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1.  Prevalence, determinants and co-morbidities of chronic kidney disease among First Nations adults with diabetes: results from the CIRCLE study 
BMC Nephrology  2012;13:57.
Indigenous peoples worldwide are experiencing elevated rates of type 2 diabetes and its complications. To better understand the disproportionate burden of diabetic end stage renal disease (ESRD) among Canadian First Nations people (FN), we examined prevalence, determinants, and co-morbidities of chronic kidney disease (CKD) within this population.
The 2007 Canadian FN Diabetes Clinical Management and Epidemiologic (CIRCLE) study conducted a cross-sectional national medical chart audit of 885 FN adults with type 2 diabetes to assess quality of diabetes care. In this sub-study, participants were divided by estimated glomerular filtration rate (eGFR in ml/min/1.73 m2), as well as by albuminuria level in those with eGFRs = > 60. Those with eGFRs = > 60 and negative albuminuria were considered to have normal/near normal kidney function (non-CKD). Using univariate and logistic regression analysis, they were compared with participants having eGFRs = > 60 plus albuminuria (CKD-alb) and with participants having eGFRs <60 (CKD-eGFR <60).
While 84.5% of total CIRCLE participants had eGFRs = > 60, almost 60% of the latter had CKD-alb. Of the 15.5% of total participants with CKD-eGFR <60, 80% had eGFRs 30–60 (Stage 3 CKD) but over 10% (1.6% of total participants) had ESRD. Independent determinants of CKD-alb were male gender and increasing diabetes duration, systolic BP, A1C and total cholesterol. These plus smoking rates also discriminated between FN with micro- and macro-albuminuria. Independent determinants of CKD-eGFR <60 were increasing age at diabetes diagnosis, diabetes duration, total cholesterol and systolic BP. However, participants with CKD-eGFR <60 also displayed a decreasing mean age of diabetes diagnosis as eGFR declined. Micro-vascular co-morbidities were significantly associated with CKD-alb but both micro- and macro-vascular co-morbidities were associated with CKD-eGFR <60. Only 35-40% of participants with CKD used insulin.
High prevalences of CKD-alb and early CKD-eGFR <60 among diabetic FN were largely related to modifiable and treatable risk factors. However, an earlier age of diabetes diagnosis and longer duration of diabetes characterized those with ESRD. These findings suggest that a failure to meet current standards of diabetes care interacting with an age-related survival benefit contribute to the disproportionate burden of ESRD among FN and possibly other Indigenous peoples.
PMCID: PMC3438064  PMID: 22776036
Indigenous peoples; Aboriginal; First Nations; Diabetes; Chronic kidney disease; End stage renal disease; Risk factors.
2.  Measuring quality of diabetes care by linking health care system administrative databases with laboratory data 
BMC Research Notes  2010;3:233.
Chronic complications of diabetes can be reduced through optimal glycemic and lipid control as evaluated through measurement of glycosylated hemoglobin (A1C) and low-density lipoprotein cholesterol (LDL-C). We aimed to produce measures of quality of diabetes care in Saskatchewan and to identify sub-groups at particular risk of developing complications.
Prevalent adult cases of diabetes in 2005/06 were identified from administrative databases and linked with A1C and LDL-C tests measured in centralized laboratories. A1C results were performed in 33,927 of 50,713 (66.9%) diabetes cases identified in Saskatchewan, and LDL-C results were performed in 12,031 of 24,207 (49.7%) cases identified within the province's two largest health regions. The target A1C of <= 7.0% and the target LDL-C of <2.5 mmol/L were achieved in 48.3% and 45.1% of diabetes cases respectively. The proportions were lower among those who were female, First Nations, non-urban, younger and in lower income quintiles. The same groups experienced poorer glycemic control (exception females), and poorer lipid control (exception First Nations people). Among non-Aboriginal people, younger diabetic females were least likely to receive lipid lowering agents.
Linkage of laboratory with administrative data is an effective method of assessing quality of diabetes care on a population basis and to identify sub-groups requiring particular attention. We found that less than 50% of Saskatchewan people with diabetes achieved optimal glycemic and lipid control. Disparities were most evident among First Nations people and young women. The indicators described can be used to provide standardized information that would support quality improvement initiatives.
PMCID: PMC2940772  PMID: 20807443

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