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


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

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 prediabetes


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
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




Overall – 4-8 times more common
Prevalence varies by Area, Tribe
Prevalence of diabetes is increasing
Prevalence of diabetes is increasing in youth
Prevalence of Diagnosed Diabetes
AI/ANs compared to U.S. population
1980- 2004
20
AIAN
Percent
15
US
10
5
20
04
20
02
20
00
19
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
80
0
Year
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 diabetes
Adults, by age, race/ethnicity, and sex,
United States, 2003
50
Percent
40
30
White men
White women
20
Black men
Black women
Hispanic men
10
Hispanic women
AI/AN men
AI/AN women
0
20-44
45-64
65+
20+*
*Age-adjusted based on the 2000 U.S. population
Source: 2002-03 National Health Interview Survey and 2003 Indian Health Service outpatient data.
Prevalence of diagnosed diabetes among AIAN
children and young people, by age group,
1990-2004
50
Per 1000
160% increase
<15
15-19
40
20-24
30
25-34
20
94% increase
10
128% increase
77% increase
0
1990
1994
1998
Year
Source: IHS Diabetes Program Statistics
2001
2004
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
American Diabetes Association. Diabetes Care 2007; 30;(Suppl.1):S4-41.; Strong Heart Study
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
Schulz LO et al. Diabetes Care 29(8);2006
1990
Obesity Trends
2001
1990
Diabetes Trends
2001
BRFSS, 1990- 2001
NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.
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!



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 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 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
Public Health Approaches
to Diabetes
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 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 FoodSystem Change – Kibbe M. Conti RD CDE
Conti KM. Journal of Transcultural Nursing, July 2006
Developing Nutrition Models to Tell the Story of FoodSystem Change – Kibbe M. Conti RD CDE
Conti KM. Journal of Transcultural Nursing, July 2006
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

Questions
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