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Background: Diabetes-related end-stage renal disease disproportionately affects indigenous peoples. We explored the role of differential mortality in this disparity. Methods: In this retrospective cohort study, we examined the competing risks of end-stage renal disease and death without end-stage renal disease among Saskatchewan adults with diabetes mellitus, both First Nations and non-First Nations, from 1980 to 2005. Using administrative databases of the Saskatchewan Ministry of Health, we developed Fine and Gray subdistribution hazards models and cumulative incidence functions. Results: Of the 90 429 incident cases of diabetes, 8254 (8.9%) occurred among First Nations adults and 82 175 (90.9%) among non-First Nations adults. Mean age at the time that diabetes was diagnosed was 47.2 and 61.6 years, respectively (p < 0.001). After adjustment for sex and age at the time of diabetes diagnosis, the risk of end-stage renal disease was 2.66 times higher for First Nations than non-First Nations adults (95% confidence interval [CI] 2.24-3.16). Multivariable analysis with adjustment for sex showed a higher risk of death among First Nations adults, which declined with increasing age at the time of diabetes diagnosis. Cumulative incidence function curves stratified by age at the time of diabetes diagnosis showed greatest risk for end-stage renal disease among those with onset of diabetes at younger ages and greatest risk of death among those with onset of diabetes at older ages. Interpretation: Because they are typically younger when diabetes is diagnosed, First Nations adults with this condition are more likely than their non-First Nations counterparts to survive long enough for end-stage renal disease to develop. Differential mortality contributes substantially to ethnicity-based disparities in diabetes-related end-stage renal disease and possibly to chronic diabetes complications. Understanding the mechanisms underlying these disparities is vital in developing more effective prevention and management initiatives., Indigenous peoples experience an excess burden of diabetes-related end-stage renal disease, (1-4) but the reasons for this disparity are incompletely understood. Although the increase in end-stage renal disease among indigenous [...]

Background: First Nations people in Canada experience a disproportionate burden of type 2 diabetes mellitus. To increase our understanding of this evolving epidemic, we compared the epidemiology of diabetes between First Nations and non-First Nations adults in Saskatchewan from 1980 to 2005. Methods: We used administrative databases to perform a population-based study of diabetes frequency, incidence and prevalence in adults by ethnic background, year, age and sex. Results: We identified 8275 First Nations and 82 306 non-First Nations people with diabetes from 1980 to 2005. Overall, the incidence and prevalence of diabetes were more than 4 times higher among First Nations women than among non-First Nations women and more than 2.5 times higher among First Nations men than among non-First Nations men. The number of incident cases of diabetes was highest among First Nations people aged 40-49 ,while the number among non-First Nations people was greatest in those aged 70 or more years. The prevalence of diabetes increased over the study period from 9.5% to 20.3% among First Nations women and from 4.9% to 16.0% among First Nations men. Among non-First Nations people, the prevalence increased from 2.0% to 5.5% among women and from 2.0% to 6.2% among men. By 2005, almost 50% of First Nations women and more than 40% of First Nations men aged 60 or older had diabetes, compared with less than 25% of non-First Nations men and less than 20% of non-First Nations women aged 80 or older. Interpretation: First Nations adults are experiencing a diabetes epidemic that disproportionately affects women during their reproductive years. This ethnicity-based pattern suggests diverse underlying mechanisms that may include differences in the diabetogenic impact of gestational diabetes., The global epidemic of type 2 diabetes mellitus disproportionately affects indigenous and developing populations. (1) Although genotypic variants related to energy balance may underlie this epidemic, (2) the rapid emergence [...]

OBJECTIVE -- To determine possible differences in gestational diabetes mellitus (GDM) between aboriginal and non-aboriginal people in the Saskatoon Health District. RESEARCH DESIGN AND METHODS -- This was a prospective [...]

Because of disparities in incidence of diabetes in pregnancy (DIP) among First Nations (FN) and non-First Nations (non-FN) women in Saskatchewan, we compared predictors and early maternal/child complication rates of gestational diabetes (GDM) and pre-GDM between the 2 populations from 1980 to 2013.

