022) were selected for this review, and after applying the inclusion and exclusion criteria, screening, and removing duplicates, 10 articles were selected for the final review - three qualitative studies, three observational studies, and four studies without a specified methodology. We used the JBI (Joanna Briggs Institute) checklist, NOS (Newcastle-Ottawa Scale) checklist, and SANRA (Scale for the Assessment of Narrative Review) checklist for quality assessment. We found that all the articles showed that the prevalence of diabetes is increasing in all the Aboriginal communities despite all the interventional programs already in place. Rigorous health plans, health education, and wellness clinics for primary prevention can all be effective in reducing the potential risks of diabetes. More studies exploring the prevalence, effects, and outcomes of diabetes in the indigenous population of Canada are needed to effectively understand the disease and its complications in this group.

Associations of health status and diabetes among First Nations Peoples living on-reserve in Canada

OBJECTIVE

Our objective is to describe self-reported health status, prevalence of diabetes and obesity and their associations in participants from the First Nations Food, Nutrition and Environment Study (FNFNES) in order to identify possible correlates of health in First Nations adults.

METHODS

FNFNES is a participatory study with First Nations Peoples living on reserve lands south of the 60th parallel. Health and diabetes were self-reported, and prevalence of obesity was evaluated. Socio-demographic and lifestyle factors and traditional food (TF) activities were investigated for associations with health parameters.

RESULTS

High prevalence rates of overweight/obesity (78-91%) and diabetes (19% age-standardized prevalence) were found. Smoking rates were high and physical activity was low. In multivariable analyses, obesity was associated with region, income source, age, gender, smoking and self-reported health; diabetes and lesser self-reported health were associated with obesity and lower education. Diabetes was strongly associated with lesser self-reported health and weakly associated with being a smoker.

CONCLUSION

We have identified possible correlates of health in this population that can help to better understand the underlying concerns and identify solutions for First Nations and their partners. We urge governments and First Nations to address the systemic problems identified with a holistic ecosystem approach that takes into consideration the financial and physical access to food, particularly TF, and the facilitation of improved health behaviour. New mechanisms co-developed with First Nations leadership should focus on supporting sustainable, culturally safe and healthy lifestyles and closing the gaps in nutrition and food insecurity.