Don’t let pride get in the way of a diabetes check

“I’ve always said that people shouldn’t be ashamed to go get tested,” said Stephen Simon.  “Some people are ashamed to admit they have diabetes.”

Simon, a Korean War veteran and recent recipient of the Queen Elizabeth II Diamond Jubilee Medal, lives on Big Cove First Nation in New Brunswick and describes himself as “an 80-year-old retired old dog.”

In 2002, he lost sight in one of his eyes because of diabetic retinopathy. He was diagnosed with diabetes in 1984, clued in that something was wrong when he started losing his appetite, was always thirsty, and suffered leg cramps.

“I think people need to take a book, study what diabetes is all about so that when they become diabetic, they know how to deal with it,” Simon said.

He has experienced firsthand people who don’t want to be made aware of their medical condition.

“I had a friend who was ashamed about being diabetic. He eventually died,” Simon said. “Too bad a person has to be too proud to admit to being a diabetic.”

According to the Canadian Diabetes Association, diabetic retinopathy is projected to increase 61 per cent by the year 2031. The Canadian National Institute for the Blind has begun to step up its efforts to address eye diseases in the Aboriginal community.

“We’ve really identified that we’re not serving the Aboriginal population well,” said Cathy McFee, executive director with the Alberta/Northwest Territory branch of CNIB.

In 2004, the CNIB completed a federally-funded report entitled “Circles of Light Project,” which identified obstacles preventing Aboriginal people from accessing vision health services and gaps in services. It was determined that access to services was “severely limited” and that Aboriginal people wanted their own programs delivered by their own people within their own communities.

Lack of reliable, long-term funding has made it difficult for the CNIB to address the issues identified in the report, McFee said. Pilot or project funding only allows for a limited amount of work to be carried out.

“The only way … that we can be successful in any kind of partnership in outreach is if we are able to engage Aboriginal leaders in that process,” she said, noting that the process takes time to build.

Recent funding from BHP Billiton has allowed the CNIB to go into remote communities in the N.W.T. and provide both eye service as well as train-the-trainer workshops. BHP Billiton funding has also enabled the CNIB’s caregiver’s manual to be upgraded.
“(The manual) is taking the information about vision loss and some of the rehab approaches and talking about some of the services, but it’s putting it within a cultural perspective,” said McFee.

The CNIB is also pursuing a relationship with the CDA as a means to reach Aboriginal communities.

“We felt there would be an opportunity to work closely with them,” McFee said.

Diabetes has reached epidemic proportions among the Aboriginal population.  According to Health Canada, First Nations on reserve have a rate of diabetes three to five times higher than that of other Canadians. Diagnoses occur, on average, 15 years earlier than the general population, with 25 to 40 per cent of First Nation adults diagnosed. More First Nation women than men have diabetes, a reversal of the general population trend.

The Canadian Diabetes Association is funding Aboriginal-focused projects as a means to both address the increasing needs and to understand the reasons behind it.

The CDA is funding a five-year project in British Columbia targeting children of three Pacific Coast First Nations communities. Dr. Dina Panagiotopoulos, an assistant professor in the Department of Pediatrics at the University of British Columbia in Vancouver, is studying the rates of obesity, pre-diabetes or type 2 diabetes in those children. Obesity and type 2 diabetes are major health problems in First Nations children.

Dr. Ellen Toth, professor in the Department of Medicine at the University of Alberta, in Edmonton, recently received funding from the CDA to study the prevalence of diabetes in First Nations communities that practise self-determination.

“We want to know whether cultural continuity mitigates against prevalence of diabetes,” Toth said. Cultural continuity includes control of education, language, and culture.

This is not Toth’s first foray into examining diabetes and its impact on Aboriginal people. She was a guiding force in forming the partnership between the U of A and BRAID research initiative which provides a Mobile Diabetes Screening Initiative to Aboriginal people living off-reserve, in Métis communities and to remote communities throughout Alberta, screening individuals to see if they have diabetes, or if they are at risk of getting diabetes or cardiovascular disease.

Universities in Saskatchewan, Manitoba and Ontario are also involved in undertaking diabetic work and studies with the Aboriginal population.

Dr. Stewart Harris of the Schulich School of Medicine and Dentistry of the University of Western Ontario is coordinating a national effort, which includes Toth and other members of the academic community for a primary care reform project on the management of diabetes.  Funding is still pending. Harris is the CDA chair in diabetes management.

In response to the climbing diabetic figures, the federal government established the Aboriginal Diabetes Initiative in 1999. ADI has entered the third phase, now spanning 2010-2015, with the focus to reduce type 2 diabetes.