Diabetes rates soar in aboriginal population
Access to healthy foods lacking on reserves, report says
First Nations are bearing the brunt of “an epidemic of the 21st century” with diabetes rates three to five times higher than the rest of the population, says a report from the Canadian Diabetes Association.
Reserves in particular — but also other low-income communities — need better access to affordable, healthy foods, says the report, released Monday in Vancouver. On-reserve diabetes rates hover around 15 per cent, and are as high as 25 per cent in some cases. The disease is showing up more in children, too.
Poor diets high in fat, sugar and refined foods have contributed to 74 per cent of adults and 43 per cent of youth being overweight or obese on some reserves.
The report advocates a return to appropriate traditional foods, particularly in remote areas. Testing and treatment also need to improve to avoid complications such as heart disease, kidney failure and limb amputations that are more prevalent among aboriginal people.
Dr. Evan Adams, chief medical officer with the First Nations Health Authority, agrees diabetes is a “large-scale problem” among B.C. First Nations, noting it needs to be addressed on several fronts.
“There’s no simple solution. Just a few things we need to do are related to food quality and safe places for people to get good physical activity. Also, we need medical intervention because we know that good medical care reduces mortality and complications like amputations and blindness,” Adams said.
He noted diseases like diabetes are common in indigenous groups throughout the world.
“It’s almost certainly related to their living conditions, and we know from the U.S. as well that diabetes is very often connected to rates of poverty.”
However, he said B.C.’s First Nations fare better than their counterparts across Canada.
“Our rates are not as bad as they are nationally. B.C. First Nations are doing particularly well compared to other First Nations. But it’s absolutely still a large-scale problem. The scope of it is enormous.”
There are now 3.3 million Canadians with diabetes, making up 8.9 per cent of the population.
The numbers have continued to climb since the turn of the century, from 1.2 million in 2000 to 2.4 million in 2010.
Rates of Type 1 diabetes — an autoimmune condition that leads to inadequate insulin production in the body — have remained steady. It’s Type 2 diabetes, largely caused by an aging, overweight and inactive population, that’s now responsible for most cases of the disease. Left uncontrolled, both create high blood sugar levels that damage the body from head to toe.
Direct health care costs total about $3 billion a year, the report says, projected to grow by more than 40 per cent in the next decade.
Dr. Jan Hux, chief science officer for the Canadian Diabetes Association, says stigma is an emerging issue surrounding the disease.
Research shows people with and without the disease blame individuals for developing Type 2 diabetes. That shows many people know it is linked to being overweight, inactive and eating unhealthy foods. But not all people with diabetes are overweight, says Hux, and many have a genetic predisposition to it.
Being poor in Canada can also mean not having access to affordable nutritious food.
“Once a person has diabetes, we shouldn’t be blaming them for it because we can’t know for that individual whether it was genetic or whether lifestyle was a contributing factor.
“And we know lifestyle choices aren’t always free choices. A person might live in an unwalkable neighbourhood that’s also a food desert. They have low income and are restricted to shopping at the local minimart where there are no healthy food choices,” Hux says.
Other report highlights:
• People with diabetes are three times more likely to be hospitalized for cardiovascular disease (including heart attack, stroke and narrowing of arteries) than people without diabetes; 12 times more likely to be hospitalized with end-stage renal disease; and more than 20 times more likely to be hospitalized for amputation.
• Thirty-three per cent of people with diabetes say they hesitate to tell others about their diabetes because of stigma or discrimination; 15 per cent of people with diabetes say they’ve experienced discrimination.
• Symptoms of depression are found in up to 30 per cent of people with diabetes.
• People with low incomes find the extra cost of blood sugar tests and medication to be prohibitive: 40 per cent of those earning less than $35,000 per year said they were unable to adhere to their treatment because of cost. Forty-five per cent reported choosing between buying food or paying rent and buying their medications; 18 per cent said they did not fill their prescriptions because of the cost.
• Foot complications from diabetes (which reduces circulation to the feet and can create painful nerve damage) are more common among lowerincome earners. About 28 per cent of those earning less than $50,000 reported poor circulation, compared to 14 per cent of people earning more than $50,000.
The report recommends:
• Preventing diabetes and its complications in aboriginal communities.
• Reducing the stigma related to diabetes.
• Supporting children with diabetes in school.
• Improving diabetes foot care.