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DIABETES

ISSUE

American Indians and Alaska Natives (AI/AN) have the highest rates of type 2 diabetes in the United States. Once exclusively a disease of adults, type 2 diabetes is increasingly common among AI/AN youth, threatening the health, well-being, and quality of life of future generations. Diabetes prevention efforts are an urgent priority, as well as diabetes management to prevent complications.

BACKGROUND

For three decades, the IHS has served as a leader in the fight against the diabetes epidemic in AI/AN communities, earning national and international recognition for diabetes quality improvement. Major accomplishments include developing monitoring systems of diabetes clinical care, such as the Annual IHS Diabetes Care and Outcomes Audit , and creating diabetes surveillance systems for tracking diabetes prevalence and complications. The IHS Division of Diabetes Treatment and Prevention (DDTP) has also developed and mobilized an extensive network to conduct diabetes treatment and prevention programs and activities throughout the Indian health system. Given the limited resources available for diabetes care, the IHS focuses on applying scientifically proven methods to prevent the onset of diabetes and costly diabetes-related complications such as cardiovascular, eye, nerve, and kidney disease.

SITUATION

In the Balanced Budget Act of 1997, Congress established the Special Diabetes Program for Indians (SDPI) and provided $150 million over 5 years for “the prevention and treatment of diabetes in American Indians and Alaska Natives.” Funds were reauthorized for fiscal years (FY) 2004-2009 at $150 million per year, with another $150 million per year authorized through FY 2011. The IHS established three major components of the SDPI that are administered by the IHS DDTP. Currently, 333 community-directed diabetes programs in 35 states are implementing diabetes treatment and prevention programs that address local community priorities. Another 66 demonstration projects, awarded through a competitive grant program, are translating the science of diabetes prevention and cardiovascular risk reduction into real world applications. In addition, the SDPI supports the design and implementation of health information systems to improve AI/AN data collection and analysis.

Diabetes health outcomes have improved significantly in AI/AN communities since the inception of the SDPI. One of the most important improvements is a 13 percent decrease in the mean blood sugar level (A1C) of AI/ANs with diagnosed diabetes, a major achievement over 12 years.  Decreases of this magnitude translate to a 40% reduction in diabetes-related complications.  As shown in the chart, A1C levels decreased in all age groups.

OPTIONS/PLANS

The IHS Division of Diabetes continues to strengthen the IHS diabetes infrastructure at the Headquarters and Area office levels to maintain and improve diabetes surveillance, technical assistance, provider networks, and clinical monitoring. In addition, the IHS Area Diabetes Consultants provide technical support to diabetes programs in their respective Areas by supporting culturally sensitive and focused prevention and treatment programs. A rigorous evaluation model for the SDPI also has been developed.

ADDITIONAL INFORMATION

For referral to the appropriate spokesperson, contact the IHS Public Affairs Staff at 301-443-3593.

June 2009