Diabetes care and health status of First Nations individuals with type 2 diabetes in Alberta

OBJECTIVE To describe the state of diabetes care among Alberta First Nations individuals with diabetes living on reserves. DESIGN Survey and screening for diabetes-related complications. SETTING Forty-three Alberta First Nations communities. PARTICIPANTS A total of 743 self-referred First Nations individuals with known diabetes. MAIN OUTCOME MEASURES Clinical measurements (glycated hemoglobin A(1c) levels, body mass index, waist circumference, total cholesterol, blood pressure, and the presence of kidney complications or proteinuria, retinopathy, and foot abnormalities), self-reported health services utilization, clinical history, and knowledge of and satisfaction with diabetes services. RESULTS Female participants tended to be more obese (P<.05) and to have abnormal waist circumferences more often than men (P<.05). Male participants, however, had a higher proportion of proteinuria (P<.05), hypertension (P<.05), limb complications (P<.05), and retinopathy (P<.05). Family physicians were the main diabetes care providers for most participants. Nearly half the participants felt they did not have care from a diabetes team. A total of 38% had never seen dietitians. Diabetes-related concerns were responsible for 24% of all hospitalizations and emergency department visits. Approximately 46% and 21% of participants had recommended hemoglobin A(1c) testing and foot examinations, respectively. Only 24% of participants with kidney complications were receiving treatment. A considerable proportion of participants had undiagnosed complications of diabetes: kidney damage or proteinuria (23%), high cholesterol (22%), foot complications (11%), hypertension (9%), and retinopathy (7%). CONCLUSION Diabetes care is suboptimal in Alberta First Nations communities. Rural physicians caring for First Nations individuals on reserves should be involved, along with other members of diabetes health care teams, in strategies to improve diabetes care. Our results justify the need for community-based screening for diabetes control and complications in First Nation communities.