Diabetes conference offers dire forecast

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Fear about the spread of diabetes in Canadian Aboriginal communities and hope for their prevention were served up in equal measure by participants at the Fourth International Conference on Diabetes and Indigenous Peoples held Oct. 8 to 11 in San Diego.

Medical experts from Manitoba sounded the alarm about the number of Aboriginal adults with diabetes, which in that province is expected to triple by the year 2016. They stressed the disease is also starting to appear in children as young as six years old.

Type 2 diabetes - non-insulin dependent diabetes - is showing up in First Nations children in Ontario, Manitoba, and Saskatchewan at an increasing rate, and health experts are not equipped to address the problem, said Dr. Heather Dean of the Children's Hospital in Winnipeg. The disease had traditionally been thought to affect only adults, she said, and the new development has physicians and health care workers baffled as to how to treat it.

"Most physicians are disbelievers. It's important to help them understand this exists," she said, adding she saw her first child patient with Type 2 diabetes in 1983. Since then provincial health records show 58 cases have been detected in children under 14 in Manitoba. The number of new cases has risen from one or two per year to 11 in 1996, she said.

Type 1 diabetes patients display dramatic symptoms which are treatable by insulin injection, Dean said, while Type 2 cases go undetected or are often misdiagnosed by physicians. The error can lead to blindness, amputations, kidney failure and heart disease in young adulthood.

Bertha Flett, a First Nations registered nurse from Manitoba, described the experience of her daughter, who was misdiagnosed with Type 1 diabetes in 1981 at the age of eight. In 1995 at the age of 22, the woman went blind and developed end-stage renal disease (kidney failure).

"She always says, 'now I'm in dialysis, I'm going to die,'" Flett said. Flett is now working with Native children in Manitoba to try to develop better prevention and treatment strategies.

Another report, presented by Winnipeg epidemiologist Chris Green, estimated that the number of Native people with diabetes in Manitoba will triple to 20,000 from 6,700 by the year 2016, or from 16 to 27 per cent. A similar study cannot be conducted in other provinces, Green said, because most provincial patient records do not designate whether a patient is First Nations or non-First Nations.

The conference, which included 600 delegates from Canada, the United State, Australia and New Zealand, featured solutions ranging from successful community-based programs like Canada's Kahnawake Schools Prevention Project, to medical intervention programs such as the American Indian Health Service's staged management system, an American nationally-standardized care program. Canadian presentations dominated the conference agenda, occupying two full days of plenary sessions.

A presentation by representatives of Ontario's Sandy Lake First Nation focused on that community's efforts to stop the spread of the disease. Sandy Lake First Nation Deputy Chief Harry Meekis described how his community initiated a diabetes study which found Sandy Lake to have a diabetes rate of 26 per cent - the third highest rate in the world.

"The fact that Sandy Lake holds a record, of sorts, as having the third highest prevalence of diabetes in the world is more a tragedy than a source of prestige," Meekis told more than 250 delegates. "It is imperative that we salvage the next generation from the ravages that are plaguing this generation. The preventable nature of this complex combination of physical and social calamity demands action."

Meekis stressed the importance of prevention measures such as a change toward lower-fat, lower-sugar diets and more active lifestyles, in order to decrease the impact of the disease on both older and younger generations.

"The most cost-effective approach to addressing the issue of declining health f a population would be to fund changes in lifestyle through early counselling and support," he said. "Treatment facilities alone are not sufficient to address the complex problem."

The prevention stage of the project is now underway, Meekis said, after having received funding in July. It will include a Grade 4 education program as well as an adult education program.

In a keynote address, Brenda Thomas of the Assembly of First Nations emphasized that only a combined effort by all members of Canadian Native communities would stop the spread of the disease to younger generations.

"As First Nations people, we have a responsibility to ourselves, our loved ones and our children now and in future generations, to help each other in our journey to wellness," she said. "We can do this by informing and educating each other, sharing information, healing strategies, and re-gaining the traditional knowledge of our forefathers."