Diabetes Mellitus: In Native American Populations Kelcii Fisher & Lauren Geer

33.5% of Native Americans in Southern Arizona have been diagnosed with Diabetes Mellitus according to the CDC http://www.cdc.gov/media/matte/2011/11_diabetes_Native_American.pdf

Comparison of Native American Diabetes percentages with the Total United States population percentages. http://blogs.cornell.edu/foodstories/2013/11/16/physical-properties-biology-versus-land/

2.2x More likely for American Indians and Alaska Natives to have diabetes compared with non-Hispanic whites http://www.diabetes.org/living-with-diabetes/treatment-and-care/high-risk-populations/treatment-american- indians.html?referrer=https://www.google.com/#sthash.YfgqrFFK.dpuf

68% Percent increase in diabetes from 1994 to 2004 in American Indian and Alaska Native youth aged 15-19 years http://www.diabetes.org/living-with-diabetes/treatment-and-care/high-risk-populations/treatment-american- indians.html?referrer=https://www.google.com/#sthash.YfgqrFFK.dpuf

http://www.familydocs.org/f/CDC%20Diabetes%20fact%20sheet-2011.pdf

Typical Progression of the Diabetic Foot Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both Elevated blood glucose levels over times leads to damage of nerves and blood vessels Damage in the nerves leads to neuropathy Damage occurs distal to proximal and smaller vessels first. Due to numbness: patients don’t feel cuts/ blisters which leads to infection. Unequal weight bearing on plantar surface of the foot leads to ulceration. Vascular damage inhibits normal healing, making healing times slow or unable to heal at all. If ulcer/ infection cannot be controlled amputation is next course of action. Available at: https://www.nlm.nih.gov/medlineplus/diabeticfoot.html. Accessed July 5, 2016.

Prosthetic Implications with the Diabetic Patient Most Conservative Treatment: Special Shoes: designed to make neuropathic diabetic patients weight bear properly through the plantar surface of the foot. Study shows absent sural nerve action potentials in 95% of participants Inexcitability of small foot muscles secondary to neuropathy → foot deformity and weight distribution. Inserts: designed to redistribute pressure. Allows for less weight bearing on ulcers to promote healing http://care.diabetesjournals.org/content/11/1/8.short First published: 24 July 2000 Assessed as up-to-date: 7 May 2000 Editorial Group: Cochrane Wounds Group DOI: 10.1002/14651858.CD002302View/save citation Cited by: 36 articlesRefreshcitation countCiting literature Lange, L. R. (1982). Orthotics and Prosthetics. Prosthetic Implications With The Diabetic Patient, 36(2), 96-102. Retrieved July 5, 2016, from http://www.oandplibrary.org/op/pdf/1982_02_096.pdf

Orthotics

Amputations The Doppler Ultrasound device is used to detect the amount of blood flow through the vessels. This determines the most appropriate level of amputation Conservative Amputations: Affected toe amputation Transmetatarsal amputation Major Amputations: Symes amputation-amputation through the ankle joint (foot is removed but heel pad is saved) Below-the-knee-amputation Above-the-knee-amputation Lange, L. R. (1982). Orthotics and Prosthetics. Prosthetic Implications With The Diabetic Patient, 36(2), 96-102. Retrieved July 5, 2016, from http://www.oandplibrary.org/op/pdf/1982_02_096.pdf

Prosthetics

Lower-Extremity Amputation: Incidence, Risk Factors, and Mortality in the Oklahoma Indian Diabetes Study Study of 875 Native Americans in Oklahoma Looked at incidence and risk factors for LE amputation Found: Incidence rate of LEA after 10 years after dx was 18/1000 cases per year 2x higher rate in men than women Significant risk factors were retinopathy and duration of diabetes 5 year survival rate after first amputation was 40.4% http://diabetes.diabetesjournals.org/content/42/6/876.article-info J. Lee et al. Lower-extremity amputation. Incidence, risk factors, and mortality in the Oklahoma Indian Diabetes Study- Diabetes - 1993. Retrieved: June 30, 2016 from http://diabetes.diabetesjournals.org/content/42/6/876.article-info.

Significance in Native American Populations Rate of juveniles with type II diabetes is rising dramatically. One of the most significant risk factors for amputation is duration of diabetes. If the trend continues we can expect even higher rates of diabetes in children and amputations as a result. We should be ready to meet the needs of this patient population.

Prevention Education: Explain the etiology of the disease Prepare them for signs/symptoms of the disease Healthy eating; understanding how food affects blood glucose levels Recommend community group physical activity participation Foot care programs-Make good habits! Check your feet every day AND wash your feet every day Keep the skin soft and smooth, remove corns and calluses gently Wear shoes and socks at all times and protect your feet from hot and cold Early detection of lesions Diabetic Foot ulcers http://link.springer.com/article/10.2165/00003495-200666070-00003#/page-1 http://jama.jamanetwork.com/article.aspx?articleID=200119 https://www.nlm.nih.gov/medlineplus/diabeticfoot.html

American Indian Diabetes Preventions Programs National Institute of Diabetes and Digestive, and Kidney Diseases: Diabetes Prevention Program goals were: Achieve 7% weight loss Exercise 2.5 hours/wk Decrease total caloric intake and the amount of fat consumed Learn ways to overcome barriers to healthy eating and exercise to achieve success National Indian Health Board: SDPI (Special Diabetes Program for Indians) currently provides 404 grant programs in 35 states Focuses on decreasing average blood glucose levels, reducing cardiovascular disease, and educating on prevention and weight management programs for youth; there is a significant increase in promoting health lifestyle behaviors https://www.ihs.gov/MedicalPrograms/Diabetes/?module=programsSDPI http://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/message-hope-prevent-diabetes-native-american-communities/Pages/default.aspx http://www.nihb.org/sdpi/

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