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Making it work - addressing program implementation challenges in Indigenous communities
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CANADIAN JOURNAL OF DIABETES
D-0662
D-0664
Is gestational diabetes a good predictor of abnormal glucose metabolism among canadian aborigines?
Making it work - addressing program implementation challenges in Indigenous communities
M.L. Chateau-Degat1, E. Dewailly1, S. Déry2, D. Pereg1, G.M. Egeland3, E. Nieboer4, Y. Bonnier-Viger5, A. Ferland1, S.J. Weisnagel6, J. Robitaille7 1 Laval University, Public Health Research Unit - CHUQ, Québec, Canada 2 Direction régionale de santé publique du Nunavik, Kuujjuak, Canada 3 McGill University, School of Dietetics and Human Nutrition, Ste AnneBellevue, Canada 4 Mc Master University, Hamilton, Canada 5 Cree Board of Health and Social Services of James Bay, Chisasibi, Canada 6 Laval University, Diabetes Research Unit, Québec, Canada 7 Laval University, Department of Food Science and Nutrition and Institute of Nutraceuticals and Functional Foods (INAF), Québec, Canada
S. Lynch1, R. Carriere1, J. Ramsay1, P.T. McGowan1, T. Cayer1, M.V. Davies1, K. Hannah1 1 University of Victoria, Centre on Aging, Delta, Canada
Type 2 diabetes (T2D) reaches epidemic proportions in many of Canadian’s First Nations and Indian Cree populations. Nevertheless, Inuit from Nunavik show a low prevalence of T2D. Gestational diabetes (GDM) has been proposed as a predictor of T2D in various populations, particularly among Cree from James Bay region. Moreover, GDM is highly prevalent among Indian Cree population; yet, the impacts of GDM on T2D among Canadian’s First Nations population are poorly investigated. aims: To identify the impact of a history of GDM on the suboptimal glucose metabolism among Canadian First Nations women. Methods: Study participants were recruited during two different health surveys conducted between 2004-2008 in the Nunavik and James Bay regions (Québec, Canada). Participants included in the current analysis comprised 419 Inuit and 176 Cree adult women (18-74 years) who previously gave birth. History of GDM and T2D was obtained from medical records for each participant. Women with either T2D or impaired fasting glucose (obtained from blood fasting glucose measurements at the time of recruitment) were classified as having a postpartum suboptimal glucose metabolism. Comparisons between the two ethnic groups were performed by ANCOVA and the influence of GDM on suboptimal glucose was determined by logistic regression analyses. results: Among all participants, 6.5% had a history of GDM; this proportion was not statistically different between ethnic groups (Inuit: 6.7% vs. Cree: 5.9% ; p=0.73). Women with prior GDM showed higher plasma total-cholesterol, LDL-cholesterol and triglycerides concentrations (p<0.05). The prevalence of a suboptimal glucose metabolism amongparticipants was 13.2% and this proportion was significantly higher among Cree(30.1% vs. 7.1%, p<0.0001). Cree women also showed a metabolic profile that is more deteriorated, as they show higher waist circumference (110 vs. 91 cm, p<0.0001), higher plasma triglycerides levels (1.5 vs. 1.0 mmol/L,p<0.0001), lower plasma HDL-cholesterol levels (1.3 vs. 1.8 mmol/L, p<0.0001) and higher systolic blood pressure (120vs. 114 mmHg, p<0.0001) compared to Inuit women. Adjusted logistic regression revealed that a GDM history predicted significantly the likelihood of having a suboptimal glucose metabolism (OR: 3.9 [1.5-9.8]). This association was markedly seen among Inuit women (OR: 7.7 [2.6-22.2]). conclusion: Among Canadian Cree and Inuit women, GDM history is associated with a suboptimal glucose metabolism as previously shown in other populations at risk. Moreover, our results suggest that among a population such as the Cree, showing a high prevalence of T2D and associated metabolic diseases GDM history has less impact on suboptimal glucose metabolism. Indigenous communities and ethnicity issues No conflict of interest
aims: While there is evidence demonstrating the effectiveness of diabetes self-management programs in Indigenous populations, there are also implementation challenges, notably: remote locations with small populations, cultural and ethnic diversity, and complex issues of poverty. The aim of this research was to identify and understand these specific challenges, and develop strategies for successful implementation of community self-management programs. Methods: Between 2005 and 2009 a team from University of Victoria conducted four sequential studies examining this challenge in First Nations communities in British Columbia, Canada. Using qualitative methodology, the 2005 study elicited perspectives on program processes and materials, training, and implementation processes from community leaders. The 2006 study focused on the use of information and skills in the communities following