How To Reduce Type 2 Diabetes Risk In One Abaica First Nations Community By Addressing Diabetes In Pregnancy

Transcription

1 Breaking the Cycle: Reducing Type 2 Diabetes risk in one Alberta First Nations Community by addressing diabetes in pregnancy Presentation to The Lawson Foundation October 16th, 2013 Mr. Randy Littlechild, EMT, Health Director, Maskwacis Dr. Ellen Toth, Principal Investigator, University of Alberta with assistance from Kristin Lee Keith, medical student

2 Hobbema (4 bands) is 1 hour south of Edmonton, Alberta. Brief history Population Housing Health

3 Breaking the Cycle: Reducing Type 2 Diabetes risk in one Alberta First Nations Community by addressing diabetes in pregnancy Background:

4 The epidemic Population growth Case finding Pregnancy: Diabetes begets diabetes Diabetes Behaviours Genetics Environment Modified from Engelgau

5 Developmental trajectory Sensitive phase Genetic devlopment Environmental influences: nutrition etc Epigenetic adaptation: modification of genes resulting in different phenotypes Pregnancy, Maskwacis, 2013

6 Prevalent Diabetes Cases for Status Aboriginals in the Hobbema Community, Number of Cases (Ages >= 1) 600 Hobbema Hobbema

7 Crude Mortality Rates for Status Aboriginals in the Hobbema Community, Rate per 1,000 (Ages >= 1) Hobbema with Diabetes Hobbema without Diabetes

8 Crude Rates of End Stage Renal Disease for Status Aboriginals in the Hobbema Community, Rate per 100,000 (Ages >= 1) 5, , , , , , Hobbema with Diabetes Hobbema without Diabetes 2, , ,

9 Increasing rates of diabetes amongst status Aboriginal youth in Alberta, Canada Richard T. Oster, Jeffrey A. Johnson, Stephanie U. Balko, Larry W. Svenson and Ellen L. Toth Int J Circumpolar Health 2012, 71

10 Breaking the Cycle: Reducing Type 2 Diabetes risk in one Alberta First Nations Community by addressing diabetes in pregnancy Background: Very high rates of diabetes, including diabetes in youth (young women and girls) Relatively high birth rates 2007: Morbidity and mortality review 2010: Home care nursing complaint : Increase in C-sections (infections)?

11 Breaking the Cycle: Reducing Type 2 Diabetes risk in one Alberta First Nations Community by addressing diabetes in pregnancy Investigation: E Toth / AHS / Maskwacis / APNP/AH Results: C-sections lower, not higher Diabetes rates high Risk factors high Stillbirths high No way to confirm infections Late presentation of pregnancy (1 st 21 weeks vs provincial average of 15) and fewer prenatal visits (6 vs provincial average of 10)

12 APNP data Newborn Information Year Total Total Number of births (babies) Number of Liveborn (per 100 live births) Number of Low Birth weight Babies (liveborn <2500g) Low Birth Weight Rate (per 100 live births) 4.6% 4.9% 5.8% 5.8% 8.2% 7.6% 5.4% 7.3% 8.0% 5.6% 7.3% 7.4% 6.5% Provincial Low Birth Weight Rate 6.0% 6.2% 6.2% 6.5% 6.4% 6.5% 6.6% 7.0% 6.6% 6.3% 6.9% 6.8% 6.1% Number of High birth weight Babies (liveborn >4500g) High Birth Weight Rate (per 100 live births) 4.2% 4.5% 5.4% 4.7% 4.3% 4.0% 3.6% 5.4% 6.4% 4.5% 4.1% 3.0% 4.5% Provincial High birth weight rate 2.3% 2.4% 2.3% 2.1% 2.2% 1.7% 1.6% 1.6% 1.8% 1.7% 1.6% 1.6% 1.9% Number of Live born Babies >4000g Birth weight >4000g Rate (Liveborn) 19.8% 20.2% 22.9% 16.4% 18.8% 17.2% 17.3% 16.8% 20.6% 17.5% 15.5% 19.4% 18.5% Provincial Rate babies >4000g (Liveborn) 12.2% 12.6% 12.5% 12.2% 11.9% 18.7% 11.0% 11.0% 10.8% 10.8% 10.2% 10.5% 11.5%

13 Figure 1. Age-adjusted prevalence of diabetes in pregnancy over time by ethnicity in Alberta, GDM prevalence First Nations Non First Nations 7 Rate, % Oster, submitted

14 Figure 1. Age-adjusted prevalence of diabetes in pregnancy over time by ethnicity in Alberta, Pre-gestational diabetes prevalence First Nations Non First Nations Rate per Oster, submitted

15 Breaking the Cycle: Reducing Type 2 Diabetes risk in one Alberta First Nations Community by addressing diabetes in pregnancy Investigation: E Toth / AHS / Maskwacis / APNP Proposal to Lawson Foundation, approved, funding received, project started in 2013 Pilot project (summer student 2011 and 2012) Plans

16 Breaking the Cycle: Reducing Type 2 Diabetes risk in one Alberta First Nations Community by addressing diabetes in pregnancy Pilot project (summer student 2011 and 2012) Case series review of 38 pregnancies from Maskwacis women complicated by diabetes, 2011 to date Care provided by Maskwacis Health Center, including diabetes program + Dr Toth, and neighbouring town(s), as well as referral centers, Edmonton, Red Deer.

17 Breaking the Cycle: Reducing Type 2 Diabetes risk in one Alberta First Nations Community by addressing diabetes in pregnancy Pilot project results Mean maternal age 32 (range 14-41) Mean gravida 4.5 (range 0-13) Diabetes diagnosis clear and simple : 10 /38 GDM: 22 / 38 Overt: 2 / 38 Type 2 pre-gestational: 11 / 38 IGTP: 1 / 38 Normal but previous GDM : 1 / 38 Type 1 pre-gestational: 1 / 38

18 Breaking the Cycle: Reducing Type 2 Diabetes risk in one Alberta First Nations Community by addressing diabetes in pregnancy Pilot project results, outcomes High risk: 38/38 Diabetes control adequate: rare C-sections: > 50% 1 early loss, no stillbirths Baby birth weight: incomplete data Post Partum Status:????

19 Breaking the Cycle: Reducing Type 2 Diabetes risk in one Alberta First Nations Community by addressing diabetes in pregnancy Pilot project results, summary Multiple barriers: cultural, trust, transportation, child care, system, physician and health care professionals, geography Outcomes suboptimal but caution: small select numbers and no comparison group

20 Breaking the Cycle: Reducing Type 2 Diabetes risk in one Alberta First Nations Community by addressing diabetes in pregnancy Next steps: carry out full project Consent women (and babies?) for longitudinal study, use comparison groups from APNP Participatory research in community, raise awareness, increase services in community We will let you know in 2 years time!

21 Questions?