title: Best Practices for the Prevention and Management of Diabetes and Obesity-Related Chronic Disease among Indigenous Peoples in Canada: A Review.
abstract: OBJECTIVE
  To carry out a systematic review of interventions that have aimed at improving screening, treatment, prevention and management of type 2 diabetes and obesity-related chronic disease in Indigenous communities in Canada from 2008 to 2014, with the aim of identifying current best practices.
  
  
  METHODS
  A comprehensive literature review was carried out through an electronic database search using Medline, EMBASE, PubMED and Google scholar.
  
  
  RESULTS
  We identified 17 publications, comprising 13 evaluated interventions. Of them, 7 were school-based programs focused on children, 5 focused on adults, and 1 included both adults and children. Most interventions aimed at encouraging behaviour change, especially dietary change, but did little to address the underlying context of systemic marginalization and colonialism experienced in many Indigenous communities. Interventions focused on improving fitness were more effective than those aimed at dietary change. Overall, we found a range of successes among these interventions. Those that met with limited success reported that complex social issues and poverty presented challenges to effective intervention work in these communities. Participatory action research methods and community ownership of the intervention were found to be essential for project success.
  
  
  CONCLUSIONS
  Diabetes-focused intervention research in Indigenous communities appears to be a low priority for Canadian funders and policymakers. More intervention research is urgently needed in these communities. To be effective, this work must take an approach that is historically deep and sufficiently broad as to enable the ideologic, policy and institutional changes necessary in order to achieve true equity. This will involve addressing colonialism, racism and social exclusion as broader determinants of health.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: kathleen.rice@mail.utoronto.ca.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Rice
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
authors.forename: Braden
authors.initials: B
authors.lastname: Te Hiwi
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
authors.forename: Merrick
authors.initials: M
authors.lastname: Zwarenstein
authors.affiliation: Department of Medical Education, College of Medicine, Faculty of Health Sciences, University of Manitoba, Manitoba, Canada.
authors.forename: Barry
authors.initials: B
authors.lastname: Lavallee
authors.affiliation: Department of Health Sciences and Emergency Management, School of Professional Studies, Cape Breton University, Sydney, Nova Scotia, Canada.
authors.forename: Douglas Edward
authors.initials: DE
authors.lastname: Barre
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
authors.forename: Stewart B
authors.initials: SB
authors.lastname: Harris
mesh_terms: D002170:Canada; D003920:Diabetes Mellitus / Q000208:ethnology / Q000517:prevention & control*; D006303:Health Services, Indigenous; D006801:Humans; D007198:Indians, North American; D009765:Obesity / Q000150:complications / Q000208:ethnology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012959:Socioeconomic Factors
keywords: Indigenous; Indigène; best practices; diabetes; diabète; les meilleures pratiques; prevention; prévention; review; revue; traitement; treatment