Program teams with community to address diabetes 'epidemic'

By Paul Mayne

"It's an epidemic." There's really no other way Stewart Harris can describe the overwhelming prevalence of diabetes among Canada's First Nation's communities.

"I've spent the better part of two decades working with First Nation's communities to gain a better understanding of how big this epidemic is, why is it happening, why is it particularly affecting them, and is there anything we can do about it," said the Schulich School of Medicine & Dentistry professor. "And the epidemic is continuing to grow."

Diabetes occurs in First Nation's communities almost five times that of the general population. Diagnoses occur, on average, 15 years earlier than the general population, with upwards of 25 to 40 per cent of First Nation adults diagnosed. More First Nation women than men have diabetes, opposite the general population.

Change, Harris said, is needed now.

"It's clear their metabolism, and hence their genetic makeup, predisposes them to diabetes," said Harris, the Canadian Diabetes Association Chair in Diabetes Management. "We get diseases on the basis of two things, our genes and our environment, or a combination of both, and 40 years ago, there was no diabetes in their communities, so in the course or one to two generations this epidemic has emerged."

And nowhere is this more prevalent than during the reproductive years of First Nation's women. When weight is gained during pregnancy, Harris said, this, along with an increase in hormones, puts women at greater risk for diabetes. In fact, almost three times higher than the general population.

To address this issue, Harris' latest research project, Healthy Moms, Healthy Babies, is a community lifestyle program which aims to increase awareness and improve care of First Nations women gestational diabetes.

Along with fellow Western researchers Irene Hramiak, Michelle Mottola and Selina Liu, the project is comprised of a healthy lifestyle component focusing on exercise during pregnancy with the use of cutting-edge technology - continuous glucose monitors - which can record blood sugar levels every two minutes, along with traditional finger-prick testing.

"One thing we are doing is creating community-based lifestyle exercise programs. Community people have been hired and trained to introduce walking programs and educating them about healthy food choices, what they can do to manage their diabetes and, therefore, protect their babies," Harris said. "Pregnancies with diabetes lead to worse outcomes at delivery for mother and baby, and puts the baby at future risk for diabetes.

"If we can intervene and have good diabetes control, you can mitigate those bad outcomes."

Harris added three First Nation's communities have signed up as part of his project including Mohawks of the Bay of Quinte, Six Nations of the Grand River and Walpole Island First Nation. He is hoping for 60 female volunteers, with the program running for 12 months and being led with an on-reserve community healthcare professional.

Harris quickly brushes off the idea all that is needed is a better diet and exercise regiment, and problem solved. With Ontario having a 10 per cent prevalence of diabetes - and rates continually climbing - that simple idea is not working well in the general population, let alone communities where it's almost 40 per cent of the population.

"There is definitely an education component that needs to be involved with this, but at the same time, if you don't have access to facilities, programs or awareness, it makes it even harder," Harris said. "We want to help these women become aware and enable them to undertake better lifestyles."

While there is a major care gap and the epidemic continues to grow, Harris said it's not all doom and gloom. Federal and provincial governments are stepping up with funding and Western continues to be a leading centre for diabetes research.

"If (this epidemic) didn't exist 40 years ago, why can't we go back?" Harris asked.