1. Diabetes in American Indian/Alaska Native Communities
Yvette Roubideaux MD MPH
Assistant Professor
College of Medicine
The University of Arizona

2. Overview Diabetes in American Indians and Alaska Natives
Traditional foods

3. Diabetes
A group of disease characterized by high levels of blood glucose (blood sugar)
Common types of diabetes
Type 1 diabetes – 5-10%
Type 2 diabetes – 90-95%
Gestational diabetes – 7% of all pregnancies
Diabetes is common and serious
can lead to serious health conditions and premature death
NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.

4. U.S. Diabetes Prevalence
In 2005
20.8 million people have diabetes
14.6 million diagnosed with diabetes
6.2 million undiagnosed
54 million US adults age 20 and older have pre-diabetes
increased risk for diabetes and cardiovascular disease
Prevalence is increasing over time
NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.

5. Age-Adjusted Prevalence of Diagnosed Diabetes by Race/Ethnicity and Sex, United States, 1980–2005
Data Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. U.S. Bureau of the Census, census of the population and population estimates.

6. Diabetes in American Indians and Alaska Natives
Overall – 4-8 times more common
Prevalence varies by Area, Tribe
Prevalence of diabetes is increasing
Prevalence of diabetes is increasing in youth

7. Prevalence of Diagnosed Diabetes AI/ANs compared to U.S. population
That is because, in spite of our best efforts and successes so far in treating diabetes, the epidemic of diabetes continues to increase. Although diabetes is also increasing in the U.S. population as a whole, the increase in the Indian population is even more dramatic, as we see in this chart showing the relative increases from 1980 to 2004 between the two populations.
Source: IHS Program Statistics and National Diabetes Surveillance System. Age-adjusted to the 2000 US standard population with the exception of 1981–1993 data for AIAN, which was age-adjusted to the 1980 US standard population.

9. Prevalence of diagnosed diabetes among AIAN children and young people, by age group, 1990-2004
Per 1000
160% increase
94% increase
128% increase
77% increase
Year
Source: IHS Diabetes Program Statistics

10. Complications Higher rates of complications for AIANs
ESRD from diabetes – 6.8 times higher
Lower Extremity Amputations – 3 times higher
Cardiovascular disease – 2 times higher
Age-adjusted death rates – 4.3 times greater
Diabetes is the 4th leading cause of death

12. Risk Factors for Diabetes
Older age
Overweight (BMI ≥ 25)
Family History
Race/ethnicity
History of gestational diabetes
Signs of insulin resistance
Pre-diabetes
IGT or IFG
Hypertension
Abnormal lipid levels
History of vascular disease
PCOS
Inactive lifestyle
American Indians and Alaska Natives
All of the above and
Degree of Indian blood quantum
American Diabetes Association. Diabetes Care 2007; 30;(Suppl.1):S4-41.; Strong Heart Study

13. Why is the prevalence of diabetes so high in AIANs?
Some genetic/familial factors
Large role of environmental/lifestyle factors
Lifestyles have changed over time
Traditional  Western
Increased Obesity
Decreased physical activity
Example: Pima Indians

14. Pima Indians – Mexico vs. US
Pima Indians in Mexico
Similar genetically to US Pima Indians
More “traditional” lifestyle
Lower obesity
Higher physical activity
Lower prevalence of diabetes
Schulz LO et al. Diabetes Care 29(8);2006

15. Obesity Trends Diabetes Trends
1990
2001
Diabetes Trends
1990
2001
These maps show the dramatic increase in obesity and diabetes in the United States from 1990 to 2001.
This increase is important because obesity is a major risk factor for type 2 diabetes and because about 55% of adults in the U.S. who have diabetes are also obese (CDC).
Reference
BRFSS, CDC 1990 – 2001.
Centers for Disease Control and Prevention. Prevalence of overweight and obesity among adults with diagnosed diabetes--United States, and MMWR. 2004;53:
BRFSS,
NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.

16. We’re Eating More!
Daily caloric intake increased by 523 calories from 1970 to 2003.
- Bigger portion sizes
- More eating out/fast food consumption
- Fat-free foods perceived as low calorie
Ernst N. Am J Clin Nutr 1997;66(suppl):965S-72S.

17. We’re Moving Less! More automation / less activity at work.
Less energy to get to work, school & shop.
Remote controls, drive-through windows, garage door openers, etc.

19. Risk Factors for Diabetes
Dependence on market or commercially prepared foods
U.S. Commodity Food Program
Special Supplemental Nutrition Program for Women, Infants and Children (WIC)
Senior Meals
School Meals
Fast food restaurants, convenience stores
Restaurants

20. Why is the prevalence of diabetes so high in AIANs?
Some genetic/familial factors
Large role of environmental/lifestyle factors
Lifestyles have changed over time
Traditional  Western
Increased Obesity
Decreased physical activity
Example: Pima Indians

21. Public Health Approaches to Diabetes

22. Special Diabetes Program for Indians
Balanced Budget Act 1997
$30 million per year x 5 years
Grants for prevention and treatment of diabetes
IHS, tribal and urban Indian programs
Funded over 300 programs
Funding increased and extended three times
$150 million per year through 2011
Variety of prevention and treatment activities
Outcomes – improved care for individuals with diabetes, increased access to services, including prevention activities

23. Special Diabetes Program for Indians
Two types of programs in place
1) Community-directed programs (333)
Some programs chose to do prevention activities
2) Competitive Demonstration Projects (66)
SDPI Diabetes Prevention Program
SDPI Healthy Heart Project

25. Developing Nutrition Models to Tell the Story of Food-System Change – Kibbe M. Conti RD CDE
Conti KM. Journal of Transcultural Nursing, July 2006

26. Developing Nutrition Models to Tell the Story of Food-System Change – Kibbe M. Conti RD CDE
Conti KM. Journal of Transcultural Nursing, July 2006

30. Diabetes in AIANs Serious problem for AIANs
Risk factors include genetic and environmental factors
Changing lifestyles
Change in physical activity, diet
Strategies to prevent and treat
Lessons from healthy traditions
Education about healthy foods/eating and physical activity

31. Questions

32. Contact Information
Yvette Roubideaux MD MPH
The University of Arizona
500 N. Tucson Blvd., #110
Tucson AZ 85716
phone