BRAID Research, University of Alberta www.braiddm.ca

1. The Diabetes-Related Health of Aboriginal Women with a History of
Gestational Diabetes
Richard T. Oster, Ellen L. Toth
Department of Medicine, University of Alberta
Results of simple regression analysis (univariate)
1. Background 3. Results Variable OR P-value
The prevalence of type 2 diabetes is increasing, seemingly unabated (1). Many Canadian A total of 3568 adult (≥ 20 years) Aboriginal women were screened (2611 First Nations and
Aboriginal populations suffer type 2 diabetes rates that are 2-5 times higher than the non- 957 Métis). Of these, 369 (10.3%) reported having previous GD and were included in the Age 1.07 (1.04 - 1.09) <0.001
Aboriginal population (2, 3), with Aboriginal women being disproportionately affected (4). It is current analysis. Interestingly, rates of GD were significantly higher among First Nations Waist circumference 1.04 (1.02 - 1.05) <0.001
believed that a complex combination of social, cultural, environmental and genetic factors are women (12.1%) compared to Métis women (5.5%) (p<0.001).
at play. In attempts to further understand the causes, the possible contribution of gestational
BMI 1.06 (1.02 - 1.10) 0.002
diabetes (GD) has received recent attention. In Aboriginal populations, it is suggested that GD Of the 369 included women, 316 were First Nations, 53 were Métis, and 215 had developed
contributes to a vicious cycle by increasing the risk of type 2 diabetes in both offspring and diabetes by the time of screening. Unsurprisingly, women with diabetes had higher mean Systolic blood pressure 1.03 (1.01 - 1.04) 0.001
mothers (5). values for age, waist circumference, BMI, systolic blood pressure, mean arterial pressure, and
total cholesterol, and were more likely to have metabolic syndrome, to be First Nations and Diastolic blood pressure 1.02 (0.99 - 1.04) 0.174
The risk of diabetes varies depending on the population being studied and is further elevated to have a sibling with diabetes.
among obese women and those with a family history of diabetes (6), which is particularly Mean arterial pressure 1.03 (1.01 - 1.05) 0.01
problematic for First Nations women who suffer significantly higher rates of both diabetes and Characteristics of Aboriginal women with a history of GD. Values are means (±
obesity (7). For instance, a retrospective chart review of First Nations women diagnosed with GD Total cholesterol 1.32 (1.08 - 1.63) 0.008
SD) or prevalence (95% CI).
in the Sioux Lookout Zone, Ontario found that greater than 70% developed type 2 diabetes
Variable No diabetes Diabetes P-value Parent with diabetes 1.28 (0.84 - 1.95) 0.243
within four years (8). However, little is known of risk factors for developing type 2 diabetes
among Aboriginal women with a history of GD. (N = 154) (N = 215)
Sibling with diabetes 2.91 (1.84 - 4.59) <0.001
Age (years; n=369) 37.7 (9.8) 45.7 (12.5) <0.01
We investigated the diabetes-related health of Aboriginal women with a history of GD in the Metabolic syndrome 3.13 (1.98 - 4.95) <0.001
province of Alberta. Our purpose was to uncover predictors of diabetes. Waist circumference (cm; 103.4 (15.2) 110.3 (13.4) <0.01
n=334) First Nations ethnicity 5.45 (2.80 - 10.61) <0.001
BMI (kg/m2; n=345) 31.6 (6.1) 33.7 (6.4) <0.01
2. Methods Systolic blood pressure 117.0 (16.5) 123.0 (15.1) <0.01 Odds ratios (OR) of variables associated with diabetes in Aboriginal women with
We accessed the databases of three separate community-based diabetes and risk screening a history of GD. Values are ORs (95% CI).
(mmHg; n=360)
projects. Subjects self-referred from Aboriginal and rural communities in Alberta. Variable Unadjusted OR Adjusted OR*
Diastolic blood pressure 73.1 (10.8) 74.6 (8.9) 0.17
(mmHg; n=360)
Age 1.07 (1.04 - 1.09) 1.06 (1.03 - 1.09)
K Mean arterial pressure
(mmHg; n=360)
87.6 (11.7) 90.5 (9.7) <0.01
Waist circumference 1.04 (1.02 - 1.05) 1.05 (1.01 - 1.09)
Total cholesterol (mmol/L; 4.9 (0.9) 5.2 (1.2) 0.01
Sibling with diabetes 2.91 (1.84 - 4.59) 2.34 (1.30 - 4.20)
n=323)
% Parent with diabetes 54.3 % (46.0 - 62.3) 59.8% (52.9 - 66.4) 0.29 Metabolic syndrome 3.13 (1.98 - 4.95) 3.24 (1.74 - 6.04)
(n=369)
% Sibling with diabetes 24.2% (17.6 - 31.8) 48.1% (41.3 - 55.0) <0.01 Ethnicity† 5.45 (2.80 - 10.61) 6.38 (2.64 - 15.40)
(n=369)
*Adjusted for confounders (mean arterial pressure, BMI, and total cholesterol)
% Metabolic syndrome 23.5% (17.1 - 31.1) 48.6% (41.7 - 55.5) <0.01
† First Nations compared to Métis
(n=369)
% First Nations (n=369) 74.5% (66.8 - 81.2) 94.4% (90.4 - 97.1) <0.01
Canadian Aboriginal Issues
Aboriginal Affairs and
Northern Development
Age at diagnosis (years; N/A 35.5 (10.6) N/A
4. Conclusions
Database, www.ualberta.ca/ Canada, www.ainc-
n=202) Age, waist circumference, having a sibling with diabetes, having metabolic syndrome and
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h Duration of diabetes (years; N/A 10.5 (9.5) N/A being of First Nations ethnicity are independent predictors of diabetes among women with
n=202) previous GD. First Nations ethnicity is more predictive of diabetes than Métis ethnicity.
Subjects were screened with clinical exams and portable lab technology between the years In the final adjusted model, significant associations remained for waist circumference (odds
2003-2011. Body mass index (BMI), waist circumference, total cholesterol, blood pressure,
ethnicity, age, diabetes status, as well as the presence of metabolic syndrome and family history
ratio [OR] 1.05; 95% CI 1.01 - 1.09), age (OR 1.06; 95% CI 1.03 - 1.09), having a sibling with
diabetes (OR 2.34; 95% CI 1.30 - 4.20), metabolic syndrome (OR 3.13; 95% CI 1.74 - 6.04),
5. References
of diabetes was assessed. Chi-square tests and t-tests were used to identify any between group 1. Shaw JE et al. Diabetes Res Clin Pract. 2010;87(1):4-14. 2. Young TK et al. CMAJ. 2000;163(5):561-6.
and First Nations ethnicity (OR 6.38; 95% CI 2.64 - 15.40). 3. King M et al. Lancet. 2009;374(9683):76-85. 4. Dyck R et al. CMAJ. 2010;182(3):249-56.
differences. Statistical modeling using multiple regression analysis (purposeful) was conducted to 5. Osgood ND et al. Am J Public Health. 2011;101(1):173-9. 6. Krishnaveni GV et al. Diabetes Res Clin Pract. 2007;78(3):398-404.
quantify the relationships between diabetes and measured variables. 7. Ho L, et al. Ethn Health. 2008;13(4):335-49. 8. Mohamed N, et al. Int J Circumpolar Health. 1998;57(Suppl 1):355-8.