Presentation on theme: "Diabetes in American Indian/Alaska Native Communities"— Presentation transcript:
1 Diabetes in American Indian/Alaska Native Communities Yvette Roubideaux MD MPHAssistant ProfessorCollege of MedicineThe University of Arizona
2 Overview Diabetes in American Indians and Alaska Natives Traditional foods
3 DiabetesA group of disease characterized by high levels of blood glucose (blood sugar)Common types of diabetesType 1 diabetes – 5-10%Type 2 diabetes – 90-95%Gestational diabetes – 7% of all pregnanciesDiabetes is common and seriouscan lead to serious health conditions and premature deathNIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.
4 U.S. Diabetes Prevalence In 200520.8 million people have diabetes14.6 million diagnosed with diabetes6.2 million undiagnosed54 million US adults age 20 and older have pre-diabetesincreased risk for diabetes and cardiovascular diseasePrevalence is increasing over timeNIDDK, 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 commonPrevalence varies by Area, TribePrevalence of diabetes is increasingPrevalence of diabetes is increasing in youth
7 Prevalence of Diagnosed Diabetes AI/ANs compared to U.S. population That is because, in spite of our best efforts and successes so far in treating diabetes, the epidemic of diabetes continues to increase. Although diabetes is also increasing in the U.S. population as a whole, the increase in the Indian population is even more dramatic, as we see in this chart showing the relative increases from 1980 to 2004 between the two populations.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 1000160% increase94% increase128% increase77% increaseYearSource: IHS Diabetes Program Statistics
10 Complications Higher rates of complications for AIANs ESRD from diabetes – 6.8 times higherLower Extremity Amputations – 3 times higherCardiovascular disease – 2 times higherAge-adjusted death rates – 4.3 times greaterDiabetes is the 4th leading cause of death
12 Risk Factors for Diabetes Older ageOverweight (BMI ≥ 25)Family HistoryRace/ethnicityHistory of gestational diabetesSigns of insulin resistancePre-diabetesIGT or IFGHypertensionAbnormal lipid levelsHistory of vascular diseasePCOSInactive lifestyleAmerican Indians and Alaska NativesAll of the above andDegree of Indian blood quantumAmerican 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 factorsLarge role of environmental/lifestyle factorsLifestyles have changed over timeTraditional WesternIncreased ObesityDecreased physical activityExample: Pima Indians
14 Pima Indians – Mexico vs. US Pima Indians in MexicoSimilar genetically to US Pima IndiansMore “traditional” lifestyleLower obesityHigher physical activityLower prevalence of diabetesSchulz LO et al. Diabetes Care 29(8);2006
15 Obesity Trends Diabetes Trends 19902001Diabetes Trends19902001These maps show the dramatic increase in obesity and diabetes in the United States from 1990 to 2001.This increase is important because obesity is a major risk factor for type 2 diabetes and because about 55% of adults in the U.S. who have diabetes are also obese (CDC).ReferenceBRFSS, CDC 1990 – 2001.Centers for Disease Control and Prevention. Prevalence of overweight and obesity among adults with diagnosed diabetes--United States, and MMWR. 2004;53:BRFSS,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 calorieErnst 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 foodsU.S. Commodity Food ProgramSpecial Supplemental Nutrition Program for Women, Infants and Children (WIC)Senior MealsSchool MealsFast food restaurants, convenience storesRestaurants
20 Why is the prevalence of diabetes so high in AIANs? Some genetic/familial factorsLarge role of environmental/lifestyle factorsLifestyles have changed over timeTraditional WesternIncreased ObesityDecreased physical activityExample: Pima Indians
22 Special Diabetes Program for Indians Balanced Budget Act 1997$30 million per year x 5 yearsGrants for prevention and treatment of diabetesIHS, tribal and urban Indian programsFunded over 300 programsFunding increased and extended three times$150 million per year through 2011Variety of prevention and treatment activitiesOutcomes – improved care for individuals with diabetes, increased access to services, including prevention activities
23 Special Diabetes Program for Indians Two types of programs in place1) Community-directed programs (333)Some programs chose to do prevention activities2) Competitive Demonstration Projects (66)SDPI Diabetes Prevention ProgramSDPI Healthy Heart Project
30 Diabetes in AIANs Serious problem for AIANs Risk factors include genetic and environmental factorsChanging lifestylesChange in physical activity, dietStrategies to prevent and treatLessons from healthy traditionsEducation about healthy foods/eating and physical activity