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ABSTRACT
Background: Diabetes prevalence is substantially higher among Canadian First Nations populations than the non-First Nation population. Fasting serum triglycerides have been found to be an important predictor of incident diabetes among non-indigenous populations. However, there is a great need to understand diabetes progression within specific ethnic groups, particularly First Nations populations.
Objective: The purpose of this study was to test for an association between fasting serum triglycerides and incident diabetes, changes in insulin resistance and changes in β-cell function in a Manitoba First Nation cohort.
Methods: Study data were from two diabetes screening studies in Sandy Bay First Nation in Manitoba, Canada, collected in 2002/2003 and 2011/2012. The cohort was composed of respondents to both screening studies (n=171). Fasting blood samples and anthropometric, health and demographic data were collected. A generalised linear model with Poisson distribution was used to test for an association between fasting triglycerides and incident diabetes.
Results: There were 35 incident cases of diabetes among 128 persons without diabetes at baseline. Participants who developed incident type 2 diabetes were significantly older and had significantly higher body mass index (BMI; p=0.012), total cholesterol (p=0.007), fasting triglycerides (p<0.001), and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) (p<0.001). Fasting triglyceride level was found to be a statistically significant positive predictor of incident diabetes independent of age, sex and waist circumference at baseline. Participants with triglycerides in the highest tertile (≥2.11 mmol/l) had a 4.0-times higher risk of developing incident diabetes compared to those in the lowest tertile (p=0.03). Notably, neither waist circumference nor BMI were significant predictors of incident diabetes independent of age, sex and triglycerides.
Conclusion: Fasting triglycerides may be useful as a clinical predictor of insulin resistance and diabetes development among First Nations populations. Unlike other ethnic groups, BMI and waist circumference may be less important factors in diabetes development.
Acknowledgments
This work was supported by the Canadian Institutes of Health Research (CIHR) and the Manitoba Health Research Council (MHRC) Regional Partnership Program grant. KC was funded through the Med II Summer Research Program, Max Rady College of Medicine, University of Manitoba. NDR is the recipient of a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Award (2009–2012), an MHRC Studentship (2012–2014) and a Manitoba Network Environment for Aboriginal Health Research Award (2011–2013), as well as top-up funding from the University of Manitoba, Faculty of Medicine, Faculty of Graduate Studies and Department of Community Health Sciences. We acknowledge the support of the study community and research participants, as well as all those involved in data collection.
Disclosure statement
No potential conflict of interest was reported by the authors.
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Notes on contributors
Natalie D. Riediger
NDR contributed to the conception and design, acquisition of data, analysis and interpretation of data and assisted in drafting the article. KC contributed to the analysis and interpretation of data and drafted the first version of the manuscript. VL, RN and SB contributed to the conception and design, acquisition of data, analysis and interpretation of data and revised the article for intellectual content. All authors gave final approval of the version to be published.