Diabetes in American Indian/Alaska Native Communities

1. Diabetes in American Indian/Alaska Native Communities Yvette Roubideaux MD MPH Assistant Professor College of Medicine The University of Arizona

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

3. 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.

4. 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.

5. 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.

6. 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

7. 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.

9. 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

10. 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

12. 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

13. 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

14. 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

15. Obesity Trends 1990 2001 Diabetes Trends 1990 2001 BRFSS, 1990- 2001 NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.

16. 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.

17. 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.

19. 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

20. 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

21. Public Health Approaches to Diabetes

22. 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

23. 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

25. Developing Nutrition Models to Tell the Story of Food-System Change – Kibbe M. Conti RD CDE Conti KM. Journal of Transcultural Nursing, July 2006

26. Developing Nutrition Models to Tell the Story of Food-System Change – Kibbe M. Conti RD CDE Conti KM. Journal of Transcultural Nursing, July 2006

30. 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

31. Questions

32. 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