Beyond Expectations: Why Do Aboriginal and Euro-Canadian Patients with Type 2 Diabetes on a Northern, Rural Island Demonstrate Better Outcomes for Glycemic, Blood Pressure and Lipid Management than Comparison Populations?

Abstract

OBJECTIVE To determine differences in type 2 diabetes screening, control and management of glycemic levels, blood pressure and lipids between Aboriginal and Euro- Canadian residents of a rural island in Ontario, Canada. METHOD This was a cross-sectional study of patients with type 2 diabetes (n=909); 29.6% were Aboriginal. We compared screening frequencies, laboratory values and medications. RESULTS Euro-Canadian patients used fewer antihyperglycemic agents, had a higher rate of glycated hemoglobin (A1C) testing (89.2%, vs. 80.3% for Aboriginal patients), better A1C values (7.0% vs. 7.3%) and higher rates of attained glycemic targets (62.9% vs. 50.5%). Aboriginal patients were diagnosed younger (48.2 years vs. 56.8 years for Euro-Canadian patients) and nearly twice as likely (19.4% vs. 10.9%) to have highly elevated glycemic levels (A1C >8.5%). Blood pressure and lipid levels showed only minor variations between groups, with Euro-Canadians showing higher medication levels. CONCLUSION Compared to previous Canadian studies, both Aboriginal and Euro-Canadian patients in this study demonstrated better control of glycemic and lipid levels despite their relatively isolated, rural place of residence. Unexpectedly small differences in these physiological measures were observed between the 2 patient groups. The positive findings are likely a result of high-quality, culturally sensitive, interdisciplinary care. Development of interventions is still warranted, particularly a focused intervention for patients with highly elevated glycemic levels.