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The Deal with Diabetes

If you can draw to mind one of those medical forms that doctors’ offices require patients to fill out, you’ll remember the section on family medical history.  The check marks in mine would include Diabetes, Cancer, and Gallbladder issues.  These medical conditions aren’t simply common to my family members but to the American Indian population at large.  To be more specific, American Indians and Alaskan Natives are 2-3 times more likely to have diabetes than the overall American society.  With severe complications such as lower-extremity amputation, kidney failure, blindness, cardiovascular disease, and even premature death diabetes is not to be taken lightly.  That is why this blog entry is devoted to the defining of diabetes and summarizing the ways in which to decrease the risk of affliction.

diabetesWhat is diabetes?  Diabetes is a condition in which a person’s body is unable to convert food into energy.  To be more specific, a person suffering from diabetes lacks the proper insulin function necessary to change blood glucose into energy.  Type 2 Diabetes, is the predominant type seen in Native American populations.  Type 2 Diabetes is caused by cells in the muscles, liver, and fat misusing insulin.  The result is an increase of blood glucose and energy starvation for cells.  Sadly, the onset of affliction in American Indian communities is occurring at an ever younger age.

Here are a few facts and figures to consider before reading further:
1) Between 1995 and 2004 the prevalence of diabetes in American Indians and Alaskan Natives under the age of 35 increased from 8.5 to 17.1 per thousand.
2) By 2002 approximately 30% of those 55 and older in these same communities also had diabetes.
3) Also, by 2002 15% of all American Indians and Alaskan Natives over 20 years of age receiving care from Indian Health Services (IHS) had diabetes.  The number is actually thought to be higher when undiagnosed cases are taken into account.

What is the reason for this increase that the Center for Disease Control (CDC) says is approaching epidemic proportions?  The truth is that no singular cause exists, though there are numerous theories which attempt to point out the main factor.  Lifestyle changes in diet and activity are perhaps the most important aspects to be discussed.

Modernization allows for a more sedentary lifestyle along with a diet high in fat and low in fiber.  As the main food source for many individuals living on reservations, the federal government’s food assistance programs, such as FDPIR, food stamps, and WIC are believed to have contributed to these growing health concerns.  The term “commode bod” refers to the physical appearance of those American Indians whose diet consists largely of commodity foods high in fat and sweeteners.

Along with this increased reliance on highly processed diet was the loss of a traditionally active lifestyle that involved a mixture of hunting, fishing, and harvesting one’s own food.  With the main source of entertainment for many now coming in the form of television, the result is obesity which often is the precursor to diabetes.  High levels of stress and genetic predispositions to poor insulin function in Native American populations have also been identified as factors.

Signs and symptoms include increased thirst or hunger, fatigue, increased urination, unexplained weight loss, blurred vision, or sores that do not heal.  While having one or more of these symptoms does not necessitate having diabetes, it never hurts to speak with a physician if you have concerns.  There are also several ways to lower the risk of developing diabetes.  Daily physical exercise, making healthy food choices, and maintaining a reasonable body weight are key.  For women, who in studies of American Indian populations had a higher number of diabetes cases than men, breast feeding is also a tool of prevention.

Yet, for a turnaround in this rampant spread, individual efforts alone are not enough.  Community-based prevention programs must be encouraged and suggestions to establish a string of satellite clinics to reach dispersed populations in Indian Country have also been made.  Research has indicated that culturally appropriate wellness initiatives may increase the chances for success.  It should be noted that the FDPIR commodity package has also changed in recent years which may better the health of its recipients but studies have not yet been released not his issue.

Thus, just as there is no one catalyst for diabetes development, neither is there one simple solution.  A multifaceted approach on the individual, community-based, and government level (i.e. IHS) may be the best bet for changing the statistics that exist today.

Sources/Further Reading:
“Background Report on the Use and Impact of Food Assistance Programs on Indian Reservations.” Urban Institute. <http://www.urban.org/url.cfm?ID=411133&gt;.

“Diabetes Prevalence Among American Indians and Alaska Natives and the Overall Population – United States, 1994-2002.” Centers for Disease Control and Prevention <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5230a3.htm&gt;.

“Diagnosed Diabetes Among American Indians and Alaska Natives Ages <35 Years – United States, 1994-2004.” JAMA: The Journal of the American Medical Association 297.5 (2007).

“I Can Lower My Risk for Type 2 Diabetes.” National Diabetes Information Clearinghouse (NDIC) <http://diabetes.niddk.nih.gov/dm/pubs/amIatrisktype2AI/&gt;.

“Investigation of Risk Factors Contributing to Diabetes Risk in American Indian/Alaskan Native Youth.” National Center for Biotechnology Information. U.S. National Library of Medicine <http://www.cmch.tv/SearchDetail2.aspx?rtrn=advnce&gt;.

“Nutrition a Pressing Concern for American Indians, Part III.” Food Safety News. <http://www.foodsafetynews.com/2012/03/nutrition-a-pressing-concern-for-american-indians-1/&gt;.

“Prevention and Treatment of Type 2 Diabetes Mellitus in Children, With Special Emphasis on American Indian and Alaska Native Children.” Official Journal of the American Academy of Pediatrics <http://pediatrics.aappublications.org/content/112/4/e328.full&gt;.

“Reducing Diabetes in Indian Country: Lessons from the Three Domains Influencing Pima Diabetes.” Human Organization 63.1 (2004).

“Stress Burden and Diabetes in Two American Indian Reservation Communities.”American Diabetes Association: Diabetes Care <http://care.diabetesjournals.org/content/31/3/427.full&gt;.

“Trends in Diabetes Prevalence Among American Indian and Alaska Native Children, Adolescents, and Young Adults.” National Center for Biotechnology Information. Sept. 2002. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447266/&gt;.

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