Because of the immediate and long-term consequences of diabetes in pregnancy (DIP) for mother and child, we compared frequencies of gestational diabetes (GDM) and pre-GDM between First Nations (FN) and non-FN people in Saskatchewan from 1980 to 2009.

The barriers to physical activity among adolescent girls grouped according to biological maturity and school grade status are investigated. Results indicate that minutes spen t in moderate to vigorous physical activity daily reduced by 40% between school grades four and 10. Interpersonal barriers are also examined.

OBJECTIVES:To determine among rural-dwelling on-reserve Saskatchewan First Nations people whether racial discrimination is associated with depression, and in turn, if this relationship is moderated by gender.

To determine the risk for diabetes mellitus (DM) among Saskatchewan First Nations (FN) and non-FN women with prior gestational GDM.

To compare the long-term risks of end stage renal disease and death among First Nations and non-First Nations people with youth-onset diabetes.

To study the epidemiology of diabetes among Saskatchewan First Nations and non-First Nations children.

Since First Nations people (FN) with diabetes experience higher rates of end-stage renal disease (ESRD) than others, we aimed to better understand these disparities by comparing the epidemiology of ESRD between FN and other Saskatchewan residents (OSK) with diabetes over a prolonged period.

AIMS: To examine the association of birth-related factors with diabetes risk in offspring.

To estimate the current prevalence of overweight/obesity in a Woodland Cree First Nations community and examine trends over time.

Saskatchewan Aboriginal people are experiencing epidemics of both type 2 diabetes (T2DM) and tuberculosis (TB). The purpose of this study was to determine if a relationship exists between diabetes and TB in Saskatchewan and to establish whether there is a difference in the degree of any association between Aboriginal and non- Aboriginal people. Utilizing Saskatchewan Health databases, TB incidence (cases identified from 1986–2001) was compared between four subpopulations identified from 1991–1995: Registered Indians (RI) with and without diabetes, and other Saskatchewan people (OSKP) with and without diabetes. Diabetic women aged 20–59 years had higher average annual incidence rates of TB than non-diabetic women, but within-population rate ratios of TB in diabetic versus non-diabetic women were only significant in those aged 50–59 (2.7 [CI 1.28, 5.72] in RI and 3.9 [CI 1.58, 9.67] in OSKP). No other within-population diabetic subgroup had significantly higher rates of TB. The only male diabetic group that had a higher rate of TB were RI plus OSKP men aged 50–59 years. Overall, diabetes preceded TB in 87/111 individuals with both diseases (p<0.0001). Our results suggest that T2DM is a predictor for TB in Saskatchewan women aged 20–59 but particularly in RI and OSKP women aged 50–59 years. This has implications for TB screening and prevention initiatives. Les Autochtones de la Saskatchewan sont aux prises avec des épidémies de diabète de type II et de tuberculose. Dans cette étude, nous avons voulu déterminer s’il existe un lien entre le diabète et la tuberculose en Saskatchewan, et s’il y a une différence entre les Autochtones et les non-Autochtones en ce qui a trait au degré d’association éventuel entre ces maladies. À l’aide des bases de données du ministère de la Santé de la Saskatchewan, nous avons comparé la fréquence de la tuberculose (les cas détectés de 1986 à 2001) dans quatre souspopulations définies pour la période de 1991 à 1995: les Indiens inscrits, diabétiques et non diabétiques, et les autres habitants de la Saskatchewan (AHSK), diabétiques et non diabétiques. Chez les femmes diabétiques de 20 à 59 ans, le taux d’incidence annuel moyen de la tuberculose était plus élevé que chez les femmes non diabétiques, mais les ratios des taux de tuberculose entre les femmes diabétiques et non diabétiques dans chaque population n’étaient significatifs que pour les femmes de 50 à 59 ans (IC de 2,7 [1,28 à 5,72] chez les Indiennes inscrites et de 3,9 [1,58 à 9,67] chez les AHSK). Aucun autre sous-groupe de diabétiques à l’intérieur d’une population n’avait de taux sensiblement plus élevés de tuberculose. Le seul groupe d’hommes diabétiques dont le taux de tuberculose était plus élevé se composait d’Indiens inscrits et d’AHSK âgés de 50 à 59 ans. Globalement, le diabète avait précédé la tuberculose chez 87 des 111 sujets ayant les deux maladies (p<0,0001). Nos résultats donnent à penser que le diabète de type II est un prédicteur de la tuberculose chez les femmes de la Saskatchewan de 20 à 59 ans, mais plus particulièrement chez les Indiennes inscrites et les autres habitantes de la Saskatchewan âgées de 50 à 59 ans. Ceci aurait des conséquences pour le dépistage et les mesures de prévention de la tuberculose.

