Indigenous adult Canadians with diabetes have a nearly three times increased risk for end-stage renal disease (ESRD) than other adult Canadians with diabetes, a new finding that underscores the need to develop more effective prevention and management initiatives to overcome ethnicity-based health disparities.

Indigenous peoples experience an excess burden of diabetes-related ESRD, but the reasons for this are not fully understood, Roland Dyck, MD, of the community health and epidemiology department and the medical department of the University of Saskatchewan in Saskatoon, and fellow investigators explained in CMAJ. The group launched a retrospective cohort study to examine ESRD among Saskatchewan adults with diabetes, from both the indigenous First Nations population and the non-First Nations population.

Most of the 90,429 incident cases of diabetes that developed during the study period of 1980–2005 occurred among non-First Nations adults (82,175, or 90.9%), with the mean age at diagnosis 61.6 years. Among the 8,254 (8.9%) First Nations adults with incident diabetes, the mean age at diagnosis was 47.2 years.

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ESRD developed in 0.7% of non-First Nations adults and in 2.4% of First Nations adults. After adjustment for sex and age at the time of diabetes diagnosis, the risk for ESRD was determined to be 2.7 times higher among the First Nations adults compared with the non-First Nations adults. Multivariable analysis with adjustment for sex showed a higher risk for death among First Nations adults. This mortality risk decreased with increasing age at time of diabetes diagnosis. Persons experiencing diabetes onset at younger ages were at greatest risk for ESRD, whereas those who received a diagnosis of diabetes at older ages were at greatest risk for death.

Dr. Dyck’s group pointed out that because First Nations adults are typically younger at diabetes diagnosis, they are more likely to survive long enough for ESRD to develop. They also noted that the prevalence of diabetes among First Nations children tripled in the 25-year period studied.

“These demographic trends suggest that steadily increasing numbers of young First Nations individuals will face prolonged exposure to the metabolic consequences of type 2 diabetes,” the researchers wrote. “Without substantial improvements in the prevention and treatment of this disease, this pattern will likely translate into increasing numbers of First Nations people with diabetes-related end-stage renal disease and possibly other chronic diabetes complications.”