The prevalence of type 2 diabetes (T2D) among Indigenous Canadians has been alarmingly high for decades. ​​Diabetes rates for First Nations individuals living on-reserve are as high as 17.2 per cent, compared to five per cent of the general population. 

The difference isn’t rooted in individual behaviours alone; it reflects a ‘colonial epidemic’ of T2D, driven by the historical and ongoing impacts of colonization, cultural disruption, structural inequities, and intergenerational trauma.

What is T2D?

Insulin is the hormone that helps move glucose, or sugar, from the bloodstream into the cells for energy. T2D is a chronic condition in which the body becomes resistant to or does not produce enough insulin to keep blood glucose at normal levels. When glucose builds up in the blood instead of being absorbed by the cells, it can lead to serious health problems over time, including heart disease, kidney damage, and nerve damage.

Unlike type 1 diabetes, where the body’s immune system destroys insulin-producing cells, T2D develops gradually and is influenced by both genetic factors and social and environmental conditions. Social factors can include chronic stress, access to healthy foods, opportunities for physical activity, and socioeconomic barriers. While many people can manage T2D with healthy eating, regular exercise, and weight loss, others may additionally require medication or insulin therapy to maintain safe blood glucose levels.

Genetics, environment and intergenerational effects

The elevated T2D rates in Indigenous populations cannot solely be attributed to genetic predisposition, which is an inherited tendency that makes one more likely to develop a certain condition. A 2016 study from Queen’s University suggests that a potential biological contributor could be the ‘thrifty genotype’ hypothesis, where genes that promoted efficient energy storage during times of famine could now lead to obesity and T2D in modern, resource-rich environments.

But these scientific interpretations cannot be separated from historical context, which shows that abrupt lifestyle changes were forced on communities through colonization.  

Prior to widespread colonization, many Indigenous communities relied on nutrient-rich, physically active, and land-based harvesting lifestyles. These systems were targeted under colonial rule and have been significantly reduced. This shift has been compounded with food insecurity in Indigenous communities — which have limited food options, particularly healthy ones — and limited support that can result in a sedentary lifestyle and the overconsumption of highly processed, available foods.

Moreover, a 2018 study from the University of Manitoba suggests that prenatal and early-life exposures to T2D matter. In Indigenous communities with high rates of gestational diabetes — a type of diabetes that develops during pregnancy — children may face an elevated risk of T2D earlier in life, creating intergenerational cycles of disease. 

Ultimately, the elevated pattern in TD2 rates in Indigenous communities arises from a combination of genetic influences and the long-lasting colonial disruptions of their environment, diet, social structure, and culture.

Colonial legacies and health inequities

When the Canadian government established the reserve system, it outlawed Indigenous peoples’ ways of gathering resources, stifling their ability to use their land and food sources. These actions disrupted longstanding systems of hunting, harvesting, and community care, leading to current issues like food insecurity, poverty, and limited access to traditional foods. 

The residential school system, discriminatory legislation from the Canadian government, and underfunding of Indigenous healthcare, education, and community, have left enduring scars on the health and well-being of Indigenous communities. These scars continue to impact the social, economic, and environmental conditions that contribute to the higher prevalence of T2D within Indigenous communities today.

Socio-economic disadvantages also play a major role: higher poverty rates, food insecurity, inadequate housing, and limited access to safe recreational spaces compromise healthy living practices, which increase a person’s risk for T2D. These disadvantages have also led to cultural disruption that fundamentally affects health. 

One study from the University of Alberta in 2014 demonstrates that First Nations communities with stronger preservation of Indigenous languages and cultural practices have lower diabetes prevalence, highlighting how cultural continuity may be linked to protecting communities from health inequities. 

These inequities extend into the health-care system as well. Indigenous patients with diabetes often face structural barriers and discriminatory care environments shaped by colonial histories, which can lead to reduced trust, less communication with providers, and worse outcomes overall.

What policy and health-care interventions can help address high T2D rates?

Addressing the high rates of T2D in Indigenous communities requires policy and healthcare interventions that are multi-layered, culturally grounded, and comprehensive. 

Access to and trust in the healthcare system are deeply shaped by colonialism. Research on Canadian health care systems from 2017 shows that healthcare systems rooted in non-Indigenous biomedical models often lack cultural safety, autonomy, and respect for Indigenous knowledge. 

Community-designed, culturally rooted programs — such as Diabetes Action Canada’s Indigenous patient circles and youth mentorship initiatives — can strengthen engagement and prevention efforts for T2D. 

Beyond clinical care, policy must address the social determinants of health that drive diabetes risk in Indigenous communities. This includes improving food security and expanding access to traditional, nutritious foods. Policies should also tackle broader structural issues while strengthening education, employment opportunities, and community empowerment.

Access to early screening is also essential, particularly given the earlier onset and greater severity of diabetes in many Indigenous communities. Diabetes Canada recommends more frequent screening for at-risk individuals and ensuring follow-up care is accessible within their own communities. 

At the cultural level, programs that support Indigenous language, identity, land-based activities, and traditional food practices have benefitted Indigenous patients. The path forward is indigenization in health, meaning Indigenous decision-making, interventions based on community priorities, and recognition of Indigenous rights.

The high prevalence of T2D among Indigenous peoples in Canada is more than a medical statistic; it is a marker of centuries-old injustices, disrupted ways of life, and ongoing structural inequities. The ‘colonial epidemic’ of T2D speaks to how historical policies left deep imprints on Indigenous health that pass down through generations.

Addressing the high rates of T2D in Indigenous communities demands more than generic clinical care. It requires policy that revitalizes culture, promotes economic and food security, and brings Indigenous voices to the forefront of the design and implementation of health solutions.