Sugar, sugar: Inuit diabetes rates may be undercounted

Dr. Brent Richards said his research has found that the number of Inuit with diabetes may be severely underestimated. (PHOTO BY DAVID MURPHY)

A slide from Dr. Brent Richards’ presentation to the 2016 Northern Health Forum in Quebec City this past June 16. (PHOTO BY DAVID MURPHY)

DAVID MURPHY

The number of Inuit being diagnosed with diabetes is already rising but one researcher says doctors have misdiagnosed some Inuit.

And that means the number of Inuit with diabetes may be seriously underestimated.

Due to a genetic change among about 30 per cent of Inuit, doctors have problems detecting Type 2 diabetes sufferers within that group unless they employ a specific kind of test which is very rarely used.

“Across the Inuit population of the world, we’re not diagnosing thousands of Inuit with diabetes,” said Dr. Brent Richards, an associate professor of medicine, endocrinology and genetics at McGill University.

“So they have diabetes. They are at an increased risk of early mortality. They have an increased risk of all the complications of diabetes. And we don’t know about it,” Richards said.

Richards presented his findings June 16 at the 2016 Northern Health Forum in Quebec City.

This genetic change may have been caused by a change in environment for Inuit spanning thousands of years, he said.

What’s strange, however, is that — using normal methods — doctors can’t detect Type 2 diabetes in Inuit with this type of genetic change

Doctors usually check levels of glucose — or blood sugar — using one of two methods.

One method involves testing blood sugar levels while the patient is fasting — not eating for a period of time. The other uses a blood test to measure average glucose levels.

Those who display high fasting or high to average glucose levels are diagnosed with diabetes.

“But what happens with [Inuit] who have this genetic change is that they actually have a lower glucose level when they’re not eating,” Richards said.

“And then they eat, and boom, their glucose increases fairly dramatically, well outside the normal range.”

Usually when you’re not eating, your blood sugars actually go low. So those two things balance out and your average looks normal. But your glucose after a meal is high, Richards said.

So doctors need to test Inuit when they’re eating. That test is called a two-hour oral glucose tolerance test — but it’s a hassle.

“There’s a really big dirty secret I want to tell you,” Richards told the Quebec City audience.

“This is really embarrassing. This is data from Ontario from 2009. And the number of people that had tests done for glucose after a meal was less than one per cent of the population,” he said.

In order to do the test, patients have to show up to the doctors office fasting, they have to drink a “disgusting” liquid, they have to sit in the waiting room for two hours and then get another blood test, Richards said.

“So the whole thing, including your doctor’s visit often takes five hours. So nobody does it,” Richards told Nunatsiaq News.

“We know that the estimates of diabetes that we have on the records now are wrong. Because they haven’t been tested in this way,” he said.

Richards found out about the genetic change from researchers in Denmark who studied Inuit in Greenland.

Richards then found data from about 1,000 tests from Alaskan Inuit and a small cohort of Nunavik Inuit, and they all seemed to show the same results as the Greenland study.

“We found that the same genetic change was in Inuit from Nunavik at the exact same proportion of the population as we found in Alaska and what others found in Greenland,” Richards said.

“We [are] assuming this covers Nunavut but we don’t have any samples to test that,” he said.

Richards is now in discussions with the head of medicine in Nunavik to start genetic tests in Nunavik.

He hopes to roll out a program this year to help educate physicians in the North of the problem.

“The clinical message is that we just need to find these people with diabetes and prevent them from getting the complications of diabetes and we can do that through relatively simple tests,” Richards said.

Richards said if you are worried about your risk of diabetes, ask your doctor for the two-hour oral glucose tolerance test.