Battling the silent but devastating disease of diabetes within Indian Country

By Stacey Kiehn, THHS Public Information Officer

What is diabetes? It is a disease in which your blood glucose or sugar levels are too high. Glucose comes from the foods you eat. Insulin is a hormone that helps the glucose get into your cells, giving them energy. With Type 1 diabetes, your body does not make insulin. The more common type is Type 2 diabetes, where your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood.

Over time, having too much glucose in your blood can cause serious problems such as damage your eyes, kidneys, and nerves. Diabetes can also cause heart disease, stroke and even the need to remove a limb. Pregnant women can also get diabetes, called gestational diabetes.

Symptoms of Type 2 diabetes may include low energy, thirst, weight loss, blurred vision and frequent urination. Some people may not have symptoms. A blood test can show if you have diabetes. Exercise, weight control and sticking to your diet plan can help control your diabetes. You should also monitor your glucose level and take medicine if and as prescribed.

The growing prevalence and awareness of diabetes within Native American populations has acquired particular national concern. American Indians suffer from among the highest rates of the disease in the world. In some communities of Indian Country diabetes among adults is as high as 60 percent.

At one time this disease was exclusive to adults. Now Type 2 diabetes is becoming increasingly more common among American Indian youth. The interaction between hereditary, behavioral, and environmental factors has left American Indians especially vulnerable to the effects of this silent disease. Included in these factors are the genetic predisposition to diabetes, increasingly inactive lifestyles, exposure during pregnancy, and the effects of living in unfavorable social and physical environments.

Given the statistical epidemic proportions of this disease facing Native Americans and the increased concern for human and economic costs within the U.S., Congress implemented and funded the Special Diabetes Program for Indians. It is a $150 million per year program administrated by the Indian Health Service. Now in its tenth year the program provides funding for proven treatment and prevention services. Methods include patient education, quality diabetes care, and culturally-appropriate physical activity, nutrition, and weight management activities.

Congress directed the Indian Health Service to establish three main components of the Special Diabetes Program. The components encompass community-directed and priority-driven diabetes programs, demonstration projects, and enhancing the Indian Health Service diabetes data organization. Collectively this program has assisted various grant programs, Tribal leaders, and Indian Health Service with building one of the most calculated and comprehensive diabetes treatment and prevention programs in the United States.

Because diabetes is a constant illness affecting many organ systems throughout the body, treatment activities can be very expensive. Given the high, and increasing costs of diabetes, society has a great interest in ensuring that diabetes treatment and prevention activities aimed at controlling the disease, are cost effective and widely available. Offering treatment programs addressing lifestyle changes in community or group settings generate an overarching net cost savings for future health care.

Diabetes can shorten an individual's life span by 15 years and on average cost the person diagnosed with the disease $13,243 annually for medical care. The average cost of medical care for a person without diabetes is $2,560.The Indian Health Service Division of Diabetes Treatment and Prevention, has documented the following statistics illustrating the epidemic proportion of this silent disease within the Native American population:
    • 3.3 million Native Americans according to the 2007 U.S. census
    • 561 federally recognized American Indian tribes
    • 16.3% of American Indian adults have been diagnosed with diabetes (compared against the 8.7% of non-Hispanic Caucasian population)
    • 1,758 American Indian youth under the age of 19 diagnosed with diabetes.
    • 68% increase in diabetes from 1994 to 2004 in American Indian youth ages 15 to 19.
    • 95% of American Indians with diabetes who have Type II diabetes.
    • 30% of American Indians estimated to have pre-diabetes.
    • 2.2 times greater likelihood American Indians will have diabetes as compared to non-Hispanic Caucasians.
    • 58% increase in diabetes prevalence among American Indians aged 20 to 29 from 1990 through 1998, as compared with 9.1% in the U.S. general population.
    • 3 times higher death rate due to diabetes for American Indians compared with the general U.S. population.
    • 3.5 times higher rate of diabetes-related kidney failure in American Indians as compared to the general U.S. population.
    • 18.5% reduction in new cases of kidney failure in American Indians from 1999 to 2004.
    • 3 to 4 times higher risk for developing cardiovascular disease in American Indians with diabetes compared to American Indians without diabetes.
    • 66% of American Indians with cardiovascular disease had diabetes first.

To address the statistical concern of diabetes locally, the Tribal Health Department pursued and secured funding through the Special Diabetes Program for Indians. The department was one of 30 programs to receive special "Healthy Heart Project" funding to implement an intensive cardiovascular disease risk reduction program for people with diabetes. Tribal Health's "Native Heart Beat" program staff holds monthly one-on-one visits with participants to discuss diabetes health and management. An educational program and a number of community-wide activities complement the visits including culturally relevant healthy cooking classes to help people control their diabetes and prevent its complications.

Diabetes is a major risk factor for cardiovascular disease, otherwise known as heart disease, which affects the heart or blood vessels. The goal of the Native Heart Beat program is to assist diabetics reduce their risk of cardiovascular disease by reaching each individuals goals for their blood pressure, cholesterol, blood sugars, smoking, and weight. The established goals can be met by attending 10 sessions of "Honoring the Gift of Heart Health" classes; meeting with the case manager on a monthly basis to assist the individual and their doctor in meeting the desired goals; participating in both one-on-one and group exercise sessions; attending nutrition education classes; and if necessary, tobacco cessation programs.

The Native Heart Beat program has received national recognition and has been featured in a national health magazine, Diabetes Forecast. It is touted as one of the premier programs for the treatment and management of diabetes in the area. Those interested in participating in the program or who would like to obtain additional information can contact Tina Billedeaux at 745-3525, ext. 5079.