2008 Clinical Practice Guidelines - Canadian Diabetes Association

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2008 CLINICAL PRACTICE GUIDELINES S190 17. Franks PW, Looker HC, Kobes S, et al. Gestational glucose tolerance and risk of type 2 diabetes in young Pima Indian offspring. Diabetes. 2006;55:460-465. 18. Dean H, Flett B. Natural history of type 2 diabetes diagnosed in childhood: long-term follow-up in young adult years [abstract]. Diabetes. 2002;51(suppl 2):A24. Abstract 99-OR. 19. Dyck RF,Tan L. Differences in high birthweight rates between Northern and Southern Saskatchewan: implications for Aboriginal peoples. Chronic Dis Canada. 1995. Available at: http://www.phac-aspc.gc.ca/publicat/cdic-mcc/16-3/ a_e.html. Accessed September 1, 2008. 20. Whitaker RC,Wright JA, Pepe MS, et al. Predicting obesity in young adulthood from children and parental obesity. N Engl J Med. 1997;337:899-873. 21. Gahagan S, Silverstein J; American Academy of Pediatrics Committee on Native American Child Health. Prevention and treatment of type 2 diabetes mellitus in children, with special emphasis on American Indian and Alaska Native children. Pediatrics. 2003;112:328-347. 22. Perry RC, Shankar RR, Fineberg N, et al. HbA1c measurement improved the detection of type 2 diabetes in high-risk individuals with nondiagnostic levels of fasting plasma glucose. Diabetes Care. 2001;24:465-471. 23. Macaulay AC, Paradis G, Potvin L, et al. The Kahnawake Schools Diabetes Prevention Project: intervention, evaluation, and baseline results of a diabetes primary prevention program with a native community in Canada. Prev Med. 1997;26:779- 790. 24. Macaulay AC, Harris SB, Lévesque L, et al. Primary prevention of type 2 diabetes: a tale of 2 Aboriginal communities in Canada. Can J Diabetes. 2003;27:464-475. 25. Daniel M, Green LW, Marion SA, et al. Effectiveness of community-directed diabetes prevention and control in a rural Aboriginal population in British Columbia, Canada. Soc Sci Med. 1999;48:815-832. 26. Dyck RF, Sheppard MS, Cassidy H, et al. Preventing NIDDM among Aboriginal people: is exercise the answer? Description of a pilot project using exercise to prevent gestational diabetes. Int J Circumpolar Health. 1998;57(suppl 1):375-378. 27. Paradis G, Levesque L, Macaulay AC, et al. Impact of a diabetes prevention program on body size, physical activity, and diet among Kanien'kehá:ka (Mohawk) children 6 to 11 years old: 8-year results from the Kahnawake Schools Diabetes Prevention Project. Pediatrics. 2005;115:333-339. 28. Hakanen M, Langstrom H, Kaitosaari T, et al. Development of overweight in an atherosclerosis prevention trial started in early childhood. The STRIP study. Int J Obes (Lond). 2006;30: 618-626. 29. Ritenbaugh C, Teufel-Shone NI, Aickin MG, et al. A lifestyle intervention improves plasma insulin levels among Native American high school youth. Prev Med. 2003;36:309-319. 30. Young TK, Martens PJ,Taback SP, et al.Type 2 diabetes mellitus in children: prenatal and early infancy risk factors among native Canadians. Arch Pediatr Adolesc Med. 2002;156:651-655. 31. O’Dea K. Marked improvement in carbohydrate and lipid metabolism in diabetic Australian Aborigines after temporary reversion to traditional lifestyle. Diabetes. 1984;33:596-603. 32. Boden G, Sargrad K, Homko C, et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med. 2005;142:403-411. 33. Gannon MC, Nuttall FQ. Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes. 2004;53:2375-2382. 34. Volek JS, Feinman RD. Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond). 2005;2:31. Available at: http://www.nutritionand metabolism.com/content/pdf/1743-7075-2-31.pdf. Accessed September 1, 2008. 35. Arora SK, McFarlane SI.The case for low carbohydrate diets in diabetes management. Nutr Metab (Lond). 2005,2:16. Available at: http://www.nutritionandmetabolism.com/content/pdf/ 1743-7075-2-16.pdf. Accessed September 1, 2008. 36. Sharman MJ, Kraemer WJ, Love DM, et al. A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. J Nutr. 2002;132:1879-1885. 37. Allick G, Bisschop PH, Ackermans MT, et al. A low-carbohydrate/high-fat diet improves glucoregulation in type 2 diabetes mellitus by reducing postabsorptive glycogenolysis. J Clin Endocrinol Metab. 2004,89:6193-6197. 38. Bailie RS, Si D, Robinson GW, et al. A multifaceted healthservice intervention in remote Aboriginal communities: 3year follow-up of the impact on diabetes care. Med J Aust.2004; 181:195-200. 39. Jin AJ, Martin D, Maberley D, et al. Evaluation of a mobile diabetes care telemedicine clinic serving Aboriginal communities in Northern British Columbia, Canada. Int J Circumpolar Health. 2004;63(suppl 2):124-128. 40. Tobe SW, Pylypchuk G, Wentworth J, et al. Effect of nursedirected hypertension treatment among First Nations people with existing hypertension and diabetes mellitus: the Diabetes Risk Evaluation and Microalbuminuria (DREAM 3) randomized controlled trial. CMAJ. 2006;174:1267-1271. 41. Wilson C, Curtis J, Lipke S, et al. Nurse case manager effectiveness and case load in a large clinical practice: implications for workforce development. Diabet Med. 2005;22:1116-1120. 42. Maberley D,Walker H, Koushik A, et al. Screening for diabetic retinopathy in James Bay, Ontario: a cost-effectiveness analysis. CMAJ. 2003;168:160-164. 43. Indian Health Service National Diabetes Program. Special Diabetes Program for Indians. Interim Report to Congress. 2004. Available at: http://www.ihs.gov/MedicalPrograms/ diabetes/resources/r_rtc2004index.asp.Accessed September 1, 2008.