program implementation, and ways to make the materials more culturally appropriate. The focus for the 2007 study was to examine the effectiveness of various support strategies to enhance program implementation. Lastly, the 2008 study addressed issues of program sustainability. results: Following program implementation, participants reported using the information and skills in a variety of ways. They learned skills of action planning and goal setting which could be used beyond the management of diabetes and other chronic conditions. Participants provided suggestions relating to program format and content, acceptability of training community members as Leaders, and language and cultural considerations. An Aboriginal Liaison Coordinator was hired with a focus on building relationships with communities and volunteer leaders. The findings led to modifications in training materials, including the addition of artwork and colours in the manuals and charts, resource examples from First Nations communities, and the development of a First Nations brochure and poster. To ensure sustainability, participants identified the need to provide adequate funding for transportation, rooms and promotion. conclusion: Self-management programs for persons living with diabetes in First Nations communities can be delivered in a culturally acceptable way. Indigenous communities and ethnicity issues No conflict of interest D-0665 role of ox-LDL immunocomplexes in diabetic retinopathy M. Wu1, Y. Chen1, S.A. Abdel-samie2, K. Wilson1, M.E. Boulton3, J.X. Ma1, G. Virella2, M.F. Lopes-Virella2, T.J. Lyons1 1 University of Oklahoma Health Sciences Center, Medicine, Oklahoma City, USA 2 Medical University of South Carolina, Medicine/Endocrinology, Charleston, USA 3 University of Florida, Anatomy and Cell Biology, Gainesville, USA Extravasated and oxidized low-density lipoprotein (LDL) have been identified in the retina in diabetes, and implicated in diabetic retinopathy (DR) in our recent cell culture and immunohistochemical studies. Oxidized LDL may be immunogenic, resulting in the formation of ox-LDL immunocomplexes (LDL-IC) containing IgG/M – and such complexes have recently been implicated in atherogenesis. In the current study, we investigated whether LDL-IC are associated with the initiation and progression of DR. Immunostaining of ox-LDL and IgG/M was performed in retinal sections from four different groups of human subjects: non-diabetic; (Type 2) diabetic without clinical retinopathy; diabetic with moderate non-proliferative diabetic retinopathy (NPDR);
CANADIAN JOURNAL OF DIABETES
D-0662
D-0664
Is gestational diabetes a good predictor of abnormal glucose metabolism among canadian aborigines?
Making it work - addressing program implementation challenges in Indigenous communities
M.L. Chateau-Degat1, E. Dewailly1, S. Déry2, D. Pereg1, G.M. Egeland3, E. Nieboer4, Y. Bonnier-Viger5, A. Ferland1, S.J. Weisnagel6, J. Robitaille7 1 Laval University, Public Health Research Unit - CHUQ, Québec, Canada 2 Direction régionale de santé publique du Nunavik, Kuujjuak, Canada 3 McGill University, School of Dietetics and Human Nutrition, Ste AnneBellevue, Canada 4 Mc Master University, Hamilton, Canada 5 Cree Board of Health and Social Services of James Bay, Chisasibi, Canada 6 Laval University, Diabetes Research Unit, Québec, Canada 7 Laval University, Department of Food Science and Nutrition and Institute of Nutraceuticals and Functional Foods (INAF), Québec, Canada
S. Lynch1, R. Carriere1, J. Ramsay1, P.T. McGowan1, T. Cayer1, M.V. Davies1, K. Hannah1 1 University of Victoria, Centre on Aging, Delta, Canada
Type 2 diabetes (T2D) reaches epidemic proportions in many of Canadian’s First Nations and Indian Cree populations. Nevertheless, Inuit from Nunavik show a low prevalence of T2D. Gestational diabetes (GDM) has been proposed as a predictor of T2D in various populations, particularly among Cree from James Bay region. Moreover, GDM is highly prevalent among Indian Cree population; yet, the impacts of GDM on T2D among Canadian’s First Nations population are poorly investigated. aims: To identify the impact of a history of GDM on the suboptimal glucose metabolism among Canadian First Nations women. Methods: Study participants were recruited during two different health surveys conducted between 2004-2008 in the Nunavik and James Bay regions (Québec, Canada). Participants included in the current analysis comprised 419 Inuit and 176 Cree adult women (18-74 years) who previously gave birth. History of GDM and T2D was obtained from medical records for each participant. Women with either T2D or impaired fasting glucose (obtained from blood fasting glucose measurements at the time of recruitment) were classified as having a postpartum suboptimal glucose metabolism. Comparisons between the two ethnic groups were performed by ANCOVA and the influence of GDM on suboptimal glucose was determined by logistic