Diabetes mellitus among native Americans in Canada and the United States: An epidemiological review

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Abstract
Considerable ethnic variation in the prevalence of non–insulin-dependent diabetes mellitus (NIDDM) is recognized around the world and provides an interesting case study in the interaction of genetic and environmental factors in disease causation and distribution. Over the past one half century, numerous studies have shown that Native Americans, with some exceptions such as Arctic Eskimos and subarctic Athapaskan Indians, are generally a high risk group for NIDDM. There are, however, regional differences, reflecting the differential effects of genetic susceptibility, level of acculturation, and the contributions of specific risk factors such as physical activity, diet, and obesity. This paper reviews the extensive epidemiological, clinical, and anthropological literature on NIDDM among Native Americans in Canada and the United States. It discusses the extent and magnitude of the problem, etiology and risk factors, the public health impact of its serious complications, strategies for prevention and control, and current attempts to explain the prominence of this metabolic disorder among the indigenous inhabitants of the New World.