Diabetes education materials: recommendations of tribal leaders, Indian health professionals, and American Indian community members.

PURPOSE: The Association of American Indian Physicians, the only national organization of its kind, conducted a series of focus groups to gather input from tribal leaders, Indian health professionals, and American Indian community members to guide the development of culturally appropriate diabetes education materials for the National Diabetes Education Program. METHODS: During the focus groups, participants shared their experiences with and recommendations for a variety of diabetes education materials. RESULTS: Overall, 95% of participants expressed a strong preference for diabetes education materials relevant to their specific tribe or culture. CONCLUSIONS: Recommendations from these focus groups were used to develop a national diabetes education campaign for American Indian communities.

Trends in body weight among American Indians: findings from a telephone survey, 1985 through 1996.

OBJECTIVES: This study compared trends in body mass index for American Indian men and women across selected regions of the United States. METHODS: Self-reported data were collected from the Behavioral Risk Factor Surveillance System. RESULTS: Among women in the Dakotas, New Mexico and Arizona, and Washington and Oregon, average adjusted body mass index increased significantly by 0.1 to 0.2 units per year. Among men in Alaska and the Dakotas, average adjusted body mass index also increased significantly by 0.1 to 0.2 units each year. CONCLUSIONS: Because of rapid increases in average body mass index, some American Indian populations could be burdened by an increased incidence of chronic disease.

Diabetes and associated risk factors among Native Americans.

OBJECTIVES: To estimate the prevalence of diabetes and related risk factors among Native Americans. RESEARCH DESIGN AND METHODS: We used 1988-1989 data from the Behavioral Risk Factor Surveillance System to calculate the overall, age-adjusted prevalence of diabetes, obesity, sedentary life-style, hypertension, and smoking among Native Americans. The SESUDAAN software package was used to derive confidence intervals. RESULTS: The prevalence of diabetes was 11.6% among the 768 Native American Behavioral Risk Factor Surveillance System respondents (95% confidence interval 7.8-15.4) and 4.7% among the 121,986 white respondents (95% confidence interval 4.6-4.8). The age-adjusted prevalence of diabetes was 2.5 times higher among Native Americans than among whites. The prevalence of obesity was higher among Native Americans (34.4; 95% confidence interval 31.7-37.1) than among whites (23.9%; confidence interval 23.7-24.1). The prevalences of sedentary lifestyle (58%), hypertension (16%), and smoking (28%) were similar among both populations. CONCLUSIONS: The Behavioral Risk Factor Surveillance System may prove as a useful tool for surveying Native Americans living on and off reservations for inclusion in national estimates of diabetes prevalences.

Diabetes-associated mortality in Native Americans.

OBJECTIVE: To describe diabetes-associated mortality among Native Americans. RESEARCH DESIGN AND METHODS: In this population-based study, we analyzed diabetes-associated mortality data from the IHS and the NCHS. We also examined diabetes data from the 1986 NMFS. RESULTS: IHS area-specific diabetes mortality rates for 1984-1986 ranged from 10 to 93/100,000, compared with 15/100,000 for the total U.S. population. NCHS data for the same period listed diabetes as the underlying cause of 708 deaths among Native Americans and the contributory cause of 1252 deaths; 63% of the latter deaths were attributable to circulatory diseases. The 1986 NMFS demonstrated that Native American heritage is underreported by 65% on death certificates. Using deaths identified as Native American by NMFS, the age-adjusted mortality rate for diabetes as the underlying cause for Native Americans (96/100,000) was 4.3 times that for whites and two times that for blacks. Where diabetes was a contributory cause of death, the mortality rate for Native Americans (264/100,000) was 3.7 times that for whites and 2.4 times that for blacks. CONCLUSIONS: The excessive diabetes-associated mortality among Native Americans is consistent with other indicators of the magnitude of the diabetes problem in this population. Further epidemiological research and expanded diabetes control interventions are needed.

Diabetic end-stage renal disease among Native Americans.

OBJECTIVE: To examine why ESRD has become a major source of morbidity and mortality for Native Americans with diabetes mellitus. RESEARCH DESIGN AND METHODS: Using data from the Medicare ESRD Program, we examined incidence rates for ESRD among Native Americans for the years 1983-1987. RESULTS: During this period, the annual incidence of total ESRD in Native Americans increased by 18%, from 170.5/million to 200.1/million. The incidence of diabetic ESRD increased by 47%, from 80.6/million to 118.2/million. In 1987, the age-adjusted incidence rate of diabetic ESRD was 6.8 times higher in Native Americans than in whites. CONCLUSIONS: Recommendations for the prevention of diabetic ESRD include early identification of renal disease and improved control of hypertension and blood glucose. The magnitude of diabetic ESRD among Native Americans also underscores the need for primary prevention of non-insulin-dependent diabetes mellitus.