Diabetes Among North American Aboriginals
An examination
by Chris Hibbard
Diabetes Among North American Aboriginals
According to the most common estimates, the occurrence of Type-2 Diabetes among North America’s Aboriginal Peoples is at least three (up to five) times that of the general population. Two-thirds of Aboriginal people with diabetes are women.
Though much less is known about diabetes among Métis people, results from a 2001 Aboriginal Peoples Survey (the only source of information on the prevalence of diabetes among indigenous Canadian groups) suggest that rates are well above the non-Aboriginal average, at an estimated six per cent.
Interestingly enough, Inuit people are the exception to the pattern. At present, rates of diabetes among Inuit people are still at four per cent, slightly below the national average. With this being said however, there are indications that these rates are rising as well. These rates are similarly reported in numerous studies, but the problem with studying diabetes among specific grouping, is that not everyone with diabetes knows about it or has been diagnosed as having it, and so any existing figures in all likelihood probably underestimate the true prevalence of the disease.
A 1991 Statistics Canada report (admittedly rather outdated not, 15 years later) showed that the prevalence of diabetes among native groups in Canada was then as follows:
8.5% of Indian peoples on reserves and settlements were diagnosed; 5.3% of Indian peoples off reserves; 5.5% of Métis people; and 1.9% of Inuit people. Until the 1940s, diabetes was virtually unknown among Aboriginal peoples. Statistical data over the next few decades is lacking, since few aboriginal groups have been continuously monitored for any length of time. There is some indication however, that the rates have been continuously rising.
A 1983 study of the Sioux Lookout Zone showed a prevalence rate of 2.8%. By 1994, this had risen to 3.8%, with nearly 45% of the cases having been diagnosed in the preceding five years. Given that many complications take 10-20 years to develop, and that diabetes is a relatively new condition for Aboriginal peoples, it is not surprising that there are gaps in the literature about the types, onset and severity of complications faced by Aboriginal peoples in Canada. For chronic illnesses of long duration such as diabetes, the prevalence of them can be expected to increase over time as a function of incidence, survival of people with diabetes, reproduction, and aging of the population. This is why these statistics are likely much higher today, likely double or more. In fact, in Manitoba in 1997, it was estimated that the number of Aboriginal diabetes cases was expected to increase threefold over the next 20 years.
Of these First Nations people who have been diagnosed, approximately two-thirds of them are women. Since diabetes rates vary from province to province and community to community, some areas rates are more than triple the national average. According to a 1991 Aboriginal Peoples of Canada Survey, the rates were lowest in British Columbia and the northern territories and highest in the Ontario-Manitoba-Saskatchewan areas. Why this is I could not determine.
Since diabetes has been found to lead to many other complications, the corresponding rates of cardiovascular disease, high blood pressure, and vision problems increase accordingly. In fact, among Status Aboriginals in Manitoba, almost 60% of hospitalizations for heart disease and approximately half of the hospitalizations for stroke occurred among people with diabetes. In the Kahnawake-Mohawk reserve area alone, half of those with diabetes had significant heart disease leading to heart attacks and coronary bypass surgery. The rates of diabetes-related kidney disease, leading to dialysis, are extremely high as well.
As well, people with diabetes have a 15 times greater risk of requiring lower extremity amputation than those without the disease. It was a sad statistic to read that if individuals at risk are aggressively sought out and treated, up to 50% of amputations can be prevented, but in general, for Native Americans who undergo amputation, the five-year survival rate was only 40%.
Although Type 2 diabetes is referred to as “adult-onset”, in recent years it has been diagnosed in Aboriginal children as young as 5 to 8 years of age in both northern Ontario and Manitoba, and the incidence appears to be increasing at a rapid rate. The number of Aboriginal children with diagnoses of diabetes rose from a mere 20 in 1990 to 51 less than three years later. There was a similar pattern in the Sioux Lookout Zone: in 1994, diabetes was diagnosed in 18 children under the age of 16, and by 1997 it was diagnosed in 52. As with adults, in both these areas, girls with diabetes outnumbered boys by more than five to one.
It is widely accepted among health and science communities that these high proportions of Diabetes are linked to contact with European culture. Diabetes was not known to (nor found in) Aboriginal populations until contact with European culture caused major changes to dietary habits and lifestyles. While different “Aboriginal medicines” are used as treatments from region to region, and healer to elder, the most effective treatment for diabetes is still thought to be universal: an active lifestyle and a diet based on healthy foods.
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