Currently, 8.9% of Canadians (~3.34 million) are living with diabetes (~90% of which are T2D), which has more than doubled since the year 2000. Disproportionately affected are disadvantaged populations, including Indigenous peoples, who experience rates of T2D three to five times higher than the general population.

Additionally, childhood-onset T2D, diagnosed before 18 years, has become one of the fastest growing chronic disease in Indigenous children. Alarmingly, up to ~50% of youth living with T2D will develop micro- and macro-vascular complications, including end-stage renal disease requiring dialysis, within 15 years of diagnosis, affecting their health in their most productive years and importantly, their reproductive years.

Although some of the primary risk factors for childhood onset T2D are known including: Indigenous ancestry/ethnic minority, obesity, the presence of metabolic syndrome, fatty liver disease, and exposure to diabetes in utero, understanding the role of each of these risk factors, and the complex interplay between genetics and environment in T2D development will be necessary to determining successful interventions.

The inter-generational transmission of type 2 diabetes suggests that early influences play a role in the pre-programming of T2D risk. Consistent with the Barker hypothesis of the developmental origins of health and disease, a component of T2D risk is believed to be pre-programmed due to specific early life exposures.

Growing evidence suggests that gene-environment interactions play an important role in the development of childhood obesity. Interactions between environmental exposures in the pre- and perinatal periods (GDM, lack of breast feeding) and genetics are theorized to program offspring by epigenetic modifications (altered gene expression) for obesity and T2D. This raises the possibility of targeting modifiable early life exposures in the prevention of childhood onset T2D.

The impact of poverty, food insecurity and, in some circumstances, loss of culture and identity through colonization cannot be overstated. Consistently the development of diabetes is associated with the most deprived populations. The benefit of culture, belonging, positive mental health and regular income have all been shown to be associated with decreased diabetes risk.

In this context, any efforts at prevention require an examination of the societal risk factors for chronic disease development and address these larger issues with public policy interventions. 

In this discussion, members are asked:

1. When should efforts at diabetes prevention be focused in the life-cycle?
2. Where should interventions/prevention strategies be focused (e.g. primary care practitioners, specialist clinics, school or community based programming)?
3. Who should be involved in the development and/or implementation of prevention/intervention strategies?
4. What would important components of an intervention strategy include?

Information about the discussion leader

Brandy Wicklow is a Pediatric Endocrinologist at the Winnipeg Children’s Hospital, Associate Professor at the University of Manitoba and Clinician Scientist at the Children’s Hospital Research Institute of Manitoba (CHRIM). Her research is focused on the determinants of type 2 diabetes (T2D) in children, with a particular interest in the Indigenous population of Northern Manitoba, Canada with whom she works closely in clinical care and research. She is the Principle Investigator of a birth cohort of children born to mothers and fathers diagnosed with childhood T2D (The Next Generation Cohort) examining the effects of in utero T2D exposure on growth, development and the natural history of T2D in offspring. She is the co-lead of the iCARE (Improving Renal Complications in Adolescents with Type 2 Diabetes through Research) cohort study which aims to determine modifiable risk factors in the natural history of diabetes related renal disease.

This is the seventh in a series of discussions introducing some of the programme sessions that will be featured at the IDF Congress 2019 in Busan, Korea, 2-6 December 2019.