Dyck Roland F
Department of Medicine, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, Saskatchewan, Canada S7N 0W8
Kidney Int Suppl. 2005 Aug(97):S53-7. doi: 10.1111/j.1523-1755.2005.09709.x.
Saskatchewan aboriginal people are experiencing an epidemic of type 2 diabetes (T2DM) and diabetic end-stage renal disease (DESRD). The purpose of these investigations was to study the role of the intrauterine environment in the emergence of these diseases.
Epidemiologic studies were carried out using data from the Provincial Department of Health databases, the Saskatoon Health Region obstetrical unit, the Saskatchewan Renal Transplant Program, surveys of Saskatchewan aboriginal communities, and the Canadian Organ Replacement Registry. Parameters analyzed included rates, risk factors, and outcomes of T2DM, gestational diabetes (GDM), and DESRD; birth registration information; anthropometric measurements; and human leukocyte antigen profiles.
Aboriginal ethnicity is an independent predictor of GDM. High rates of GDM appear in remote aboriginal communities before the significant appearance of T2DM and are associated with increasing rates of high birth weight. A significant relationship between high-birth-weight rates and T2DM has strengthened over several decades. Finally, higher birth weights and older mother's age (both associated with GDM), and increased frequencies of the human leukocyte antigen-A2/DR4 and A2/DR8 haplotypes are associated with DESRD among aboriginal people.
It is likely that diabetic pregnancies play a key role in the initiation, progression, and perpetuation of the T2DM epidemic among Canadian aboriginal peoples, and may additionally increase the risk for DESRD. We speculate that an ancient survival advantage that promoted caloric conservation in young women and their unborn children is now a risk factor for prepregnancy obesity, GDM, and excess fetal nutrition. Infants are often large and have an increased risk for T2DM and its complications (hefty fetal-type hypothesis).
萨斯喀彻温省的原住民正经历2型糖尿病（T2DM）和糖尿病终末期肾病（DESRD）的流行。这些调查的目的是研究子宫内环境在这些疾病发生过程中的作用。
利用省级卫生部门数据库、萨斯卡通卫生区产科病房、萨斯喀彻温省肾脏移植项目、萨斯喀彻温省原住民社区调查以及加拿大器官替代登记处的数据进行流行病学研究。分析的参数包括T2DM、妊娠期糖尿病（GDM）和DESRD的发病率、危险因素及结局；出生登记信息；人体测量数据；以及人类白细胞抗原谱。
原住民种族是GDM的独立预测因素。在T2DM显著出现之前，偏远的原住民社区中GDM发病率较高，且与高出生体重发生率增加相关。几十年来，高出生体重发生率与T2DM之间的显著关系不断增强。最后，较高的出生体重和母亲年龄较大（均与GDM相关），以及人类白细胞抗原 - A2/DR4和A2/DR8单倍型频率增加与原住民中的DESRD相关。
糖尿病妊娠可能在加拿大原住民T2DM流行的起始、进展和持续过程中起关键作用，并且可能还会增加患DESRD的风险。我们推测，一种促进年轻女性及其未出生胎儿热量保存的古老生存优势，现在成为了孕前肥胖、GDM和胎儿营养过剩的风险因素。婴儿往往体型较大，患T2DM及其并发症的风险增加（巨大胎儿型假说）。
