Diabetes hits earlier in First Nations, kidney team finds

First Nations adults with diabetes typically younger at diagnosis than non-First Nations counterparts, researchers in Saskatchewan find.

Earlier onset may explain greater risk of end-stage kidney failure

First Nations adults with diabetes are more likely to develop end-stage kidney disease compared with their non-First Nations counterparts, a Saskatchewan study suggests. 
Researchers also reported Monday's issue of the Canadian Medical Association Journal that the average age that diabetes was diagnosed among First Nations adults in Saskatchewan was 47.2 compared with 61.6 for non-First Nations adults, 

Keeping blood sugar at a healthy level is one of the recommendations for slowing progression of chronic kidney disease among people with Type 2 diabetes. (Joerg Sarbach/Associated Press)

Diabetes and high blood pressure are common causes of kidney disease. After years of decline in kidney function, end-stage renal disease can result.  
"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," Dr. Roland Dyck, a professor with the departments of community health and epidemiology, and medicine at the University of Saskatchewan and his co-authors concluded. 
"The implications of our findings are sobering. Among First Nations adults, Type 2 diabetes is increasingly occurring during younger decades of life." 
In the study, people whose diabetes occurred before age 20 and women with gestational diabetes were excluded. 
The researchers analyzed administrative data from the Saskatchewan Ministry of Health over 25 years. Over that time, there were 8,254 First Nations patients diagnosed with diabetes and 82,175 non–First Nations adults diagnosed.  
Dyck's team said they've confirmed age contributes to the elevated risk for diabetes-related end-stage renal disease among First Nations individuals. Other known contributing factors include genetics, blood pressure and blood sugar control and quality of and access to health care. 
In a journal editorial accompanying the study, Dr. Stephen McDonald of the renal unit at Royal Adelaide Hospital in Australia noted excess rates of diabetes have also been documented among indigenous groups in the U.S., Australia and New Zealand. 
Among Australian Aborigines, McDonald said increased rates of chronic kidney disease have been associated with low birth weight.

But the small number of end-stage kidney disease cases among First Nations people in the Saskatchewan study, 200, limits ability to observe effects, McDonald said. 

The study was funded by the Natural Sciences and Engineering Research Council of Canada, the University of Saskatchewan and graduate student support from the Beijing Institute of Technology.


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