OBJECTIVE -This study provides an overview of the epidemiology of diabetes in the Manitoba First Nation population. RESEARCH DESIGN AND METHODS - The study uses data derived from the population-based Manitoba Diabetes Database to compare the demographic and geographic patterns of diabetes in the Manitoba First Nation population to the non-First Nation population. RESULTS -Although the prevalence of diabetes rose steadily in both the First Nation and the non-First Nation populations between 1989

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... and 1998, the epidemiological pattern of diabetes in these two populations differed significantly. The First Nation population was observed to have age-standardized incidence and prevalence rates of diabetes up to 4.5 times higher than those found in the non-First Nation population. The sex ratio and the geographic patterning of diabetes incidence and prevalence in the two study populations were reversed. CONCLUSIONS - The results of the study suggest that diabetes prevalence will likely continue to rise in the Manitoba First Nation population into the foreseeable future, and that the impact of this rising diabetes prevalence can only be effectively managed through a populationbased public health approach focusing on primary and secondary prevention. The dramatically higher rates of diabetes in Manitoba First Nation population as compared with the non-First Nation population highlight the urgency of this activity. These prevention efforts need to be supported by further research into the reasons for the unique epidemiological patterns of diabetes incidence and prevalence in the First Nation population observed in this study. These include investigating why First Nation populations living in the Northern areas of the province seem to be protected from developing high rates of diabetes and why First Nation women experience much higher rates of the disease.