Diabetes in Canada's First Nations
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* Bruce N. Leistikow

Major tobacco companies have long recognized that tobacco use may cause hyperglycemia.1,2 Current or lifetime smoking or use of smokeless tobacco is very likely to cause diabetes as well as many of the severe complications experienced by tobacco users who have diabetes.3,4,5 

Approximately one-quarter of diabetes cases among Canada's First Nations could be attributed to smoking, even assuming relative risks (RR) of smoking-related diabetes as low as 1.5 and a smoking prevalence among First Nations populations of 64% (1/4 = [(RR – 1) × prevalence]/[1 + (RR – 1) ×prevalence]).6 Given that tobacco use probably plays a leading role in causing type 2 diabetes and its complications, I hope that physicians, researchers, governments and tobacco packagers will soon better inform the public about tobacco's roles in diabetes. 

## References

1.  1. *Nicotine review*. London (UK): British American Tobacco; 1983. Available: outside.cdc.gov :8080 /BASIS/ncctld/web/mnimages/DDW?W =DETAILSID=26903 (accessed 2000 Aug 29). 
    
    

2.  2. Wakeham H. Presentation and report to the Philip Morris, Inc., board of directors. Minnesota and Minnesota Blue Cross v. Philip Morris et al trial exhibit 10299, 1969. Available: [www.mnbluecrosstobacco.com/toblit/trialnews/](http://www.mnbluecrosstobacco.com/toblit/trialnews/) docs/TE10299.pdf (accessed 1998 Feb 24). 
    
    

3.  3. Persson P, Carlsson S, Svanstrom L, Ostenson C, Efendic S, Grill V. Cigarette smoking, oral moist snuff use and glucose intolerance. J Intern Med 2000;248(2):103-10. 
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1046/j.1365-2796.2000.00708.x&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=10947888&link_type=MED&atom=%2Fcmaj%2F164%2F8%2F1126.2.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000088807200002&link_type=ISI) 

4.  4. Nakanishi N, Nakamura K, Matsuo Y, Suzuki K, Tatara K. Cigarette smoking and risk for impaired fasting glucose and type 2 diabetes in middle-aged Japanese men. Ann Intern Med 2000;133(3):183-91. 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=10906832&link_type=MED&atom=%2Fcmaj%2F164%2F8%2F1126.2.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=000088449400003&link_type=ISI) 

5.  5. Rimm EB, Manson JE, Stampfer MJ, Colditz GA, Willett WC, Rosner B, et al. Cigarette smoking and the risk of diabetes in women. Am J Public Health 1993;83(2):211-4. 
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.2105/AJPH.83.2.211&link_type=DOI) 
    
    [PubMed](http://www.cmaj.ca/lookup/external-ref?access_num=8427325&link_type=MED&atom=%2Fcmaj%2F164%2F8%2F1126.2.atom) 
    
    [Web of Science](http://www.cmaj.ca/lookup/external-ref?access_num=A1993KW27300009&link_type=ISI) 

6.  6. Young TK, Reading J, Elias B, O'Neil JD. Type 2 diabetes mellitus in Canada's First Nations: status of an epidemic in progress. CMAJ 2000; 163 (5):561-6. 
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjMvNS81NjEiO3M6NDoiYXRvbSI7czoyMzoiL2NtYWovMTY0LzgvMTEyNi4yLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)