Presentation on theme: "Chapter 38 Stewart B. Harris, Onil Bhattacharyya,"— Presentation transcript:
1 Canadian Diabetes Association Clinical Practice Guidelines Type 2 Diabetes in Aboriginal Peoples Chapter 38Stewart B. Harris, Onil Bhattacharyya,Roland Dyck, Mariam Naqshbandi Hayward,Ellen L. Toth
2 Checklist for Aboriginal Populations 2013SCREEN for diabetes and modifiable risk factorsPREVENT obesity and gestational diabetes as well as T2DMTAILOR interventions to local cultural and geographic realities while following CPGsUse Geetha’s Checks
3 3-5 Times Higher Rates of Diabetes in First Nations than in General Population Younger age of diagnosisFemale preponderance, especially in the reproductive yearsHigher prevalence of micro- and macro-vascular disease
4 The Cause of DM in Aboriginal Groups is Complex GenesSocial StressorsLifestyle
5 Inequities Caused by Colonization are the Main Risks Decreased rates of physical activityStressDietary acculturation and an unhealthy dietFood insecurityObesity/metabolic syndromeHigh rates of diabetes during pregnancy
6 ScreeningScreening every 1-2 years in adults those with ≥1 risk factorsScreening 2 years in children age ≥10 years or at puberty, with ≥1 risk factorAppropriate dialogue, respect, planning, health education and follow-up
7 PreventionReducing risk factors, engaging the entire community and being culturally sensitiveIncludes 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 guidelinesRemote communities present difficulties with access to careExpand scope of practice for nurses or allied healthMobile screening and treatment unitsSurveillance systems with diabetes registries
9 Recommendation 1Starting 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 2Screening 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 32013Culturally 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 barriersFood insecurityPsychological stressInsufficient infrastructureSettings that are not conducive to physical activity
12 Recommendation 42013Management 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 52013Aboriginal 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 62013Aboriginal 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 72013Programs 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 professionals1-800-BANTING ( )– for patients