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Diabetes in American Indian/Alaska Native Communities. Yvette Roubideaux MD MPH Assistant Professor College of Medicine The University of Arizona. Overview. Diabetes in American Indians and Alaska Natives Traditional foods. Diabetes.

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diabetes in american indian alaska native communities

Diabetes in American Indian/Alaska Native Communities

Yvette Roubideaux MD MPH

Assistant Professor

College of Medicine

The University of Arizona

overview
Overview
  • Diabetes in American Indians and Alaska Natives
  • Traditional foods
diabetes
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.

u s diabetes prevalence
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.

age adjusted prevalence of diagnosed diabetes by race ethnicity and sex united states 1980 2005
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.

diabetes in american indians and alaska natives
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
slide7

Prevalence of Diagnosed Diabetes

AI/ANs compared to U.S. population

1980- 2004

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.

prevalence of diagnosed diabetes among aian children and young people by age group 1990 2004
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

complications
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
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

Risk Factors for Diabetes

American Diabetes Association. Diabetes Care 2007; 30;(Suppl.1):S4-41.; Strong Heart Study

why is the prevalence of diabetes so high in aians
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

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

Pima Indians – Mexico vs. US

Schulz LO et al. Diabetes Care 29(8);2006

obesity trends
Obesity Trends

1990

2001

Diabetes Trends

1990

2001

BRFSS, 1990- 2001

NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.

we re eating more
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.

we re moving less
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.
risk factors for diabetes1
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
why is the prevalence of diabetes so high in aians1
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

special diabetes program for indians
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
special diabetes program for indians1
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
developing nutrition models to tell the story of food system change kibbe m conti rd cde
Developing Nutrition Models to Tell the Story of Food-System Change – Kibbe M. Conti RD CDE

Conti KM. Journal of Transcultural Nursing, July 2006

developing nutrition models to tell the story of food system change kibbe m conti rd cde1
Developing Nutrition Models to Tell the Story of Food-System Change – Kibbe M. Conti RD CDE

Conti KM. Journal of Transcultural Nursing, July 2006

diabetes in aians
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
contact information
Contact Information

Yvette Roubideaux MD MPH

The University of Arizona

500 N. Tucson Blvd., #110

Tucson AZ 85716

520-318-7280 phone

yvetter@u.arizona.edu