Aims:To determine links between birth related factors and end-stage renal disease (ESRD). Methods:This 1:3 age, sex, and source population (registered Indians [SkRI] and other Saskatchewan people [OSkP]) matched case-control study, compared maternal age and parity, gestational age, low birth weight (LBW), and high birth weight (HBW), between subjects with and without ESRD. Results:Of 1,162 subjects, 277 cases (48 SkRI and 229 OSkP) and 601 controls (112 SkRI and 489 OSkP) had birth weight information. A trend for increased LBW rates occurred among SkRI and OSkP cases compared to controls (10.4 vs. 5.3% and 6.6 vs. 4.3%), and was significant for OSkP female cases (OR 3.66; 95% confidence interval [CI] 1.05, 12.73). Higher HBW rates occurred in SkRI cases (14.6% compared to 11.6% controls; N/S), and 3/5 female SkRI diabetic ESRD (DESRD) cases were over 3,750 g compared to 1/14 controls (p < 0.05). Only maternal age ≧30 years was an independent predictor for ESRD, particularly for OSkP non-DESRD cases (OR 2.45; 95% CI 1.03, 5.8). Cases with older mothers had lower mean birth weights than controls (3,236 vs. 3,434 g; p = 0.005). Conclusions:Older maternal age may predispose offspring to ESRD through mechanisms that differ for DESRD versus non-DESRD, and that may relate to ethnicity.

Aims:To determine the association of HLA with diabetic end-stage renal disease (DESRD) in Saskatchewan aboriginal people. Methods:This was a retrospective study of HLA profiles in four groups of Saskatchewan residents with ESRD diagnosed from 1980 to 1998: aboriginal people with and without DESRD, and non-aboriginal people with and without DESRD. The aboriginal DESRD group was also subdivided into those ≤50 and >50 years of age. Frequencies of individual and combinations of HLA antigens were compared between groups and subgroups. Results:HLA data were available for 634 subjects. Young aboriginal people with DESRD had a higher frequency of HLA-A2 than older AB DESRD subjects (69 vs. 36%; p = 0.03), and of HLA-DR4 and/or DR8 compared to older AB DESRD subjects (91 vs. 68%; p = 0.07) and AB non-DESRD subjects (91 vs. 67%; p = 0.03). Over 65% of young AB DESRD subjects had either an A2/DR4 or A2/DR8 haplotype (odds ratio 5.09 [confidence intervals 1.35, 20.15] versus older AB DESRD subjects; odds ratio 3.32 [confidence intervals 1.20, 9.3] versus AB non-DESRD subjects). Forty percent of young AB DESRD subjects were homozygous for at least one of A2, DR4 or DR8. Conclusions: Our findings suggest that DESRD in young AB subjects with T2DM has a genetic basis related to HLA.

