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Canadian Diabetes Association Clinical Practice Guidelines Type 2 Diabetes in Aboriginal Peoples Chapter 38 Stewart B. Harris, Onil Bhattacharyya, Roland.

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Presentation on theme: "Canadian Diabetes Association Clinical Practice Guidelines Type 2 Diabetes in Aboriginal Peoples Chapter 38 Stewart B. Harris, Onil Bhattacharyya, Roland."— Presentation transcript:

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 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Checklist for Aboriginal Populations 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 2013

3 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association 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 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association The Cause of DM in Aboriginal Groups is Complex Genes Social Stressors Lifestyle

5 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association 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 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association 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 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association 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 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association 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 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 1 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 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 2 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 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 3 3.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 2013

12 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 4 4.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]. 2013

13 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 5 5.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]. 2013

14 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 6 6.Aboriginal women should attempt to reach a healthy body weight prior to conception to reduce their risk for gestational diabetes [Grade D, Level 4]. 2013

15 guidelines.diabetes.ca | BANTING ( ) | diabetes.ca Copyright © 2013 Canadian Diabetes Association Recommendation 7 7.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]. 2013

16 CDA Clinical Practice Guidelines – for professionals BANTING ( ) – for patients


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