Type 2 Diabetes in High-risk Ethnic Populations Canadian Diabetes Association Clinical Practice Guidelines Expert Committee The initial draft of this chapter was prepared by Elisabeth Harvey RNEC MScN, Stewart B. Harris MD MPH FCFP FACPM and Parmjit Sohal MD PhD CCFP KEY MESSAGES • There is some evidence to support the use of ethnicspecific body mass index and waist circumference cutoffs to improve risk stratification and targeted risk management. • The complex interplay between cultural context and lifestyle supports the use of ethnic-specific communitybased diabetes prevention programs that focus on lifestyle modification. • High-risk ethnic patients develop diabetes complications, particularly cardiovascular disease and renal failure, much earlier than other populations, warranting aggressive management of relevant risk factors, including hypertension and dyslipidemia. INTRODUCTION The increase in immigration to Canada over the last 50 years has created a very ethnically diverse population. The 2006 census enumerated over 6 million foreign-born people in Canada, accounting for 19.8% of the total population, the highest proportion in 75 years (1). Among the foreign-born population who reported a mother tongue other than French or English, most reported Chinese languages (18.6%), followed by Italian (6.6%), Punjabi (5.9%), Spanish (5.8%), German (5.4%),Tagalog (4.8%) and Arabic (4.7%). Recent immigrants born in Asia (including the Middle East) comprise the largest proportion (58.3%) of newcomers to Canada, compared to 12.1% in 1971 (1).Toronto, Montreal and Vancouver are home to 68.9% of recent immigrants. In contrast, only 27.1% of Canada’s total population lives in these 3 cities (1). Ethnic disparities in diabetes prevalence have been well documented in the United Kingdom and the United States where, compared with the general population, individuals of South Asian, Chinese, African and Latin ancestry have higher rates of metabolic syndrome, impaired glucose tolerance (IGT), abdominal (central) obesity, insulin resistance (2-7), type 2 diabetes in childhood (8-10), gestational diabetes mellitus (11), and diagnosed and undiagnosed type 2 diabetes with onset at a younger age (12).Those with type 2 diabetes have poorer metabolic control (13-15) and experience higher rates of microvascular and macrovascular complications, which occur at younger ages than the general population (1,16-19). Individuals of South Asian descent represent Canada’s fastest-growing immigrant population. Of all expa- triate ethnic groups, they have the highest rates of morbidity and mortality from diabetes-related cardiovascular disease (CVD), with 40% higher age-standardized mortality from coronary artery disease than Caucasians (6,19-21). Factors responsible for ethnic disparities in diabetes prevalence are multifactorial and include genetic susceptibility, insulin resistance, inadequate socioeconomic resources, self-care capacity challenges, degree of acculturation, health literacy, psychosocial stressors, differences in treatment response, and barriers to accessing healthcare. Traditional diabetes care systems designed for mainstream populations are often of limited relevance to culturally diverse populations, as these systems emphasize the reduction of behavioural risk factors and benefits of self-care behaviours, but ignore the social, cultural, economic and physical environments in which lifestyle practices are shaped and often constrained.There is growing evidence that diabetes prevention and management strategies that target the social determinants of health, offer group support, provide services of a multidisciplinary team that includes community members with local knowledge and expertise are designed with an affinity to the cultural traditions and socioeconomic realities of the target ethnic group, and are delivered in the language of the individual, are associated with improved clinical outcomes and reduced ethnic disparities (22-30). SCREENING As the relationship between body fat, waist circumference (WC) and disease varies between ethnic groups, there is some evidence to support the use of ethnic-specific body mass index (BMI) (31) and WC (32) cutoffs to improve risk stratification and targeted risk management in different ethnic groups. Asian-specific cutoffs for risk are BMI=22 to 25 kg/m 2 (“at risk”); and BMI ≥26 kg/m 2 (“at higher risk”) (31), and WC ≥80 cm for women or ≥90 cm for men (32). Opportunistic screening by family physicians is ideal but not always accessible to high-risk new immigrant groups. Targeted, ethnic-specific, stepped screening approaches offered in the community, and developed and delivered in partnership with the target communities may refine risk stratification and identification of those who would benefit most from a visit to a family physician (5). In patients in whom a suspicion of prediabetes is high, a 2-hour 75-g oral glucose tolerance test may be considered. 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