AI/AN Communities Tackle Diabetes Through SDPI

by U.S. Medicine

November 14, 2010

WASHINGTON, DC—Established by Congress in 1997 to respond to the diabetes epidemic in Indian Country, the Special Diabetes Program for Indians (SDPI) provides funding for diabetes treatment and prevention services for IHS, Tribal, and Urban Indian health programs.

Current authorization provides $150 million per year for SDPI through September 30, 2011 and advocates are eager to see the funding reauthorized this year. “The SDPI has been overwhelmingly successful, however, there are so many initiatives competing for congressional funding that we can’t afford to assume that the SDPI will be automatically reauthorized. We have to continue to tell our SDPI stories of inspiration, hope, and progress that are transforming the health and well being of our tribal communities,” Gale Marshall, chair of the American Diabetes Association’s Awakening the Spirit Native American initiative, said of efforts to gain congressional support of a multi-year renewal of SDPI.

SDPI Tackles Diabetes

The importance of diabetes prevention in Indian Country is underscored by the high rate of diabetes among AI/AN. The IHS estimates that about 16% of American Indian and Alaska Native adults have diagnosed diabetes (compared with 8.7% of non-Hispanic whites).

The SDPI includes funding for its Community-Directed Diabetes Programs at more than 330 IHS, Tribal, and Urban Indian health programs, as well as for 30 grants for the Healthy Heart Demonstration Project and the 36 grants for the Diabetes Prevention Demonstration Project.

Through funding provided by the SDPI, AI/AN communities are able to fund programs to treat and prevent Type 2 diabetes. For example, through the Diabetes Prevention Project, demonstration project grantees are implementing curriculum from the Diabetes Prevention Program, a major clinical trial funded by NIH that demonstrated that individuals with pre-diabetes could prevent the onset of diabetes through modest weight loss and lifestyle changes. Grants are also awarded through the Community-Directed Diabetes Programs to communities to enhance or to begin local diabetes treatment and prevention programs.

Overall, leaders credit SDPI for helping to steadily improve blood sugar control in American Indians and Alaska Natives with diabetes since the inception of program. The mean LDL cholesterol level also decreased 17% in AI/AN with diabetes from 1998 to 2006.

Kelly Acton, MD, MPH, director, Division of Diabetes Treatment and Prevention at the IHS, also noted the program is making a difference in diabetes prevention for youth with more sites providing diabetes prevention programs targeting youth than when the program started. “We like to think that is movement in the right direction,” she said.

Building Programs

Diabetes expertise has continued to be built by the grantees over the 13 years of SDPI’s existence, Acton said. Some tribes were new to diabetes work when the program started 13 years ago and have now built up solid diabetes programs, she explained. “What we are doing is investing in infrastructure and investing in the long term expertise of diabetes in these communities and it doesn’t get built overnight … If you do it long enough, the system gets smarter and everyone who comes into the system as a new employee doesn’t have to start all over again, but learns this is the way we do diabetes here at x reservation or y facility.”

Acton said that the infrastructure built through the program allows it to rapidly roll out information to its providers. An example she cited of that was when IHS rolled out the results of the Diabetes Prevention Program. “We were able to roll out that information in our network through our network in a rapid time. It was because we had invested in building that network so we could get out the word to the providers.”

Lorraine Valdez, BSN, deputy director of the IHS Division of Diabetes Treatment and Prevention, noted that the demonstration projects over the last year were in “an intense data gathering mode” and that updated findings from the demonstration projects are expected. Significant achievements related to the demonstration projects are expected to be announced by HHS in the future.

Once the results are released, the hope is that more tribes will be inspired to adopt the practices and programs that were successful, Acton said. “We would love to see more and more tribes adopt the practices and programs that made those results come about because we are never going to get ahead of this epidemic until we prevent it.”

Marshall stressed that reauthorization of SDPI is important because there is much work left in addressing the epidemic, such as disseminating lessons learned over the last 13 years to more tribes across the country. “We have to be able to do that,” she said.

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