The need for such a program targeting the Native population is clear, she said.

“Type 2 diabetes has quickly emerged as one of the most serious and devastating health problems of our time; although the growing diabetes epidemic threatens populations around the world, American Indians and Alaska Natives suffer disproportionately from the highest rates of diabetes in the United States,” she pointed out. In some communities, Valdez noted, more than half of adults age 18 and older have diagnosed diabetes, with prevalence rates reaching as high as 60% and greater.  

IHS Director meets with Tribal Leaders Diabetes Committee The Tribal Leaders Diabetes Committee (TLDC) met recently with Yvette Roubideaux - Indian Health Service Director to develop a new strategic plan for the Special Diabetes Program for Indians. Photo from IHS website.

With such a high prevalence, it’s tempting to say that the increased risk is due to being American Indian, but Valdez said it’s not as simple as that. “There is some science that points to some genetic component, but it’s not as simple as saying, ‘I have a family history, so I’m going to get it,’” she explained. “Obesity (the greatest risk factor for Type 2 diabetes) is more prevalent in some tribal communities than in others.”

There was a time, she added, when the prevalence of Type 2 diabetes was very low in the Alaska area, as was obesity. “But since they became ‘civilized,’ you could blame fast-food for the increase,” she said.

With the growing challenge of obesity among children, they are now being targeted as well.

“With the programs we have in place, there are quite a few of them that have activities targeted at kids, like physical activity or weight management for obese kids and their families,” said Valdez, adding that the IHS is working under an initiative that is part of First Lady Michele Obama’s “Let’s Move” program.

Significant results achieved

The results of the demonstration project give Valdez and others hope that progress is being made. Using a method adapted for Native patients, people at risk for diabetes were encouraged to lose weight through increased physical activity, healthy eating habits and individual and group coaching. On average, those who completed the follow-up assessment had a significantly reduced eight-year risk of developing diabetes, she reported.

“The diabetes incidence rate of participants (4.3% per year), when compared to the NIH Diabetes Prevention Program study, was similar to the NIH study’s lifestyle intervention group and lower than the placebo group (11% per year) in that study,” she observed. Enrollees also achieved significant weight loss, increased physical activity, improved consumption of healthy foods, lower blood pressures, lower glucose levels and improved health-related quality of life at the follow-up and annual assessments compared with baseline.

A concurrent SDPI Healthy Heart Demonstration Project was funded in 30 IHS, tribal and urban Indian health programs to implement an intensive, clinic-based case management intervention to reduce cardiovascular disease risk factors in individuals with diabetes. Enrollees who completed the follow-up assessment had a significantly reduced 10-year risk of developing coronary heart disease. They also had significant improvements in meeting goals for control of blood pressure and blood glucose and achieved improved lipid profiles. For example, the percent of enrollees with blood pressures < 130/80 mmHg increased from 42% at baseline to 49% at the first annual assessment. Enrollees also achieved increased physical activity, increased use of aspirin, and more became non-smokers from baseline to annual assessments.