canadian diabetes association clinical practice guidelines type 2 diabetes in aboriginal peoples...
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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
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
The Cause of DM in Aboriginal Groups is Complex
Genes
Social Stressors Lifestyle
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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].
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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].
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 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
CDA Clinical Practice Guidelines
www.guidelines.diabetes.ca – for professionals
1-800-BANTING (226-8464)
www.diabetes.ca – for patients