• National prevalence of diabetes in adults was 7.4% 1995
• Prevalence among Native American adults >20 y/o ranges from 22 – 72%
• Incidence is increasing by 14% in US general population and is increasing by 46% in some Native American populations
  (American Journal of Public Health 2002 September; 92(9):1485-90.)

Why Such Prevalence in Native Americans? 

• Two Main theories (many factors)–Increased genetic susceptibility
• Population is genetically programmed to survive in fasting environment
• Consumption of more calorie rich diet then causes diabetes
• Diabetic Native Americans who consume a more traditional diet have better glucose tolerance–Fetal malnutrition/generational changes in the intrauterine environment
• Lower birth weight babies are much more likely to suffer from diabetes as adults
• Children of diabetic mothers have 4x increase in diabetes –From Medical Anthropology Vol. 20:25-64

Native Americans Suffer from more diabetes Complications 

• Incidence of 1st LE amputation in Native Americans men 20/1000
• Incidence of 1st LE amputation in rest of world < 10/1000
• BMI average of Native Americans with diabetes in Oklahoma and Arizona higher than other world populations
• Oklahoma Native Americans have highest rates of stroke, retinopathy, and proteinuria
  ( Data from WHO Multinational Study of Vascular Disease in Diabetes Diabetologia 2001 Sep 44;2:S3 - 13)

What can be done? 

• Success was defined as meeting standards of care diabetes care by chart audit
• Multidisciplinary team approach
• Coordinated clinic appointments with multiple providers on the same day
• Intensive individual nutritional counseling
• Diabetes registry
• Proactive preclinic preparation
• Case Manager with standing orders
• Strong self – management support
  (Diabetes Care: A Comparison of Management Systems. Alaska Medicine. 2000 Jan 42(1):13-9,27)
  

Native American Children & Diabetes
Among 15- to 19-year-old North American Indians, prevalence of type 2 diabetes per 1000 was 50.9 for Pima Indians, 4.5 for all US American Indians, and 2.3 for Canadian Cree and Ojibway Indians in Manitoba. From 1967-1976 to 1987-1996, prevalence increased 6-fold for Pima Indian adolescents. Among African Americans and whites aged 10 to 19 years in Ohio, type 2 diabetes accounted for 33% of all cases of diabetes. Youth with type 2 diabetes were generally 10 to 19 years old, were obese and had a family history of type 2 diabetes, had acanthosis nigricans, belonged to minority populations, and were more likely to be girls than boys. At follow-up, glucose control was often poor, and diabetic complications could occur early (Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al J Pediatr. 2000 May;136(5):664-72).