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BACKGROUND: Indigenous people worldwide are disproportionately affected by diabetes and its complications. We aimed to assess the monitoring, treatment and control of blood glucose and lipids in First Nations people in Ontario. METHODS: We conducted a longitudinal population-based study using administrative data for all people in Ontario with diabetes, stratified by First Nations status. We assessed age- and sex-specific rates of completion of recommended monitoring for low-density lipoprotein (LDL) and glycated hemoglobin ([A.sub.1c]) from 2001/02 to 2014/15. We used data from 2014/15 to conduct a cross-sectional analysis of rates of achievement of [A.sub.1c] and LDL targets and use of glucose-lowering medications. RESULTS: The study included 22 240 First Nations people and 1319503 other people in Ontario with diabetes. Rates of monitoring according to guidelines were 20%-50% for [A.sub.1c] and 30%-70% for lipids and were lowest for younger First Nations men. The mean age- and sex-adjusted [A.sub.1c] level was higher among First Nations people than other people (7.59 [95% confidence interval (CI) 7.57 to 7.61] v. 7.03 [95% CI 7.02 to 7.03]). An [A.sub.1c] level of 8.5% or higher was observed in 24.7% (95% CI 23.6 to 25.0) of First Nations people, compared to 12.8% (95% CI 12.1 to 13.5) of other people in Ontario. An LDL level of 2.0 mmol/L or less was observed in 60.3% (95% CI 59.7 to 61.6) of First Nations people, compared to 52.0% (95% CI 51.1 to 52.9) of other people in Ontario. Among those aged 65 or older, a higher proportion of First Nations people than other Ontarians were using insulin (28.1% v. 15.1%), and fewer were taking no medications (28.3% v. 40.1%). INTERPRETATION: As of 2014/15, monitoring and achievement of glycemic control in both First Nations people and other people in Ontario with diabetes remained suboptimal. Interventions to support First Nations patients to reach their treatment goals and reduce the risk of complications need further development and study., Diabetes and its related complications are major contributors to morbidity and mortality worldwide. (1-3) Indigenous populations in Canada and around the world are disproportionately affected by diabetes owing to the [...]

BACKGROUND: Diabetes mellitus is an established health concern in First Nations communities and is associated with complex influences of colonization. This study, a partnership between First Nations and academic researchers, was undertaken to determine patterns of diabetes prevalence, incidence and mortality in Ontario. METHODS: Using health services and population data from Ontario for 1995 to 2014, linked with the federal Indian Register, we calculated age- and sex-adjusted annual estimates of diabetes prevalence, incidence and mortality for First Nations people (living within and outside First Nations communities) and other people in Ontario. We also examined age- and sex-specific crude diabetes prevalence. RESULTS: Between 1995 and 2014, the prevalence of diabetes increased and the incidence decreased somewhat in all populations. Both prevalence and incidence were substantially higher among First Nations people than among other people in Ontario. In particular, First Nations women had higher prevalence than other women (4.2% v. 1.6% for ages 20-34 yr and 17.6% v. 6.0% for ages 35-49 yr). The lifetime risk of diabetes was higher among First Nations people than among other people in Ontario (57.0%, 95% confidence interval [CI] 56.3%-57.6% v. 44.5%, 95% CI 44.4%-44.6%). Over time, all-cause mortality for those with diabetes declined but remained consistently higher for First Nations people than for other people in Ontario. INTERPRETATION: Diabetes is more common among First Nations people than among other people in Ontario, particularly at younger ages and in women. First Nations-led approaches to address the high prevalence of diabetes in younger First Nations women have the potential to improve metabolic health across generations., Diabetes mellitus is an established health concern for First Nations in Canada (1,2) and is associated with other chronic conditions, increased risk of death and higher health care use. (3,4) [...]

Sexuality is an important component of overall health and quality of life, yet evidence suggests many aging adults are not discussing sexual health with their physician. The objective of this study was to understand practices of primary care physicians in discussing sexual health with aging patients. An electronic survey was distributed to primary care physicians and family medicine residents at an urban academic hospital in Ontario, Canada. The survey captured the self-reported prevalence of discussions of sexual health with patients aged 50 and above as well as patient, physician and contextual factors influencing the likelihood of discussion. Descriptive statistics were used to summarize the results. Among the 37 physicians who responded to the survey (response rate of 24%), physicians were more likely to discuss sexual health with patients aged 50–75 years than with patient s >75 years with both males (p < 0.0001) and females (p < 0.0001). Most frequently discussed issues with males were erectile dysfunction and sexually transmitted infection, while atrophic vaginitis, bleeding, and pain during intercourse were most often discussed with females. Factors limiting discussion include lack of time, multiple patient comorbidities and a perceived disinterest in sexual activity. 54% of respondents report having adequate knowledge to discuss and manage later life sexual health issues. Proactively discussing sexuality with aging adults may reveal underlying illness and facilitate future help-seeking behaviours. We suggest that primary care physicians have a responsibility to routinely initiate such discussions in clinical practice.