"Type II diabetes (T2D) has become a serious health issue worldwide. Canada’s aboriginal populations exhibit an incidence of T2D that is 3 to 5 times higher than in the non-native Canadian population. This alarmingly high rate is due to numerous factors including genetic predisposition, adoption of a sedentary lifestyle, and an increase in the consumption of non-traditional foods. In addition, the risk of diabetes related complications is increased by a cultural resistance to modern pharmaceuticals.

An innovative and multi-disciplinary New Emerging Team was created in 2003 and funded by a CIHR grant ending March 2006. The CIHR Team proposal is a continuation of the NET project and will pursue its initial aim, namely to alleviate the devastating impact of this disease on Canadian aboriginal populations by using an innovative approach that is culturally adapted to the needs and beliefs of these populations. The proposed CIHR Team project will continue to be conducted in close collaboration with the Cree of Eeyou Istchee (CEI) in Northern Quebec, a population with an adult incidence rate of T2D that has almost tripled in the last decade (nearing 20%). Natural health products (NHP) traditionally used by the CEI to treat the symptoms of diabetes will be identified using a novel ethnobotanical approach and will be tested for anti-diabetic activity and safety using cell-based bioassays, animal models of diabetes, toxicological tests, and human clinical trials. NHP demonstrating significant anti-diabetic activity and safety will be further analyzed to identify active principles in order to develop standardized preparations for Cree diabetics. Nutritional surveys will also be conducted to assess the acceptance of NHP by the CEI. These surveys also provide information relating to the presentation of the standardized plant preparations that will be most readily accepted and will promote the best compliance. Such standardized and culturally-adapted NHP preparations will then be clinically assessed in a two-step approach. Firstly, observational studies will be carried out in several communities with Cree diabetics already self-administering traditional plant preparations provided by Elders/Healers. This study will ascertain the safety of the traditional remedies and will give some insight into their efficacy. A second set of pilot clinical studies will then target Cree newly diagnosed with diabetes who will be randomized to standardized plant preparations or inactive placebo in order to confirm safety and efficacy. Clinical studies will be carried out under close collaboration between Team clinicians and Elders/Healers. In parallel, a pilot health systems study will be carried out to evaluate the best ways to integrate Cree traditional medicine into the existing Cree diabetes programs. The latter currently feature a conventional westernized approach that generally fails, in large part because it is not culturally adapted and does not favour compliance by the population that it serves.

This project requires a highly coordinated effort between the CEI, research scientists, and health care professionals. Furthermore, interdependency between the communities and scientists as well as among the various laboratories that constitute the multi-disciplinary research team is essential for the project to achieve its double goal of rigorous evaluation and culturally-adapted integration. Community Elders/Healers as well as Public Health and other staff of the CEI will be involved in every aspect of the project. Additionally, the Team’s experienced research scientists will help Cree communities to establish local facilities for the processing and standardization of plant preparations. This will include the development of measures for quality assurance and the development of sustainable culture and production methods. The multi-disciplinary research team assembled for this project possesses considerable expertise in pharmacology, biochemistry, physiology, ethnobotany, nutrition, toxicology, phytochemistry, plant biology, human clinical as well as health systems research. Strengthened by the solid and respectful relationship built during then NET grant, the proposed CIHR Team is poised to tackle the challenges of advancing beyond the established rigorous ethnobotanical and pharmacological evaluations of traditional Cree NHP toward clinical studies and the integration of traditional medicine into diabetes care and education programs. Through such an innovative, multi-disciplinary, interdependent and community-based approach, the proposed CIHR Team aims to improve the health of diabetics of the CEI and to set a culturally-relevant example for other aboriginal populations across Canada "

Cree Translation of Project Description (with audio)