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

2. 33.5%
of Native Americans in Southern Arizona have been diagnosed with Diabetes Mellitus according to the CDC

3. Comparison of Native American Diabetes percentages with the Total United States population percentages.

4. 2.2x
More likely for American Indians and Alaska Natives to have diabetes compared with non-Hispanic whites
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5. 68%
Percent increase in diabetes from 1994 to 2004 in American Indian and Alaska Native youth aged years
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7. 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: Accessed July 5, 2016.

8. 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
First published: 24 July 2000
Assessed as up-to-date: 7 May 2000
Editorial Group: Cochrane Wounds Group
DOI: / CD002302View/save citation
Cited by: 36 articlesRefreshcitation countCiting literature
Lange, L. R. (1982). Orthotics and Prosthetics. Prosthetic Implications With The Diabetic Patient, 36(2), Retrieved July 5, 2016, from

9. Orthotics

10. 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), Retrieved July 5, 2016, from

11. Prosthetics

12. 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%
J. Lee et al. Lower-extremity amputation. Incidence, risk factors, and mortality in the Oklahoma Indian Diabetes Study- Diabetes Retrieved: June 30, 2016 from

13. 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.

14. 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

15. 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

16. Questions?!