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295 PRACTICAL CHALLENGES OF PERFORMING DIABETES SCREENING IN A REMOTE ABORIGINAL COMMUNITY.
  1. J. Rozmus1,
  2. A. Macnab1,
  3. C. Panagiotopoulos1
  1. 1Department of Pediatrics, University of British Columbia, Vancouver, BC.

Abstract

Purpose Prior to the 1970s, type 2 diabetes (T2D) and its precursor, impaired glucose tolerance (IGT), were essentially nonexistent among Aboriginal Canadians. T2D and IGT are now reaching epidemic proportions in this population. Of particular concern is the appearance of T2D and IGT among Aboriginal youth. However, there are few published reports of prevalence from screening aboriginal children in Canada. At the request of the communities, we undertook to determine the prevalence of T2D and IGT among children in three remote communities of the Tsimshian Nation, with the continuing goal of working together to introduce lifestyle changes for the primary and secondary prevention of T2D. This study reveals many of the challenges of Aboriginal health research. Practical challenges included remote access, equipment and sample transport, dealing with local authorities, medical staff, and cultural attributes. We also dealt with more universal issues such as ethics, information sharing, and data ownership.

Methods The study took advantage of a preexisting relationship of several years' duration between UBC's pediatric residency program and one community an oral health program. We recruited respected local contacts to pave the way for our arrival. The study involved two trips. One team arrived the week prior to assess facilities and obtain informed consent from children and their parents. Use of IV catheters was demonstrated to the children and fasting instructions given. Meetings were held with elders, community leaders, school officials, and health center staff. The next week a five-member team arrived to perform the screening. Screening was done in the Elders' Room, a central location where all of the children could come accompanied by their parents. The two teams with all their equipment were flown in by float plane, with travel dependent on weather conditions. We stayed in the communities and participated in local activities.

Results Of the 35 children registered in grades 1 to 12, 3 had moved out of the community. Consent was obtained from all remaining 32 children. Using a floatplane directly from Vancouver resulted in all equipment arriving safely, including frozen reagents on the trip in and frozen plasma samples on the return trip. Three children did not complete the screening; one failed to fast, we were unable to obtain venous access on one 7-year-old, and one (known to have T2D) was out of the community during the screening week.

Conclusions Our approach was successful and provides a model for initiating larger-scale trials in the other communities.

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