13. Diabetes Among Indigenous Canadians

Type 2 diabetes mellitus (DM) has been increasing dramatically in the Indigenous population of Canada over the past six decades, with the prevalence of this condition reaching epidemic levels in many communities. The burden of complications related to type 2 DM is also disproportionately higher among Indigenous Canadians compared to their non-Indigenous counterparts, which has created a major clinical and public health challenge for this population. Indigenous Canadians also suffer from a higher prevalence of cardiometabolic and lifestyle risk factors for type 2 DM such as hypertension, obesity, suboptimal eating patterns, low physical activity, and smoking. Many of these factors exist on a background of (and are exacerbated by) poverty, poor housing, low educational attainment, unemployment, inadequate community resources, and suboptimal clinical care. Although recent advances in community-based interventions targeting physical activity and healthy eating practices have led to improvements in health and well-being in specific communities, lack of environmental and social support for these practices on a broader scale remains an ongoing challenge. Consequently, sustainable and broadly implemented interventions targeting type 2 DM primary and secondary prevention in Indigenous Canadians are vital. In particular, culturally appropriate primary prevention programs and clinical care strategies that include the participation of Indigenous community members is crucial for relieving the heavy burden of type 2 DM and its complications in this population.