← Objective Over the past decade, clinical studies and clinical practice guidelines have suggested the use of higher small solute clearance targets for patients on peritoneal dialysis (PD). This study asks whether these recommendations have translated into changes in clinical prescription of PD.← Study Design Data were collected annually from 1996 to 1999 on all prevalent dialysis patients in 24 Canadian centers, accounting for approximately 40% of the Canadian chronic dialysis population. Approximately a third of these patients were on PD. Full details of each patient's prescription were recorded, with particular attention to dwell volumes and frequency of exchanges for continuous ambulatory PD (CAPD) and to total treatment volumes and day dwells for automated PD (APD). The most recent Kt/V and creatinine clearance values available were recorded for each patient and the overall results for each year were compared to present treatment recommendations.← Setting 24 university- and community-based hospitals.← Results From 1996 to 1999, the use of APD, relative to CAPD, grew from 14% to 28% of all PD patients. Among CAPD patients, the proportion using dwell volumes greater than 2 L rose from 14% to 32%, and the proportion doing more than 4 dwells per day rose from 16% to 28%. The mean daily volume of prescribed fluid for CAPD patients increased from 8.3 to 9.1 L. As a result, the proportion of patients achieving a weekly Kt/V above 2.0 rose from 54% to 72%, and those receiving a Kt/V less than 1.7 fell from 22% to 10%. For creatinine clearance, those exceeding 60 L per week rose from 63% to 73%. For APD, the mean treatment volume rose from 11.8 L in 1996 to plateau at about 13.4 L in 1998 and 1999. However, the proportion of patients receiving more than 1 day dwell grew from 31% in 1998 to 40% in 1999, and the proportion that were “day dry” fell from 25% to 17%. For APD, the proportion of patients with a Kt/V above 2.0 rose from 67% to 77%, and with a creatinine clearance above 60 L, from 62% to 70%. The proportion with no recent clearance value recorded fell during the course of the study, from 45% to 27%.← Conclusion There was a marked change in PD prescription practices in Canada during the second half of the 1990s. This occurred in response to clinical studies and publication of guidelines. There is room for further improvement, especially with respect to the proportion of patients that did not have regular clearance measurements made.

Background:Intrauterine factors have been implicated in the pathogenesis of Type 2 diabetes mellitus (T2DM). Methods:In a 1:1 matched pairs case-control study, high and low birthweight (HBW, LBW) rates in Saskatchewan Registered Indian (RI) diabetic cases were compared with corresponding rates in RI without diabetes, and non-RI people with and without diabetes. Results:Birthweights were available for 73% of the 1,366 cases and 3 × 1,366 controls. A greater proportion of RI diabetics were born with HBW (>4000 grams) compared to RI non-diabetics (16.2% vs 10.7%; p<0.01). There was a significant association between HBW (but not LBW [<2500 grams]) and diabetes for RI people (OR 1.63 [95% CI 1.20, 2.24]), which was stronger for RI females and strengthened progressively from mid to late 20th century. Interpretation:Certain causes of HBW may predispose to subsequent development of T2DM in Canadian Aboriginal people (“hefty fetal phenotype” [“hefty fetal type”] hypothesis). Programs that optimize healthy pregnancies could reduce T2DM incidence in future generations. Contexte:Des facteurs intra-utérins ont été associés à la pathogénie du diabète sucré de type II (DST2). Méthode:Dans une étude cas-témoin en paires appariées (1:1), nous avons comparé les taux d’insuffisance de poids à la naissance élevés et faibles (IPNÉ, IPNF) dans les cas de diabète chez les Indiens inscrits (Ii) de la Saskatchewan aux taux correspondants chez les Ii non diabétiques et chez les personnes non diabétiques n’étant pas des Ii. Résultats:Nous avons obtenu le poids à la naissance de 73 % des 1 366 cas et de 3 × 1 366 témoins. La proportion d’Ii diabétiques nés avec une IPNÉ (>4 000 g) était supérieure à celle des Ii non diabétiques (16,2 % c. 10,7 %; p<0,01). L’association entre l’IPNÉ (mais non l’IPNF [<2 500 g]) et le diabète était significative chez les Ii (RC 1,63 [95 % IC 1,20, 2,24]) et plus prononcée chez les femmes; la tendance s’est renforcée progressivement entre le milieu et la fin du 20e siècle. Interprétation:Certaines causes d’IPNÉ prédisposent peut-être au développement ultérieur du DST2 chez les Autochtones canadiens (hypothèse du «(phéno)type fœtal prononcé»). Les programmes d’optimisation de la santé durant la grossesse pourraient réduire l’incidence de DST2 pour les générations futures.

