Diabetes in American Indian/Alaska Native Communities Yvette Roubideaux MD MPH Assistant Professor...
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Transcript of Diabetes in American Indian/Alaska Native Communities Yvette Roubideaux MD MPH Assistant Professor...
Diabetes in Diabetes in American Indian/Alaska Native American Indian/Alaska Native
CommunitiesCommunities
Yvette Roubideaux MD MPHYvette Roubideaux MD MPH
Assistant ProfessorAssistant Professor
College of MedicineCollege of Medicine
The University of ArizonaThe University of Arizona
OverviewOverview
Diabetes in American Indians and Diabetes in American Indians and Alaska NativesAlaska Natives
Traditional foodsTraditional foods
DiabetesDiabetes
A group of disease characterized by high A group of disease characterized by high levels of blood glucose (blood sugar)levels of blood glucose (blood sugar)
Common types of diabetesCommon types of diabetes Type 1 diabetes – 5-10%Type 1 diabetes – 5-10% Type 2 diabetes – 90-95%Type 2 diabetes – 90-95% Gestational diabetes – 7% of all pregnanciesGestational diabetes – 7% of all pregnancies
Diabetes is common and seriousDiabetes is common and serious can lead to serious health conditions and can lead to serious health conditions and
premature deathpremature death
NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.
U.S. Diabetes PrevalenceU.S. Diabetes Prevalence
In 2005In 2005 20.8 million people have 20.8 million people have diabetesdiabetes
14.6 million diagnosed with diabetes14.6 million diagnosed with diabetes 6.2 million undiagnosed6.2 million undiagnosed
54 million US adults age 20 and older have 54 million US adults age 20 and older have pre-diabetes
increased risk for diabetes and cardiovascular diseaseincreased risk for diabetes and cardiovascular disease
Prevalence is increasing over timePrevalence is increasing over time
NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.
Age-Adjusted Prevalence of Diagnosed Diabetes by Age-Adjusted Prevalence of Diagnosed Diabetes by
Race/Ethnicity and Sex, United States, 1980–2005Race/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 Diabetes in American Indians and Alaska Nativesand Alaska Natives
Overall – 4-8 times more commonOverall – 4-8 times more common Prevalence varies by Area, TribePrevalence varies by Area, Tribe Prevalence of diabetes is increasingPrevalence of diabetes is increasing Prevalence of diabetes is increasing in youthPrevalence of diabetes is increasing in youth
0
5
10
15
20
Year
Per
cen
t
AIAN
US
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.
1980- 20041980- 2004
Prevalence of Diagnosed DiabetesPrevalence of Diagnosed DiabetesAI/ANs compared to U.S. populationAI/ANs compared to U.S. population
Prevalence of diabetesAdults, by age, race/ethnicity, and sex,
United States, 2003
0
10
20
30
40
50
20-44 45-64 65+ 20+*
Per
cent White men
White women
Black men
Black women
Hispanic men
Hispanic women
AI/AN men
AI/AN women
*Age-adjusted based on the 2000 U.S. populationSource: 2002-03 National Health Interview Survey and 2003 Indian Health Service outpatient data.
Prevalence of diagnosed diabetes among AIAN Prevalence of diagnosed diabetes among AIAN children and young people, by age group, children and young people, by age group,
1990-20041990-2004
0
10
20
30
40
50
1990 1994 1998 2001 2004
<15
15-19
20-24
25-34
Per 1000
Source: IHS Diabetes Program Statistics
Year
160% increase
94% increase
128% increase77% increase
ComplicationsComplications
Higher rates of complications for AIANsHigher rates of complications for AIANs ESRD from diabetes – 6.8 times higherESRD from diabetes – 6.8 times higher Lower Extremity Amputations – 3 times higherLower Extremity Amputations – 3 times higher Cardiovascular disease – 2 times higherCardiovascular disease – 2 times higher Age-adjusted death rates – 4.3 times greaterAge-adjusted death rates – 4.3 times greater
Diabetes is the 4Diabetes is the 4thth leading cause of death leading cause of death
Risk Factors for DiabetesRisk Factors for Diabetes
Older ageOlder age Overweight (BMI ≥ 25)Overweight (BMI ≥ 25) Family HistoryFamily History Race/ethnicityRace/ethnicity History of gestational History of gestational
diabetesdiabetes Signs of insulin Signs of insulin
resistanceresistance Pre-diabetes Pre-diabetes
IGT or IFGIGT or IFG
HypertensionHypertension Abnormal lipid levelsAbnormal lipid levels History of vascular History of vascular
diseasedisease PCOSPCOS Inactive lifestyleInactive lifestyle
American Indians and American Indians and Alaska NativesAlaska Natives All of the above andAll of the above and Degree of Indian blood Degree of Indian blood
quantumquantum
American Diabetes Association. Diabetes Care 2007; 30;(Suppl.1):S4-41.; Strong Heart Study
Why is the prevalence of diabetes Why is the prevalence of diabetes so high in AIANs?so high in AIANs?
