ORIGINAL RESEARCHEnd Stage Renal Disease Among People with Diabetes: A Comparison of First Nations People and Other Saskatchewan Residents from 1981 to 2005
Section snippets
INTRODUCTION
Diabetes mellitus is the most common cause of end-stage renal disease (ESRD) in Canada (1), and the burden of diabetes-related ESRD on indigenous peoples is of particular concern. In 1994, we reported a disproportionate incidence of ESRD among Saskatchewan First Nations people (FN) with diabetes (2), and recent data show that this disparity persists (3). Although the reasons remain unclear, we have suggested 2 possible underlying mechanisms: first, FN with diabetes might be more prone to the
Study populations
This was a University of Saskatchewan Ethics Review Board-approved, population-based study of ESRD among people with diabetes in Saskatchewan from 1980 to 2005. Saskatchewan is a midwestern province with a stable population of approximately 1 million people. About 99% (both FN and OSK) are beneficiaries of a universal healthcare system and recorded in the Ministry of Health's insurance registry (5). They comprised the total annual populations for this study. We subdivided annual provincial
RESULTS
From 1980 to 2005 there were 90 581 incident cases of diabetes in Saskatchewan adults aged ≥ 20 years, in addition to 14 389 people who were prevalent cases of diabetes in 1980 (8). Of those, 1378 subjects with diabetes met the ESRD incident case definition. Since 143 subjects met the ESRD case definition before developing diabetes and since no ESRD incident cases occurred among FN with diabetes in 1980, the final analyses were carried out on 1226 ESRD incident cases from 1981 to 2005 (Table 1).
DISCUSSION
This study compared rates, distribution and outcomes of ESRD between Saskatchewan FN and OSK adults with diabetes from 1981 to 2005. Although ESRD incidence was initially similar between these populations, it rose rapidly among FN during the 1980s to peak at rates 3 to 4 times higher than OSK by the early 1990s. OSK men with diabetes consistently experienced higher ESRD incidence and prevalence than OSK women with diabetes, while FN sex differences were more variable. The most unique finding
DISCLAIMER
This study is based in part on non-identifiable data provided by the Saskatchewan Ministry of Health. The interpretations and conclusions contained herein do not necessarily represent those of the Government of Saskatchewan or the Saskatchewan Ministry of Health.
AUTHOR DISCLOSURES
This study was supported through internal funding.
AUTHOR CONTRIBUTIONS
RD conceived and designed the study; acquired, analyzed and interpreted the data; drafted the original and subsequent manuscript and gave final approval of the version to be published. NO analyzed and interpreted the data, revised the manuscript critically for important intellectual content and gave final approval of the version to be published. THL and AG analyzed the data, revised the manuscript critically for important intellectual content and gave final approval of the version to be
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Cited by (15)
Persistent Albuminuria in Children with Type 2 Diabetes: A Canadian Paediatric Surveillance Program Study
2016, Journal of PediatricsCitation Excerpt :That study also reported a tendency toward diagnosis of ESRD at earlier ages in First Nations children with diabetes.29 This is similar to a study of adults with type 2 diabetes that found a higher incidence of ESRD in First Nations adults.30 Whether this reflects a genetic propensity for the development of diabetic renal disease or reflects other factors (eg, comorbidities, poverty, increased likelihood of exposure to diabetes in pregnancy) is not known.
Optimizing Care for Canadians with Diabetic Nephropathy in 2015
2015, Canadian Journal of DiabetesCitation Excerpt :In Canada, diabetes affects First Nations people disproportionately. The incidence and prevalence of diabetes is more than 4 times higher among First Nations females and approximately 2.5 times higher among First Nations males (7). First Nations people are also more likely to be diagnosed at younger ages than are non-First Nations people, contributing to the rising prevalence of diabetes in young adults and children (7).
The long-term risks of end stage renal disease and mortality among first nations and non-first nations people with youth-onset diabetes
2014, Canadian Journal of DiabetesCitation Excerpt :Although unable to distinguish between type 1 and type 2 diabetes, we showed that diabetes prevalence more than tripled among First Nations youth over the 25-year period while less than doubling among non-First Nations youth. The purpose of this follow-up research was to study the long-term risks of end stage renal disease and death in this cohort with youth-onset diabetes, and to determine whether those adverse outcomes reflect the same ethnicity-based differences as those we have shown in adults (8,9). Young people with diabetes face a more prolonged exposure to the metabolic consequences of this disease than do adults.
Le diabète de type 2 chez les Autochtones
2013, Canadian Journal of DiabetesCitation Excerpt :À l'échelle provinciale, le taux d'instauration d'une dialyse est plus élevé chez les Métis, comparativement aux autres Manitobains (0,46 % vs 0,34 %) (9). Plus positivement, l'incidence de la MRST rapportée chez les autochtones s'est stabilisée depuis le début des années 1990, tant aux États-Unis (46) qu'au Canada (42), ce qui est probablement attribuable à l'arrivée sur le marché des inhibiteurs de l'ECA et à l'application des modèles de soins des maladies chroniques interdisciplinaires (46). La prévalence du syndrome métabolique est élevée chez les adultes (47) et les enfants (48,49) des Premières Nations et, comme pour le diabète de type 2, cette affection est plus fréquente chez les femmes, le taux atteignant 45 % chez les femmes d'origine Oji-Cri.
Type 2 Diabetes in Aboriginal Peoples
2013, Canadian Journal of DiabetesCitation Excerpt :The provincial dialysis initiation rate is higher for Métis than other Manitobans (0.46% vs. 0.34%) (9). On a positive note, ESRD incidence among Aboriginal peoples has stabilized since the early 1990s in both the United States (46) and Canada (42), and is probably due to the introduction of ACE inhibitors and application of interdisciplinary chronic disease care models (46). The prevalence of metabolic syndrome is elevated among both First Nations adults (47) and children (48,49) and, like type 2 diabetes, disproportionately affects females with rates as high as 45% in Oji-Cree women.
Decreased urine albumin:Creatinine ratios in infants of diabetic mothers: Does exposure to diabetic pregnancies alter fetal renal development?
2011, Journal of Developmental Origins of Health and Disease