regression analyses. results: Among all participants, 6.5% had a history of GDM; this proportion was not statistically different between ethnic groups (Inuit: 6.7% vs. Cree: 5.9% ; p=0.73). Women with prior GDM showed higher plasma total-cholesterol, LDL-cholesterol and triglycerides concentrations (p<0.05). The prevalence of a suboptimal glucose metabolism amongparticipants was 13.2% and this proportion was significantly higher among Cree(30.1% vs. 7.1%, p<0.0001). Cree women also showed a metabolic profile that is more deteriorated, as they show higher waist circumference (110 vs. 91 cm, p<0.0001), higher plasma triglycerides levels (1.5 vs. 1.0 mmol/L,p<0.0001), lower plasma HDL-cholesterol levels (1.3 vs. 1.8 mmol/L, p<0.0001) and higher systolic blood pressure (120vs. 114 mmHg, p<0.0001) compared to Inuit women. Adjusted logistic regression revealed that a GDM history predicted significantly the likelihood of having a suboptimal glucose metabolism (OR: 3.9 [1.5-9.8]). This association was markedly seen among Inuit women (OR: 7.7 [2.6-22.2]). conclusion: Among Canadian Cree and Inuit women, GDM history is associated with a suboptimal glucose metabolism as previously shown in other populations at risk. Moreover, our results suggest that among a population such as the Cree, showing a high prevalence of T2D and associated metabolic diseases GDM history has less impact on suboptimal glucose metabolism. Indigenous communities and ethnicity issues No conflict of interest
aims: While there is evidence demonstrating the effectiveness of diabetes self-management programs in Indigenous populations, there are also implementation challenges, notably: remote locations with small populations, cultural and ethnic diversity, and complex issues of poverty. The aim of this research was to identify and understand these specific challenges, and develop strategies for successful implementation of community self-management programs. Methods: Between 2005 and 2009 a team from University of Victoria conducted four sequential studies examining this challenge in First Nations communities in British Columbia, Canada. Using qualitative methodology, the 2005 study elicited perspectives on program processes and materials, training, and implementation processes from community leaders. The 2006 study focused on the use of information and skills in the communities following program implementation, and ways to make the materials more culturally appropriate. The focus for the 2007 study was to examine the effectiveness of various support strategies to enhance program implementation. Lastly, the 2008 study addressed issues of program sustainability. results: Following program implementation, participants reported using the information and skills in a variety of ways. They learned skills of action planning and goal setting which could be used beyond the management of diabetes and other chronic conditions. Participants provided suggestions relating to program format and content, acceptability of training community members as Leaders, and language and cultural considerations. An Aboriginal Liaison Coordinator was hired with a focus on building relationships with communities and volunteer leaders. The findings led to modifications in training materials, including the addition of artwork and colours in the manuals and charts, resource examples from First Nations communities, and the development of a First Nations brochure and poster. To ensure sustainability, participants identified the need to provide adequate funding for transportation, rooms and promotion. conclusion: Self-management programs for persons living with diabetes in First Nations communities can be delivered in a culturally acceptable way. Indigenous communities and ethnicity issues No conflict of interest D-0665 role of ox-LDL immunocomplexes in diabetic retinopathy M. Wu1, Y. Chen1, S.A. Abdel-samie2, K. Wilson1, M.E. Boulton3, J.X. Ma1, G. Virella2, M.F. Lopes-Virella2, T.J. Lyons1 1 University of Oklahoma Health Sciences Center, Medicine, Oklahoma City, USA 2 Medical University of South Carolina, Medicine/Endocrinology, Charleston, USA 3 University of Florida, Anatomy and Cell Biology, Gainesville, USA Extravasated and oxidized low-density lipoprotein (LDL) have been identified in the retina in diabetes, and implicated in diabetic retinopathy (DR) in our recent cell culture and immunohistochemical studies. Oxidized LDL may be immunogenic, resulting in the formation of ox-LDL immunocomplexes (LDL-IC) containing IgG/M – and such complexes have recently been implicated in atherogenesis. In the current study, we investigated whether LDL-IC are associated with the initiation and progression of DR. Immunostaining of ox-LDL and IgG/M was performed in retinal sections from four different groups of human subjects: non-diabetic; (Type 2) diabetic without clinical retinopathy; diabetic with moderate non-proliferative diabetic retinopathy (NPDR);