Because congenital anomalies of the kidneys and urinary tract (CAKUT) represent a frequent cause of end stage renal disease (ESRD) in the young, we explored the epidemiology of CAKUT and the role of diabetes in pregnancy.

Early-life risk factors, including maternal hyperglycaemia and birthweight, are thought to contribute to the high burden of cardiometabolic disease experienced by Indigenous populations. We examined rates of pre-existing diabetes in pregnancy, gestational diabetes mellitus (GDM) and extremes of birthweight over three decades in the Northern Territory (NT) of Australia.

BackgroundFirst Nations people are experiencing increasing rates of obesity and type 2 diabetes but no anthropometric information exists from before the 1950s to provide context to these epidemics.ObjectiveTo compare anthropometric indices of First Nations children and youth on first entering residential schools with historical and contemporary reference groups.MethodsThis observational cross-sectional study used archival records from the Department of Indian Affairs to calculate body mass index (BMI), height for age (HA) and weight for age (WA) of all known children and youth undergoing physical examinations on first entering residential schools in Saskatchewan and Manitoba from 1919 to 1953. Proportions of children and youth in each BMI category were determined by age, sex, time period and residential school. Z-scores for HA and WA were determined by age group and sex. Finally, median heights and weights were compared with a non-Indigenous cohort from the 1953 Canadian survey.ResultsOn admission to residential schools, 1,767 First Nations children and youth (847 boys, 920 girls) were more likely to have normal BMIs (79.8%) than Canadian children and youth today (66.5%), but lower rates of overweight/obesity (10.9% vs. 32.0%) and higher rates of underweight (9.3% vs. <2.0%). There was an overall trend of diminishing levels of underweight and increasing levels of overweight/obesity over time. Although 6.6% of boys and 7.9% of girls had HA Z-scores >−2, age-specific median heights tended to be higher than Canadian children and youth in 1953. Under 3% of children and youth had WA Z-scores of >−2.ConclusionsA large majority of First Nations children and youth exhibited normal anthropometric indices on first entering residential schools in Manitoba and Saskatchewan from 1919 to 1953. These historical findings provide an important context to the current epidemics of obesity and type 2 diabetes and suggest that the nutritional conditions in these First Nations children's communities were satisfactory during the residential school era.

BACKGROUND: Obstructive sleep apnea (OSA) is a common diagnosis in clinical practice. Excessive daytime sleepiness may be a warning for possible OSA.OBJECTIVES: To assess the prevalence of excessive daytime sleepiness as measured by the Epworth Sleepiness Scale (ESS) in a rural community population; potential risk factors for OSA were also assessed.METHODS: In 2010, a baseline respiratory health questionnaire within the Saskatchewan Rural Health Study was mailed to 11,982 households in Saskatchewan. A total of 7597 adults within the 4624 (42%) respondent households completed the ESS questionnaire. Participants were categorized according to normal or high (>10) ESS scores. Data obtained included respiratory symptoms, doctor-diagnosed sleep apnea, snoring, hypertension, smoking and demographics. Body mass index was calculated. Multivariable logistic regression analysis examined associations between high ESS scores and possible risk factors. Generalized estimating equations accounted for the two-tiered sampling procedure of the study design.RESULTS: The mean age of respondents was 55.0 years and 49.2% were male. The prevalence of ESS>10 and ‘doctor diagnosed’ OSA were 15.9% and 6.0%, respectively. Approximately 23% of respondents reported loud snoring and 30% had a body mass index >30 kg/m2. Of those with ‘doctor-diagnosed’ OSA, 37.7% reported ESS>10 (P<0.0001) and 47.7% reported loud snoring (P<0.0001). Risk of having an ESS>10 score increased with age, male sex, obesity, lower socioeconomic status, marriage, loud snoring and doctor-diagnosed sinus trouble.CONCLUSIONS: High levels of excessive daytime sleepiness in this particular rural population are common and men >55 years of age are at highest risk. Examination of reasons for residual sleepiness and snoring in persons with and without sleep apnea is warranted.