Some genetic/familial factorsSome genetic/familial factors Large role of environmental/lifestyle factorsLarge role of environmental/lifestyle factors
Lifestyles have changed over timeLifestyles have changed over time
Traditional ----------------------------Traditional ---------------------------- Western Western Increased ObesityIncreased Obesity
Decreased physical Decreased physical activityactivity
Example: Pima IndiansExample: Pima Indians
Pima Indians – Mexico vs. USPima Indians – Mexico vs. US
Pima Indians in Pima Indians in MexicoMexico Similar genetically to Similar genetically to
US Pima IndiansUS Pima Indians More “traditional” More “traditional”
lifestylelifestyle Lower obesityLower obesity Higher physical Higher physical
activityactivity Lower prevalence of Lower prevalence of
diabetesdiabetes
Schulz LO et al. Diabetes Care 29(8);2006
Obesity Obesity Trends1990 2001
Diabetes Trends1990 2001
BRFSS, 1990- 2001NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.
We’re Eating More!We’re Eating More!
Daily caloric intake Daily caloric intake increased by increased by 523523 calories from 1970 to calories from 1970 to 2003. 2003.
-- Bigger portion sizes Bigger portion sizes
-- More eating out/fast food More eating out/fast food consumptionconsumption
-- Fat-free foods perceived Fat-free foods perceived as low calorie as low calorie
Ernst N. Am J Clin Nutr 1997;66(suppl):965S-72S.
We’re Moving Less!We’re Moving Less!
More automation / More automation / less activity at less activity at work.work.
Less energy to get Less energy to get to work, school & to work, school & shop.shop.
Remote controls, Remote controls, drive-through drive-through windows, garage windows, garage door openers, etc.door openers, etc.
Risk Factors for DiabetesRisk Factors for Diabetes
Dependence on market or commercially Dependence on market or commercially prepared foodsprepared foods U.S. Commodity Food ProgramU.S. Commodity Food Program Special Supplemental Nutrition Program for Special Supplemental Nutrition Program for
Women, Infants and Children (WIC)Women, Infants and Children (WIC) Senior MealsSenior Meals School MealsSchool Meals Fast food restaurants, convenience storesFast food restaurants, convenience stores RestaurantsRestaurants
Why is the prevalence of diabetes Why is the prevalence of diabetes so high in AIANs?so high in AIANs?
Some genetic/familial factorsSome genetic/familial factors Large role of environmental/lifestyle factorsLarge role of environmental/lifestyle factors
Lifestyles have changed over timeLifestyles have changed over time
Traditional ----------------------------Traditional ---------------------------- Western Western Increased ObesityIncreased Obesity
Decreased physical Decreased physical activityactivity
Example: Pima IndiansExample: Pima Indians
Public Health Approaches to Public Health Approaches to DiabetesDiabetes
Special Diabetes Program for IndiansSpecial Diabetes Program for Indians
Balanced Budget Act 1997Balanced Budget Act 1997 $30 million per year x 5 years$30 million per year x 5 years Grants for prevention and treatment of diabetesGrants for prevention and treatment of diabetes IHS, tribal and urban Indian programsIHS, tribal and urban Indian programs Funded over 300 programsFunded over 300 programs
Funding increased and extended three timesFunding increased and extended three times $150 million per year through 2011$150 million per year through 2011 Variety of prevention and treatment activitiesVariety of prevention and treatment activities Outcomes – improved care for individuals with Outcomes – improved care for individuals with
diabetes, increased access to services, including diabetes, increased access to services, including prevention activitiesprevention activities
Special Diabetes Program for IndiansSpecial Diabetes Program for Indians
Two types of programs in placeTwo types of programs in place1) Community-directed programs (333)1) Community-directed programs (333)
Some programs chose to do prevention activitiesSome programs chose to do prevention activities
2) Competitive Demonstration Projects (66)2) Competitive Demonstration Projects (66) SDPI Diabetes Prevention ProgramSDPI Diabetes Prevention Program SDPI Healthy Heart ProjectSDPI Healthy Heart Project
Developing Nutrition Models to Tell the Story of Food-Developing Nutrition Models to Tell the Story of Food-System Change – Kibbe M. Conti RD CDESystem Change – Kibbe M. Conti RD CDE
Conti KM. Journal of Transcultural Nursing, July 2006
Developing Nutrition Models to Tell the Story of Food-Developing Nutrition Models to Tell the Story of Food-System Change – Kibbe M. Conti RD CDESystem Change – Kibbe M. Conti RD CDE
Conti KM. Journal of Transcultural Nursing, July 2006
Diabetes in AIANsDiabetes in AIANs
Serious problem for AIANsSerious problem for AIANs Risk factors include genetic and Risk factors include genetic and
environmental factorsenvironmental factors Changing lifestylesChanging lifestyles Change in physical activity, dietChange in physical activity, diet
Strategies to prevent and treatStrategies to prevent and treat Lessons from healthy traditionsLessons from healthy traditions Education about healthy foods/eating and Education about healthy foods/eating and
physical activityphysical activity
QuestionsQuestions
Contact InformationContact Information
Yvette Roubideaux MD MPHYvette Roubideaux MD MPH
The University of ArizonaThe University of Arizona
500 N. Tucson Blvd., #110500 N. Tucson Blvd., #110
Tucson AZ 85716Tucson AZ 85716
520-318-7280 phone520-318-7280 phone
[email protected]@u.arizona.edu