Diabetes

Diabetes is an insidious, debilitating disease that affects nearly sixteen million people in the United States . It attacks the kidneys and heart, can cause blindness, limb amputation and has been linked to heart disease. In Indian Country it has reached epidemic proportions with over 107,000 Native Americans diagnosed with Type II diabetes. That is 14.5% of the Native American population (American Diabetes Association). Many more have yet to be diagnosed. Type II Diabetes is the fourth leading cause of death in Native Americans. Indians suffer from higher prevalence of complications associated with diabetes. Higher rates of diabetes in combination with a poorer prognosis have led to disproportionately high mortality rates in American Indian populations (Gilliland et. al 2002).

There is no cure for diabetes and the best recommendation at this time is prevention. The conclusion of the recent Strong Heart Study; “preventive programs must be designed and implemented” (2002 Diabetes Care 25:53). The following information is meant to provide information on resources available to communities and individuals. There are many preventions programs that have been implemented in Indian communities the following highlights just four. The hope is to present a sample of what can be done in Indian Country. Also, we hope they serve as a resource and spark in other communities.

Diabetes is a degenerative disease that owes much to lifestyle. Type 2 Diabetes is a metabolic disorder resulting from the body's inability to make enough insulin or to properly use insulin. It is the most common form and accounts for 90 to 95 percent of diabetes. Type 2 diabetes is nearing epidemic proportions (American Diabetes Association). Overall prevalence of Type 2 diabetes in Native Americans is 14 percent vs. 5.2 percent in the general population. In some tribes 50 percent of the population has diabetes (American Diabetes Association). The rates of type 2 diabetes among other indigenous groups world wide is on the rise. Type 2 diabetes is prevalent in groups that forty or fifty years ago had rarely reported any incidence of it, but now they are reporting high rates of the disease.

Diabetes also has major consequences for virtually every system in the body that may become chronic, debilitating, and costly to the health care system and quality of life. Besides cardiovascular disease, diabetes is a major risk factor for end stage renal disease, peripheral neuropathy, non-traumatic limb amputations, blindness, lipid abnormalities, impotence, periodontal disease, infections and depression. The duration of the disease is a major factor for the development of complications. This is a major concern for the increasingly younger age of onset of type 2 diabetes.

Type 2 diabetes is a disease that affects the body's ability to produce insulin. Insulin is a hormone that allows blood sugar to enter the cells of the body and be used for energy (American Diabetes Association). The symptoms of Type 2 diabetes are subtle and are not often apparent to the patient. As a result, approximately half of the population with Type 2 diabetes is unaware that they have the disease and by the time the disease is diagnosed secondary complications may have occurred. Some of the secondary complications include eye problems, high blood pressure, kidney failure, coronary heart disease, and loss of sensation in both hands and feet.

To address the epidemic of Type 2 diabetes in American Indians the Center for Disease Control has established the National Diabetes Prevention Center . NDPC is located in Gallup, NM. The goal of NDPC is to identify what works best in diabetes prevention models and to support community-based prevention efforts. The NDPC is attempting to move beyond traditional public health practices and seeks to encourage innovative and culturally rich approaches to diabetes prevention (Pegler et al 2003).

The purpose of NDPC is to develop and sustain alliances with local, regional, and national American Indian and Alaska Native organizations, other federal agencies, and nonprofit institutions to help build strong links and increase the capacity for diabetes care and prevention within American Indian communities. In 1999, in collaboration with IHS and other partners, the National Diabetes Education Program (NDEP) launched a diabetes awareness campaign, called "Control Your Diabetes for Future Generations," targeted to AI/ANs (available at http://ndep.nih.gov/conduct/psa-amerind.htm). More recently, NDEP launched the "Move It!" campaign to promote physical activity among Indian teens.

Exercise and Diet programs are pivotal in the prevention of diabetes the programs highlighted here encompass both diet and exercise within their structure. Diet is an environmental/ behavioral factor and is believed to play a significant role though the evidence for this is largely circumstantial. Research has shown that obesity is strongly related to the development of type 2 diabetes. Studies suggest that a Western lifestyle is associated with an adverse health profile and that the adverse metabolic consequences of modernization (colonization) might be reduced if a traditional life style is maintained (Williams et al, 2001). An adoption of an Anglo diet may increase the risk of developing diabetes in some Indian populations, but there is no definitive evidence at this time.

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