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| |  Diabetes Epidemic Strikes Native Canadian Community TORONTO, Feb. 5, 1997 -- A research team led by Drs. Bernard Zinman and Stewart Harris found that the native community of Sandy Lake in northwestern Ontario, has the highest prevalence of Non-Insulin Dependent Diabetes Mellitus (often referred to as Type II diabetes) of any Canadian population. The research team based at the Samuel Lunenfeld Research Institute (SLRI) of Mount Sinai Hospital in collaboration with other investigators, published their findings in the February 1997 issue of Diabetes Care. "The key finding of the study was the demonstration of an overall prevalence of Type II diabetes in Sandy Lake which was five times the national average," says Dr. Bernard Zinman, senior scientist at the SLRI and professor of medicine at the University of Toronto (U of T). "In addition, young females in the community have particularly high rates of obesity, low levels of physical fitness and impaired glucose tolerance (a prediabetes condition)." The age standardized prevalence of diabetes was found to be 26 per cent with 14 per cent suffering from impaired glucose tolerance for a total of 40 per cent with abnormal carbohydrate metabolism. Type II diabetes is a condition in which the body cannot process sugar and other energy sources properly and is often triggered by obesity and low levels of physical fitness. Type II diabetes is typically more common in the 50+ population. However, in many indigenous communities around the world, there are alarmingly high rates of Type II diabetes in the population aged 18 to 49. In Sandy Lake, individuals as young as 10 have been diagnosed with Type II diabetes. Sandy Lake has the third highest rate of diabetes in the world. "In Sandy Lake, these changes in health status have occurred in the last 15 to 20 years," says Zinman who also heads the Mount Sinai Hospital and the Toronto Hospital Division of Endocrinology and Metabolism. "The community is now starting to experience the serious and costly long-term complications of diabetes including visual impairment, kidney failure, amputation and premature heart disease." Changes in native lifestyle and modern medicine across North America in the past 30 to 40 years have resulted in a decrease in infectious diseases and death from malnutrition. Unfortunately, at the same time, a marked increase in chronic diseases such as obesity, diabetes and cardiovascular disease has occurred. "The ancestors of the Sandy Lake community survived as hunters and gatherers using their traditional skills which required high energy output to survive in an often hostile environment," says Zinman. "In a feast or famine environment, people with the ability to store nutrients for long periods (the so-called "thrifty" genotype) had a major survival advantage. Now, however, members of the Sandy Lake community - like many of us - live a predominantly sedentary lifestyle in an environment of nutrient excess. As a result, the thrifty genotype no longer becomes a survival advantage but results in obesity. The consequence of high rates of obesity and physical inactivity is epidemic levels of Type II diabetes." The development of Type II diabetes in this community is a perfect example of the interaction between environmental factors and genetic makeup leading to undesirable consequences. Recognizing the severity of this health problem and its impact, the chief and council of the community initiated a partnership with the Mount Sinai Hospital health care team. A total of 728 inhabitants of Sandy Lake participated in the recently published study which targeted all permanent residents of the community aged 10 and older. In addition to measuring the prevalence of diabetes and its associated risk factors, DNA was collected to help SLRI researchers, in collaboration with a team led by Dr. Robert Hegele from St. Michael's Hospital and U of T, to evaluate the genetic factors responsible for the very high rate of diabetes. Intervention Strategy Already in Place Study results showed an urgent need to develop culturally appropriate, community-based public health intervention programs to help prevent a continuing increase in Type II diabetes and its devastating complications in the population of Sandy Lake. Accordingly, the clinical research team has implemented a four-pronged intervention strategy using home visits; local media and special events; a healthy food choice grocery program; and a healthy lifestyle school curriculum program. Once evaluated, the intervention strategy will provide a model intervention plan which can be used by other First Nations communities in North America. Funding for the study came from grants from the National Institutes of Health and the Ontario Ministry of Health. The research team, co-headed by Dr. Zinman and Dr. Stewart Harris, University of Western Ontario, also includes: Joel Gittelsohn, PhD, John Hopkins University; Anthony Hanley; Annette Barnie, RN, SLRI; Dr. Thomas Wolever, St. Michael's Hospital and U of T; Joe Gao, PhD, SLRI; and Dr. Alexander Logan, SLRI and U of T. Mount Sinai Hospital's SLRI, affiliated with U of T, is widely recognized as one of Canada's premier research facilities focussing on molecular biology, cancer, fetal development and the genetic basis of disease. The Sandy Lake study is one of several population-based genetic studies under way at the SLRI. Others include asthma, colorectal and breast cancer and inflammatory bowel disease.
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