NIDDM-Y in First Nation children in Canada

Prevalence of NIDDM-Y in children in many First Nations communities in Manitoba and northwestern Ontario is now severalfold greater than the prevalence of IDDM in the general pediatric population. Rates vary among First Nations communities in Canada owing to inconsistent screening programs and different genetic risk. The number of undiagnosed, asymptomatic cases is predicted to be at least 2x greater than the known cases. Serious complications of diabetes are known to occur in the early third decade of life and within 10 years of diagnosis. Long-term follow-up data are scarce. Nonpharmacologic management in youths has been successful in short-term studies but generally unsuccessful in achieving long-term acceptable glycemic control. The safety and efficacy of pharmacologic interventions have not been proven in this age group, particularly the prepubertal group. NIDDM-Y fits the WHO criteria for a disease appropriate for screening. There is an urgent need for consistent community-based screening programs and randomized controlled trials of pharmacologic interventions to test the safety and efficacy of these agents in primary prevention and secondary prevention of complications in youths.